Gout is a medical term for symptomatic hyperuricemia. Hyperuricemia is a condition where the uric acid level in the blood is beyond the normal limit for the age and sex. Uric acid is a salt found in the blood which is a breakdown product of protein in the blood which is excreted in the urine.
Hyperuricemia maybe asymptomatic or symptomatic when the excess uric acid deposits in the subcutaneous tissue (Tophi) or in the joints (gout)
Causes
Gout can be due to excess uric acid intake usually due to binge of alcohol and or red meat or other forms of protein.
The second cause can be due to excess production in the body. This can be due to a genetic enzyme abnormality. It is seen quite often in specific races such as filipinos. It may also be due to excess cell breakdown due to chemotherapy.
The third cause can be due to decreased excretion of uric acid by the body. This maybe due to early renal failure.
Symptoms
Usually unexplained musculoskeletal pain is the commonest presentation of gout. Most common presentation is pain in the joint of the ball of the great toe (podagra). In the upper limb it can present as frozen shoulder, unexplained synovitis tendinitis or bursitis of the shoulder, lateral epicondylitis, trigger finger, De Quervain’s tenosynovitis or carpal tunnel syndrome.
In the lower limb it can present as knee effusion/synovitis, great toe ball joint pain, tendinitis around the ankle, plantar fasciitis and unexplained foot and ankle pain.
Diagnosis
Blood tests are done to confirm the acute inflammation and exclude infection. The blood tests also include screening the current uric acid level and screening for kidney and liver function as a cause of hyperuricemia.
X-Rays or local musculoskeletal ultrasounds may diagnose uric acid in the soft tissue. If a co-existing septic joint is suspected, the joint maybe aspirated and the fluid sent for examination to rule out an infection.
Conservative Treatment Options
Treatment of the acute inflammed joint
- Rest
- Ice
- Compression bandage
- Elevation
This is the usual protocol for any inflamed joint. Apart from this regular anti-inflammatory medications may be given. If the joint does not respond to strong antiinflammatory medications, a short course of oral Colchicine along with anti-gout medications maybe given. Oral steroids can also help at times.
If the joint still doesn’t respond and co-existing sepsis has been ruled out a steroid injection into the tendon origin, tendon sheath or joint can be given.
Treatment of the hyperuricemia
The hyperuricemia if asymptomatic may be initially treated with dietary modifications. This includes avoiding colas, red meat and some types of alcohol. If the hyperuricemia is symptomatic then 3 months of uric acid lowering medications can be tried. There are many different types of uric acid lowering medicines but the most common types are the ones that help to excrete uric acid through the kidney (uricosuric drugs) or the ones that decrease production through alternate metabolic pathways (Xanthine Oxidase inhibitors).
Treatment of the tendinitis/arthritis
Depending on the area involved, gout as a cause of tendinitis or arthritis can be treated as per the region involved, in the late stage. Links to these conditions may be found on the respective webpages.