Prescription - November 23, 2003

Every fortnight Dr Sunita Agarwal highlights a common, but often ignored, medical problem.


Gout (gowt) causes sudden, severe attacks of pain and tenderness, redness, warmth, and swelling in some joints. Known as "the disease of kings and the king of diseases," gout has been studied by physicians and has caused suffering in many people for centuries.

What are the symptoms?

The most common symptom of gout is sudden, severe attacks of pain, tenderness, redness, warmth and swelling in some joints. It usually affects one joint at a time, especially the joint of the big toe, but can also affect the knee, ankle, foot, hand, wrist and elbow. Deposits of uric acid, called tophi, can appear as lumps under the skin around the joints and at the rim of the ear. In addition, uric acid crystals can also collect in the kidneys and cause kidney stones. Episodes develop very quickly, and the first episode often occurs at night.

Episodes may be caused by:
Drinking too much alcohol
Eating too much of certain foods
Surgery
Sudden, severe illness
Crash diets
Joint injury
Chemotherapy

What causes it?

Gout results from a build-up in the body of too much uric acid, which forms crystals that deposit in joints and cause inflammation.

Gout can be inherited or happen as a complication of another condition. Uric acid is a substance that normally forms when the body breaks down waste products called purines.

Normally uric acid breaks down in the blood and is eliminated in urine. When the body increases its production of uric acid or if the kidneys do not eliminate enough uric acid from the body, levels build up. This is called hyperuricemia. Hyperuricemia is not a disease and is not dangerous. However, if excess uric acid crystals form as a result of hyperuricemia, gout can develop.

Who is at risk?

Mostly men between age 40 to 50, but it can affect anyone of any age. Women with gout usually develop it after menopause.

How is it diagnosed?

Standard diagnostic tools for gout may include a medical history and physical examination, a blood test for hyperuricemia, and urine sample. For a definitive diagnosis of gout, a sample of synovial fluid from the affected joint is required. X-rays can provide helpful information in some cases.

Treatment options

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) block prostaglandins which is responsible for the inflammation and pain. They are taken orally as long as symptoms persist. Indomethacin (Indocin) is the usual choice.

Colchicine, a derivative of the autumn crocus, has been used to treat gout for thousands of years. This drug relieves the pain and swelling and can help prevent future attacks. Although highly effective, it is no longer the first treatment choice due to the potential for side effects.

Corticosteroids may be used if NSAIDs are not tolerated.

Allopurinol (Lopurin, Zyloprim) blocks uric acid production and is the drug most often used in long-term treatment for older patients and those with high levels of excreted uric acid.

Home remedy

Some people may benefit from a reduction of purine rich foods. These include anchovies, sardines (in oil), fish roes, herring, yeast, organ meats (e.g., liver, kidneys), legumes (e.g., dried beans, peas, and soybeans), meat extracts, gravies, mushrooms, spinach, asparagus, cauliflower, and poultry. Weight loss can help reduce uric acid levels in those people that are overweight.

Research being done

Scientists are studying other NSAIDs for treating gout and are analysing new compounds to develop safe, effective medicines to treat gout and other rheumatic diseases.

Research is being done on the efficacy of fish oil supplements in reduction of the risk of gout. They are also studying the structure of the enzymes that break down purines in the body, in hopes of achieving a better understanding of the enzyme defects that can cause gout.

— Dr Sunita Agarwal can be contacted on dr_Agarwal@vsnl.com or visit website www.agarwalhospitals.com