Gout

Gout is a very common, painful form of arthritis which causes swelling, redness and stiffness of the joints. Gout is caused by increased levels of uric acid in the tissues and blood from abnormal metabolism. Eating certain foods rich in purines such as liver and dried beans can elevate the body’s level of uric acid. These Increased levels of uric acid can also cause kidney stones. Gout usually affects the big toe and can later attack ankles, heels, knees, wrists, fingers, and elbows. If untreated, gout can result in permanent joint and kidney damage.

Pseudogout is a condition having similar symptoms, but is different from gout because it is caused from calcium phosphate rather than uric acid.

Causes

The exact cause for the development of gout is unknown. In gout, there is increased production and decreased metabolism of uric acid, resulting in formation of uric acid crystals around the joints and in organs such as the kidneys.

Gout is more common in people having a family history of gout, those who drink alcohol, and taking certain medications which can raise the level of uric acid in blood. The probability of developing gout is more in men and also in women after menopause.

People suffering from conditions such as diabetes, kidney disease, obesity, sickle cell anaemia, leukemia and other blood cancers are more prone to develop gout. This is because the medication used for treating such conditions can interfere with removal of uric acid from the body.

Symptoms

Symptoms initially seen with gout include warm, red, swollen joints, commonly in the big toe but can also involve other joints such as knee, ankle, and small joints of the hands. resulting in joint pain and tenderness.

Initially such symptoms may affect one or two joints, lasting for 1-2 weeks, but as the disease progresses, multiple joints can be affected for a longer duration.

For patients with gout, the development of kidney stones and formation of uric acid crystals outside joints occurs more frequently. Such crystals, known as tophi, are painless but useful in diagnosis and may be found in earlobes, elbows and Achilles tendon.

Diagnosis

In gout uric acid level increases, therefore different tests are employed for assessing the level of uric acid in blood and also in urine. Along with this, synovial fluid analysis which shows uric acid crystals as well as synovial biopsy may be done.

X-rays of the painful joint is recommended for accessing the underlying joint damage due to gout. It is to be noted that high levels of uric acid does not always indicate gout.

Treatment

The treatment of gout includes medications having painkiller and anti-inflammatory effect such as NSAIDs, colchicines, and corticosteroid. In addition, certain medications such as allopurinol and probenecid reduce the level of uric acid in the blood.

In cases where severe damage of the joint has taken place due to lack of efficient treatment, surgery may be recommended.

Prevention

For preventing a gout attack, patients should eat a healthy diet, avoid alcohol, and if obese should try to lose weight. Try to limit eating purine-rich foods especially anchovies, oils, organ meat, legumes, mushrooms, spinach and cauliflower. Fatty foods should be avoided and increased carbohydrate diet may be recommended.

Why is gout so poorly treated?
Provider, community and patient barriers

• Belief that only acute attacks require treatment
• Lack of understaing about the role of urate-lowering therapy
• Pessimism about patient adherence
• Perceptions of gout as trivial, humorous, self-inflicted
• System barriers to optimal gout care (e.g. time constraints and a lack of incentives)

Pseudogout

What is pseudogout?

Pseudogout is a type of arthritis that is characterised by the development of a painful swelling that occurs suddenly in one or more joints. It is also known as calcium pyrophosphate deposition disease (CPPD) because of the type of crystals that are deposited on the joint during the disease process.

Joints Commonly Affected by Pseudogout

The most commonly affected joints are the knees, followed by the wrists and ankles.

Symptoms of Pseudogout

During a pseudogout attack, the following signs and symptoms may be experienced in the affected joints:

• Swelling
• Warmth
• Severe pain

Causes of Pseudogout

Pseudogout has been associated with the deposition of pyrophosphate dihydrate crystals inside the joint, although most people with such crystal deposits do not develop pseudogout. These crystals increase in number as you grow older and are present in at least half of population over the age of 85 years.

Risk Factors for Pseudogout

The following factors put you at a higher risk of developing pseudogout:

• Old age: Your risk for developing pseudogout increases as your grow older.
• Traumatic joint injury: Having sustained serious joint trauma or undergoing surgery increases your risk.
• Genetic predisposition: You may be at a higher risk for pseudogout if other members of your family have the condition.
• Mineral imbalance: High blood levels of calcium and iron, and low levels of magnesium increase your risk for pseudogout.
• Certain medical conditions: Pseudogout has been linked with the presence of an underactive thyroid gland or an overactive parathyroid gland.

Complications of Pseudogout

The pyrophosphate dihydrate crystals which have been linked to pseudogout may damage the joint, mimicking signs and symptoms of rheumatoid arthritis or osteoarthritis.