What is gout?
Gout is a condition in which a chemical called urate becomes excess in the body and builds up to form crystals which collect in joints causing swelling and pain. Urate is usually harmless, but in some people and under some conditions, the levels become so high that they begin to cause problems.
There are a number of things that have been identified to be associated with increased urate levels in blood. They include:
• Excessive alcohol intake
• Consumption of certain foods in large quantities, such as red meat and shellfish
• Disease conditions like hypertension and diabetes
• Drugs like diuretics (for hypertension) and aspirin.
What are the symptoms?
The joint most commonly affected in gout is that of the big toe. The joints of the foot, ankle, knee, wrist, finger, and elbow may also be involved. The pain comes on suddenly usually at night and lasts over a few hours. It can be so severe that even the weight of bedclothes over the joint is unbearable.
The pain is usually associated with swelling, and the surrounding skin may look red and shiny.
Deposits of urate crystals may also be found under the skin on the hands, knees, wrists, elbows, or ears. These deposits are called tophi.
What treatments work?
There are quite a number of drugs used to both treat an attack of gout and to prevent further ones.
- Applying an ice pack to the affected joint may help to reduce the pain and redness
- Take care of the above listed conditions that may predispose to excess urate levels
- Drink a glass of skimmed milk each day.
Drugs to treat ongoing attacks include:
- Painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs). They are best taken with food to protect the stomach from ulcers.
- Colchicine may be prescribed if taking NSAIDs is not safe.
- Corticosteroid tablets, or a corticosteroid injection into the affected joint to reduce the inflammation.
A gout attack should go away in about 7 to 10 days, and for some people, that’s the only one they get in their lives.
However, most people who have had one attack get more. A small number of people get frequent attacks and this may damage their joints and make them feel stiff.
Drugs which help prevent further gout attacks include:
- Allopurinol. It is usually given about a couple of weeks after an attack because it may make symptoms worse if taking during an attack. There is also the possibility of having an attack soon after the first intake.
- Probenecid. It may be used if allopurinol fails. You need to drink plenty of fluids when you take this to reduce the chances of stones forming in the kidneys.
- Febuxostat. A new drug which can be taken in place of allopurinol.
These drugs reduce the amount of urate in the body. They are usually taken for life once started to avoid a return attack after stopping the medication. You can talk to your doctor for advice before you start.
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