Gout, also referred to as gouty arthritis, is a disorder of amino acid metabolism, which typically manifests in men in their fourth decade of life. It can cause extreme pain in the affected joints, most commonly the big toe. The pain is caused by compression of sodium monourate crystals that have been deposited over time in the soft tissues of the joints due to faulty enzyme action.
Gout Symptoms
Gout occurs in four stages, each with its own characteristics, indicating quite readily to the clinician what is causing the patient's complaint. The first stage is actually asymptomatic and is found on lab results with an elevated level of uric acid. At this stage, the individual will have no signs of the condition but will be predisposed to renal calculi, or kidney stones, and may later develop gouty arthritis. The second stage, known as acute gouty arthritis, is an attack of gout characterized by extreme pain in the big toe, most often, but pain may occur in the knees as well. The affected joint is swollen, reddish and warm, not unlike an infection. It is not uncommon for a victim to complain that just the weight of a bed sheet on the toe is too much to take. An episode will usually last a few days, but if left untreated, the pain can last for weeks in some unfortunate individuals.
Gout's Later Stages
The third stage is essentially a worsening of the second stage, with attacks occurring in more than one joint concurrently, most often in the lower extremity, but in the small joints of the wrist, hand and elbow as well. Here doctors are most likely to see characteristic changes on X-rays that help to confirm the diagnosis. Chronic gout---the fourth stage---does not occur much in modern times due to long-term drug therapy. In the past, victims could expect large crystal deposition in the tendons of their hands, feet and elbows and layers just below the skin, which could erupt and spill their contents.
Gout Treatment
Treatment of gout relies on both the doctor and patient taking a role to effectively manage it. Medically, colchicine is the drug of choice for acute attacks. In patients for whom the diagnosis has been made previously, nonsteroidal anti-inflammatories, or NSAIDs, are helpful. Patients can help with their care and prevent future attacks by staying well-hydrated and having a balanced diet that does not weigh heavily on proteins, as it is their breakdown that creates the antagonizing precursors.
References
- "The Merck Manual, 16th Edition"; Merck Research Laboratories; 1992
- "Essentials of Skeletal Radiology"; T. Yochum, L. Rowe; 1987
