Purines are organic compounds that are not necessarily harmful. In fact, they are part of all human tissue and found in many foods. Purines produce uric acid and uric acid produces urate crystals. Uric acid has two chemical forms (tautomers) in which it exists. The one is stable and the other unstable. The unstable form can form urate crystals which are nearly insoluble in water and deposit themselves in the joints to cause gout.
The uric acid excess (hyperuricemia) can be caused by the following:
- Production of uric acid: An over-production of uric acid by the body as part of the normal excretion processes. Over production contributes to about 10% of all incidents.
- Excretion of uric acid: An under-excretion of uric acid by the kidneys contributes to about 90% of all gout attacks.
- Dietary factors: Diets high in purine-containing foods can contribute to the development of gout.
- Genetic pre-disposition: Lesch-Nyhan Syndrome is a genetic disease caused by an enzyme deficiency.
- Medication: Stopping or starting certain anti-gout medication can precipitate an acute gout attack. Certain diuretics may also cause gout.
- Aspirin: Aspirin should no longer be recommended as it can cause an acute gout attack at low doses and patients may experience side-effects at higher doses.
- Family history: Gout tends to stay in families.
SIGNS AND SYMPTOMS
A common form of arthritis, gout is characterised by recurrent attacks of extreme pain, swelling, and redness. Unlike most other types of arthritis which develop slowly, an attack of gout occurs suddenly, quite literally overnight. Gout can present in different joints, but the first metatarsophalangeal joint (big toe) is most often affected. Called podagra it accounts for 50% of all gout attacks. Other joints, such as the heels, knee, wrist, and fingers may also be affected.
The following are characteristic of gout:
- Recurrent: It has a recurrent nature and will return again and again
- Intense pain: The acute attack usually begins between two and four in the morning. This is due to the lower body temperature during the night
- Inflammation has the following components. The affected joint is red in colour, swollen, hot, very sensitive to any touch
- Fatigue and fever
- Tophi: Long-standing increased uric acid levels may result in hard, painless deposits of uric acid crystals. These deposits are known as Tophi. Some people have gout attacks every few months, while others are luckier only suffering an attack every few years. Unfortunately, as time passes attacks tend to become more frequent and to affect more joints.
Pain management is a crucial part of living with gout. The aim of gout treatment is to settle the symptoms of the acute attack quickly and safely. This treatment is usually short-term and limited to the duration of the flare. An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack (without treatment) takes approximately 7-14 days. The following are used to assist with the treatment of gout:
- Cold compress: The application of cold compress several times during the day may decrease the inflammation and reduce pain.
- Rest: To ease the pain during a gout attack, rest and elevate the joint that hurts. Medicines used to treat acute attacks
- NSAIDs: Taken at the beginning of an attack NSAIDs ease pain and help to reduce inflammation. These drugs should be taken with food, as they can erode the lining of the stomach. Care should be taken in elderly people, especially those with kidney problems. NSAIDs reduce the inflammation caused by deposits of uric acid crystals but have no effect on the amount of uric acid in the body. Do not use aspirin as it may change uric acid levels in the blood and may make the attack worse.
- Colchicine isn’t a painkiller however it is often effective at decreasing inflammation caused by the crystals interacting with the joint lining. There is usually a dramatic response to oral colchicine. Joint pain generally begins to subside after 12 hours of treatment and is gone within 36-48 hours. A low daily dose of colchicines can prevent future attacks.
- Corticosteroids: If NSAIDS and colchicine are ineffective recommend that customers see their general practitioner who can prescribe corticosteroids. The drugs can be administered orally or injected directly into the inflamed joint. Corticosteroids can be prescribed to patients who have accompanying kidney, liver, or gastrointestinal problems. Corticosteroids usually provide rapid relief from gout symptoms however because of their potential side effects if used for a long time, corticosteroids are usually prescribed only for a short time.
Gout is an incredibly painful condition but making these healthy lifestyle changes may help prevent gout attacks. The emotional effects of gout can have just as much impact as the physical symptoms. Long term damage and severe pain from the attacks of gout can affect patients’ daily life, disturb sleep, and affect mood.
4 STAGES OF GOUT?
1. High uric acid levels – no symptoms. During the first stage, patients have high uric acid levels but no other symptoms.
2. Acute gout attacks – excess uric acid has formed crystals, causing painful inflammation in the joints. During the attack (which may come without warning) the area becomes hot, red, swollen, and extremely tender.
3 . Between gout attacks – even when patients aren’t experiencing painful attacks, they still have gout. In fact, research suggests that the uric acid crystals that cause painful gout attacks remain in the joints as long as uric acid levels are high. So, joint damage may still continue even between gout attacks.
4. Chronic gout – gout’s final phase is the most disabling phase of the disease. Over time, deposits of crystallised uric acid can cause chronic pain, destroy joints, damage surrounding tissues, and may also lead to deformities.
Patients suffering from gout will benefit in the long term from healthy changes to their lifestyle taking steps to decrease their uric acid level and keep it low:
- Maintain a healthy body weight
- Exercise regularly (both muscle strengthening and cardio)
- Cut down on alcohol consumption and avoid binge drinking
- Keep hydrated – drink plenty of water
- Follow a diet that limits purine-rich foods
- Manage high blood pressure
- Increase intake of vitamin C-rich foods
- Add low-fat dairy products to your diet
- Avoid fructose (a type of sugar found in soft drinks, sweets, cookies, etc)
- Use aspirin sparingly