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Gout Attack: Treatment and Surgery

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What is gout, and what causes it?
Gout is a form of inflammatory arthritis that is caused by the deposition of uric acid in the joints. It can occur all of a sudden, producing intense pain and swelling as well as deformed and stiff joints.Although the big toe is typically affected, gout can also strike the ankle, knee, foot, elbow, or fingers.

Courtesy: Arthritis Society Canada

A gout attack occurs suddenly, often at night. The impacted joint feels warm to the touch and is red and swollen. The initial attack usually involves only one joint, most often the big toe, and lasts a few days. Subsequent flares may involve multiple joints and last for weeks, with shorter intervals of remission in between. When uric acid levels in the blood are excessively high, it may result in deposits of urate crystals in the joints, which is what causes gout.

Courtesy: Creaky Joints

The most common cause is the kidneys’ impaired ability to excrete uric acid, which can be hereditary, or a result of kidney diseases, medications such as diuretics, alcohol use, or lead poisoning. Overconsumption of purine-rich foods can contribute to higher urate levels, but it is rarely the only cause. Some examples of purine-rich foods include red meat, organ meat, anchovies, sardines, asparagus, beer, etc.

How is gout formed, and what riskfactors are associated with it?
A highconcentration of urate promotes its precipitation and formation of crystals in joints, causing inflammation and pain. The joints in the extremities are more frequently affected by gout because uric acid crystals can develop more easily at lower temperatures. Urate crystals may also deposit under the skin around the joints, forming hard lumps called “tophi” that are not usually painful but can limit joint motions and lead to deformities.

Courtesy: Art of Health Chiropractic
Osteoarthritis risk is also increased by gout-related joint damage.Urate deposits in the kidneys can harden into kidney stones that can obstruct urine flow.Gout is more common in men. It often starts in middle age in men and after menopause for women. Other risk factors include diet, obesity, other health conditions, family history, and surgery or trauma.

Diagnosis requires the detection of urate crystals in synovial joint fluid. This is because not all people with high serum urate levels develop gout. A blood test by itself is insufficient for diagnosis. Acute gout attacks are treated with anti-inflammatory drugs, such as NSAIDs whose regular use may also help prevent or reduce the frequency of attacks.Medication that blocks urate formation or increases urate excretion may be used for this purpose since tophi can be dissolved by reducing serum urate.
Without proper treatment, a gout patient will continue to have recurrent joint pain episodes, which will eventually lead to joint damage. So, it is important that early treatment is started by a rheumatologist to lower the uric acid and prevent the development of further episodes. There’s a dire need for people to modify their lifestyles, activities, and the foods that they consume to mitigate the risk of getting gout and ultimately alleviate the suffering that gout causes for many people around the world.

Gout Surgery
There are a few surgical procedures available for those with more severe gout conditions. They are as follows:

  • The removal of tophi
  • The fusion of the joint
  • The replacement of the joint

The Removal of Tophi
Tophi may get painful and bloated. They might even crack open, drain, or develop an infection. Tophi removal entails getting rid of the sore, inflamed, or bloated growths. The method entails removing a tophus while preserving as much of the surrounding tissue as possible. If the tophus is infected, or if it is causing excruciating discomfort or deformity, a doctor may choose this course of action.

The Fusion of the Joint
The bones in a joint are fused together during joint fusion.Your doctor could advise having smaller joints fused together if advanced gout has irreversibly ruined a joint. Although this procedure may result in some mobility loss, it can lessen symptoms like chronic pain. Joint fusion is frequently used by surgeons on smaller joints because it can aid inalleviating pain.Both pain relief and joint stability can be improved with this procedure.

The Replacement of the Joint
This procedure involves the removal of the painful, tophaceous gout-damaged joint and its replacement with an artificial jointin order to alleviate discomfort and retain mobility. The knee is where this procedure is performed most frequently.

Gout is a condition caused by a monohydrate crystal deposit of monosodium urate. It can affect people of all ages and from all walks of life especially middle-aged men for the most part.When treating gout, clinical chemists must be equipped with the knowledge they need to support prescribing clinicians and maximize therapeutic outcomes.Pharmacists can understand gout as a serious disease by learning about risk factors, typical symptom presentations, and important diagnostic criteria.

In terms of lowering pain in gout patients with acute gout, a number of medications have moderate to strong evidence of efficacy. There is no doubt that urate-lowering treatment succeeds in lowering urate levels. Reduced serum urate should eventually result in fewer gout attacks, although the advantages and disadvantages of long-term urate-lowering medication have yet to be proven. Patient preferences are expected to play a significant role in decision-making (as mentioned above), and physicians and patients will be better informed about the risk:benefit trade-off for various decisions if there are better estimates of the size of the benefit of the urate-lowering medication.