Gout

Gout causes sudden pain and inflammation, usually in a single joint. The base of the big toe is the most common site, but any joint may be affected. The disorder affects many more men than women. In women, gout rarely appears before the menopause.

What are the cause?

An attack of gout is usually caused by raised blood levels of uric acid (a waste product of the breakdown of cells and proteins). An excess of uric acid may be caused by the overproduction and/or decreased excretion of uric acid and may lead to uric acid crystals being deposited in a joint. The underlying cause of gout is unknown, but the condition, is often inherited. A few people with gout also develop kidney stones formed from excess uric acid.

Gout may occur spontaneously or be triggered by surgery, being over-weight, drinking alcohol, treatment with diuretics, or excess cell destruction associated with chemotherapy.

What are the symptoms?


The symptoms if gout usually flare up suddenly. They may include:

- Redness, tenderness, swelling and warmth around the affected area.
- Pain, which may be severe, in the affected joint or joints.
- Mild fever.

In long-standing gout, deposits of uric acid crystals, may collect in the earlobes and the soft tissues of the hands or feet, forming small lumps called tophi.

What might be done?

Your doctor may suspect that you have gout from your symptoms and arrange for blood tests to measure your uric acid levels. To confirm the diagnosis, he or she may arrange for you to have a joint aspiration (below), in which fluid is withdrawn from the affected joint and examined for uric acid crystals.

Gout may subside by itself after a few days. To reduce severe pain and inflammation, you may be treated with a nonsteroidal anti-inflammatory drug, the antigout drug colchicine, or with oral corticosteroids. If gout persists, your doctor may give you a corticosteroid injection directly into the affected joint.

If you have recurring gout, you may need lifelong treatment with preventive drugs such as allopurinol to reduce the production of uric acid or probenecid to increase the excretion of uric acid.

Your doctor may recommend that you reduce alcohol consumption and avoid foods such as liver. You may be able to reduce the frequency and severity of attacks by losing excess weight.

What is the prognosis?

Gout is painful and can disrupt normal activities, but attacks can be controlled with drugs and changes in lifestyle. Repeated attacks may damage the joint.


JOINT ASPIRATION

During joint aspiration, fluid is withdrawn from a swollen joint with a needle and syringe, possibly under local anaesthesia. The fluid is then examined to find the cause of the swelling. Joint aspiration may also be carried out to relieve swelling due to excess fluid and to diagnose or treat disorders such as gout, pseudogout, and rheumatioid arthritis.

Knee joint aspiration

You will be asked to keep your knee relaxed so that the needle can be inserted easily. The patella is held still while the needle is passed into the space under the patella and fluid is withdrawn.