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diseaseconditions.peperonity.net

◆ GOUT

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=>GENERAL INFO:
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The word Gout is from Latin and it means drop. Known as "the disease of kings and the king of diseases," gout has been studied by physicians and has caused suffering in countless humans at least since the days of Hippocrates.

Gout afflicts an estimated 840 out of 100,000 people. Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes. Gout is a condition with abnormally high levels of uric acid in the blood. It is characterized by recurring attacks of joint inflammation (arthritis), deposits of hard lumps of uric acid in and around the joints and decreased kidney function and kidney stones.

The joint inflammation is caused by deposits of uric acid crystals in the joint fluid (synovial fluid) and joint lining (synovial lining). Intense joint inflammation occurs when the white blood cells engulf the uric acid crystals, causing pain, heat and redness of the joint tissues.
Gout is an hereditary disorder, the intrinsic element of which is an inborn instability of nuclein metabolism which may remain latent, but under the influence of extrinsic factors, infections, becomes manifest, as betokened by local inflammatory tissue reactions in joints or elsewhere the specific character of which is attested by the associated uratic deposition

=>CAUSES:
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Gout is caused by a defect in metabolism that results in an overproduction of uric acid, or a reduced ability of the kidney to eliminate uric acid. The exact cause of the metabolic defect is unknown. The disorder causes painful arthritis, especially in the joints of the feet and legs. The condition may also develop in people with diabetes mellitus, obesity, sickle cell anemia, and kidney disease, or it may follow drug therapy that interferes with uric acid excretion. Certain drugs, can also cause gout. Certain diseases such as leukemia and hemoglobin disorders lead to excessive production of uric acid in the body.


=>SYMPTOMS:
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Gout develops in a person gradually or suddenly with severe symptoms. Symptoms develop suddenly and usually involve only one or a few joints. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. Excruciating pain in the "Big Toe" in the recent past may indicate Gout.

The affected joint appears warm, red, and tender. The pain at the joints may subside in several days, but may recur at irregular intervals. Subsequent attacks usually have a longer duration.

In some people, it may progress to chronic gouty arthritis, while others may have no further attacks.


=>INCIDENCE:
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Men, postmenopausal women, people with kidney disease, diabetes mellitus, sickle cell anemia, or obesity have higher chances of getting Gout.

=>DIAGNOSIS:
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Physical examination of the joints shows swelling, redness and warmth.

Joint fluid analysis shows uric acid crystals.

Uric acid (in blood test) may be elevated above 7.5 mg/dl.

Joint X-rays may be normal.



=>TREATMENT:
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Preventing acute gout attacks is equally as important as treating the acute arthritis. Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption, and medications to reduce hyperuricemia.

Maintaining adequate fluid intake helps prevent acute gout attacks. Adequate fluid intake also decreases the risk of kidney stone formation in patients with gout. Alcohol is known to have diuretic effects which can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia.

Dietary changes can help reduce uric acid levels in the blood. Since purine chemicals are converted by the body into uric acid, purine rich foods are avoided. Examples of foods rich in purine include shellfish and organ meats, such as liver, brains, kidneys, and sweetbreads.
Weight reduction can be helpful in lowering the risk of recurrent attacks of gout. This is best accomplished by reducing dietary fat and calorie intake, combined with a regular aerobic exercise program.

There are three aspects to the medication treatment of gout. First, pain relievers such as acetaminophen/Tylenol or other more potent analgesics are used to manage pain. Secondly, anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs (NSAIDS), colchicine, and corticosteroids are used to decrease joint inflammation. Finally, medications are considered for managing the underlying metabolic derangement that causes hyperuricemia and gout. This means treating the elevated levels of uric acid in the blood with medications that reduce these levels.

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