By Ms Aisha Noreen:
The general prevalence of gout is 1–4% of the general population. In western countries, it occurs in 3–6% in men and 1–2% in women. The prevalence of Gout is increasing day by day globally. In the developed countries the incidence of Gout is greater than the underdeveloped countries and some ethnic group are more prone to be a predisposition of gout. The prevalence of in China is lower than the rest of the world and it is only endemic where there obesity is present at the background. Gout and hyperuricemia is more liable in male than female. Male to female ratio for hyperuricemia and gout is 2:1 and 34:1 respectively. Globally prevalence of gout is 0.08 %. It is a leading cause of morbidity and mortality. It is ranked as 138th number as a disability factor and impacts an economic burden. In comparison with world prevalence of gout is highest in Australia and is comparable with New Zealand.
In Karachi, Pakistan the prevalence of gout is more in male as compared to females in adult ages and in females it occurs after menopause. Worldwide incidence of gout increases gradually due to poor dietary habits such as fast foods, lack of exercises, increased incidence of obesity and metabolic syndrome
Uric Acid, Hyperuricemia, and Gout
Hyperuricemia is a common metabolic disorder globally with elevated levels of serum urate / uric acid (UA) up to 6.8 mg/dL, which is the approximate limit of urate solubility. It is a precursor of GOUT, a rheumatic inflammatory disease characterized by the deposition of uric acid in the form of monosodium urate (MSU) crystals in joints. It may be due to under secretion or over production of both. Monosodium urate crystals stimulated a powerful inflammatory reaction resulted in acute joint pain.
Gout has a substantial effect on physical function, productivity, quality of life, and health care costs. Uncontrolled gout is associated with significant use of emergency care services.
Causes of Hyperuricemia and Gout
Decreased excretion of uric acid through the kidneys is responsible for about 85-90 percent of hyperuricemia. The remaining 10-15 percent is due to overproduction of uric acid.
Chronically elevated uric acid levels predispose some individuals to develop gouty arthritis, kidney stones, and uric acid renal disease. However, many people with hyperuricemia are asymptomatic.
Asymptomatic hyperuricemia is a stage in which the serum urate level is raised, but symptoms of gout are not present.
Watch for your gout symptoms. Don’t be surprised if symptoms appear suddenly. They often occur at night. Symptoms are usually the most painful within the first 4 to 12 hours after the initial attack. These symptoms include:
· Intense joint pain: in feet (often at the base of the big toe), ankles, knees, or wrists
· Joint discomfort after the initial attack
· Redness and other signs of inflammation, like warmth, swelling and tenderness
· Difficulty moving the affected joint
Consider your risk for gout. There are some risk factors you can’t control, like a family history of gout or the prevalence of gout in adult men and postmenopausal women. But, you can control other risk factors like being overweight (or obese), untreated high blood pressure, diabetes, metabolic syndrome, and heart and kidney disease, diet. Recent surgery or trauma may also increase your risk for gout.
Get a diagnosis of gout. If you are unsure whether you have gout, talk with your doctor. Your doctor will make a diagnosis based on your symptoms and medical history. Further testing and lab work might be needed.
Testing may include taking a sample of joint fluid, running a blood test to see your uric acid levels, or getting an X-ray, ultrasound, or CT scan (although imaging tests aren’t usually used).Joint fluid is analyzed for the presence of urate crystals that are visible under the microscope
Managing a Gout Attack
Gout attacks are unexpected and painful; here’s how to get a handle on them.
Few things in life are more painful than a gout attack, so if you’re awakened in the wee hours by a joint that is tender, swollen, red and radiating heat, you’ll want to act fast. Here’s what you can do when a gout attack starts to ease the pain of the attack and reduce the risk of others.
Take medicine you have on hand. Start treatment immediately with over-the-counter ibuprofen or naproxen.
Ice down. Applying an ice pack to the painful joint may help ease pain and inflammation. Wrap a pack (a bag of crushed ice or frozen peas will also do) in a dish cloth and apply to the area for 20 to 30 minutes at a stretch several times a day.
Call your doctor. Let your doctor know what is going on right away. She may prescribe a new medication or have you come to the office for a joint fluid test (to confirm the gout diagnosis) or an injection of a corticosteroid to start relieving inflammation quickly. Getting treatment within the first 24 hours of the start of an attack can lessen its length and severity.
Get a cane. Walking with a cane during an acute gout attack can help keep pressure off your painful joint.
Elevate your foot, if affected. Raising your foot with pillows so it’s higher than your chest may help lessen swelling.
Diet and gout
Studies have shown that consuming certain types of food can bring on a gout attack. Substances known as purines are present in animal and plant foods and turned into uric acid in the body.
1. Cut back on purine-rich foods. Your body breaks down purine in food to produce uric acid which contributes to gout pain. Either avoid purine-rich food or limit your servings to two to four servings a week. Ingestion of foods rich in purines such as cooked or processed food especially from animal and seafood origin is a key element of increasing uric acid precursors.
2. Eat foods that lower your uric acid levels. Some foods can protect against high uric acid levels. Try to eat foods rich in phytate which can prevent kidney stone formation, including kidney stones with uric acid. To get phytate, eat two to three servings of beans, lentils, mushrooms, peas, legumes, and dairy products do not carry any risk on hyperuricemia and gout, thus, can be allowed in gout patients. Furthermore, foods rich in vitamin C, low fat dairy products, and plant oils such as olive, sunflower and soy were associated with reduced risk for hyperuricemia and gout. Vitamin C in between 500-1,000 milligrams per day, was found to increase renal excretion of uric acid so it can be used as a supplement during management of gout
3. Take a supplement. There are several supplements that are recommended to treat gout. Consider taking omega-3 fatty acids (especially EPA), bromelain (which acts as an anti-inflammatory), or the B vitamin folate, quercitin, or Devil’s Claw (all of which reduce uric acid levels). Take the supplements according to the manufacturer’s dosing recommendations and always talk to your doctor before supplementing. Some supplements may interfere with medication.
Bromelain is an enzyme that comes from pineapples and is often used to treat digestive issues.
Anyone with gout should avoid supplemental Vitamin C or niacin. Both of these vitamins may increase uric acid levels.
4. Eat more vegetables. While you may be cutting a lot of foods out of your diet, don’t forget to add healthy foods. Eat plenty of vegetables to get a variety of health benefits and nutrients. Interestingly, studies have shown that purine-rich vegetables such as pulses, spinach, mushrooms, and cauliflower do not increase the chances of developing gout. Oats also do not increase this risk, which is good news for the heart.
Eating healthy is an important part of maintaining a healthy weight. Losing weight or maintaining a healthy weight can keep your uric acid levels low.
5. Drink plenty of fluids. Staying hydrated helps flush out uric acid (the cause of your joint pain) and prevent kidney stones, another possible problem associated with high uric acid levels. Aim for eight to 16 cups of fluids a day, at least half of them water.
6. Avoid alcohol. Although it may be tempting to have a drink to relax when you’re in pain, it’s important to avoid alcohol, especially beer, which contains high levels of purines. The body creates uric acid when it metabolizes purines. Furthermore, alcohol inhibits the excretion of uric acid from your body.
With a healthy, low-purine diet, the outlook for someone with gout is positive. A diet that helps reduce the levels of uric acid in the body is essential and can prevent any damage caused to the joints.
Other lifestyle changes that may help in the management of gout are:
Maintaining a healthy weight. If necessary, losing weight can lower the risk of developing further gout attacks. It will also reduce the chances of developing heart problems.
Exercising. As well as the obvious benefits, engaging in physical activity is an important part of maintaining a healthy weight
Attacks of gout are most painful during the first 24 hours. Gout generally affects the big toe, and even the weight of a blanket can feel unbearable. If it is left untreated, gout can spread to other joints in the body, in both the upper and lower limbs.
Other treatments for gout include the following:
Anti-inflammatory (NSAIDs), colchicine, and steroid medication to give immediate relief to the symptoms during an attack
Certain medications such as allopurinol to reduce the levels of uric acid in the body