|
 Hyperuricemia
is defined as a plasma urate (uric acid) level greater than
420 µmol/L (7.0 mg/dL) in males (or 380 µmol/L) in females;
however, high uric acid level does not necessarily mean a
person will develop gout.If gout is suspected, the serum
urate test should be repeated once the attack has subsided.
Other blood tests commonly performed are:
►full blood count
►Electrolytes
►Renal function
►Erythrocyte sedimentation rate (ESR). This
serves mainly to exclude other causes of arthritis, most notably septic
arthritis.
The most reliable test for gout is
finding uric acid crystals in the joint fluid obtained by arthrocentesis.
Arthrocentesis:
is a common office procedure performed under local
anesthesia. Using sterile technique, fluid is withdrawn (aspirated) from the
inflamed joint, using a syringe and needle. The joint fluid is then analyzed for
uric acid crystals and for infection. Shiny, needle-like uric acid crystals are
best viewed with a polarizing microscope. The diagnosis of gout can also be made
by finding these urate crystals from material aspirated from tophi nodules and
bursitis fluid.
A definitive diagnosis of gout is from light microscopy of joint fluid aspirated
from the joint (this test may be difficult to perform) to demonstrate
intracellular monosodium urate crystals in synovial fluid polymorphonuclear
leukocytes. The urate crystal is identified by strong negative bi-refringence
under polarized microscopy, and their needle-like morphology. A trained observer
does better in distinguishing them from other crystals.
| How to treat and prevent gout? |
Preventing acute gout attacks is equally as important as treating the acute
arthritis.
Prevention of acute gout involves:
►Maintaining adequate fluid intake helps
prevent acute gout attacks. Adequate fluid intake also decreases the risk of kidney
stone formation in patients with gout.
►Avoid alcohol which 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 so, the reduction in
alcohol consumption represents one of the point prevent gout.
►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 such as meat, fish, dry beans (also
lentils and peas), mushrooms,
spinach,
asparagus, and
cauliflower can lower
plasma urate levels 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 eating less combined with a regular aerobic exercise program
but this must be done under the doctor supervision because in some cases rapid
loss of weight can worsen gout.}
►Take medication to decrease the level of
uric acid in the blood.
►Consuming
purine-neutralizing foods, such as fresh fruits (especially cherries and
strawberries) and most fresh vegetables, diluted celery juice and B-complex and C vitamins can also help lower plasma urate levels.
►Drink a lot of water and fluids this help to
flush out acid acid and keeps it from depositing in the tissues.
►Avoid diet sodas this act as diuretics in many people, causing uric acid to
concentrate in the blood which can then easily precipitate.
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| Diet and gout |
|
Low purine diet |
foods rich in purines |
►Cherries were reported to reduce
uric acid
►Strawberries or
blueberries (and other dark red/blue berries) are also reputed
to be beneficial. The anthocyanins which give the berries their blue
and purple hues, after entering the body, turn into powerful anti-inflammatory.
►Celery extracts (celery or celery seed either in capsule form or as a tea) is
believed by many to reduce uric acid levels (although these are also diuretics). Celery
extracts have been reported to act synergistically with
anti-inflammatory drugs
►Cheese has been recommended as a low-purine
food, and dairy products have been found to reduce the risk of gout.
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limit food high in protein such as
►Meat
►Tamarind
►Sweetbreads
►Kidneys
►Liver
►Brains
►Sardines and anchovies
►Seafood
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|
Medical treatment |
There are three aspects to the
medication treatment of gout.
First:
Pain relievers such as Acetaminophen or other more potent analgesics are
used to manage pain.
Secondly:
Anti-inflammatory agents such as:
►Non-steroidal anti-inflammatory drugs
(NSAIDs): NSAIDs such as indomethacin and naproxen are effective
anti-inflammatory medications for acute gout. These medications are tapered
after the arthritis resolves. Common side effects of
NSAIDs include irritation
of the gastrointestinal system, ulceration of the stomach and intestines, and
even intestinal bleeding. Patients who have a history of allergy to aspirin or
nasal polyps should avoid NSAIDs because of the risk of an intense allergic
(anaphylactic) reaction.
NSAIDs such as ibuprofen can also reduce the pain and inflammation slightly,
although aspirin should not be used as it can worsen the condition.
►Colchicine for acute gout is most commonly administered by mouth, but can also
be given intravenously. Orally, it is given hourly or every two hours until
there is significant improvement in pain or the patient develops
gastrointestinal side effects such as severe diarrhea. Other common side effects
of Colchicine include nausea and vomiting.
►Corticosteroids: such as prednisone, given
in short courses, are powerful anti-inflammatory agents for treating acute gout.
They 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. Long-term chronic use of corticosteroids is
discouraged because of serious long-term side effects. are used to decrease joint
inflammation.
Third:
Medications medications for acute
gout attacks, other drugs can be taken over prolonged periods to lower blood
uric acid levels. Lowering blood uric acid levels reduces the risk of recurrent
attacks of arthritis, kidney stones, and kidney disease, and also dissolves hard
tophi deposits. Medicines used to lower blood uric acid level work either by
increasing the kidney excretion of uric acid, or by decreasing the body's
production of uric acid from the purine in foods. Since many patients with
elevated blood uric acid levels may not develop gouty attacks or kidney stones,
the decision for prolonged treatment with uric acid-lowering drugs should be
individualized.
►Allopurinol:
lowers the blood uric acid level by preventing uric acid
production. It actually blocks the metabolic conversion from purine in foods to
uric acid. This medication should be used with caution in patients with poor
kidney function, as they are at a particular risk of developing side effects,
including rash and liver damage.
if an attack occurs when the patient isn't on allopurinol yet, he has to wait
until the end of the attack to start
allopurinol.
►Allopurinol
acts on purine catabolism, without disrupting the biosynthesis of
purines. It reduces the production of uric acid by inhibiting the biochemical
reaction immediately preceding its formation.
Allopurinol is a structural
analogue of the natural urine base, hypoxanthine. It is an inhibitor of xanthene
oxidase enzyme which is responsible for the conversion of
hypoxanthine----->Xanthene
------>uric acid , the end product of purine metabolism in man.
►Allopurinol
is metabolized to the corresponding xanthene analogue, oxipurinol (
alloxanthine ), which is also an inhibitor of xanthene oxidase.
Allopurinol
is
approximately 90% absorbed from the gastro- intestinal tract. Peak plasma levels
generally occurs at 1.5 hours & 4.5 hours for
Allopurinol
& oxipurinol.
Approximately 20% of the ingested Allopurinol is excreted in the feces.
►Allopurinol has a long plasma half-life, approximately 15 hours & therefore
effective xanthene oxidase inhibition is maintained over a 24 hours period with
a single daily dose of Allopurinol.
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| Tips |
Professional medical care is needed for long term management of gout.
►Preparation H hemorrhoidal ointment can be applied to
the swollen skin to reduce the swelling temporarily.
►Ice may be applied for 20–30 minutes
several times a day. There are concerns that uric acid crystallization is
accelerated by low temperature, but in a 2002 study in the "Journal of
Rheumatology" patients who used ice packs had better relief of pain with no
negative side effects.
►Keeping the affected area elevated above the level of the
heart may help as well. |
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