GOUT problems in adult

What Is Gout

History

·         Historically known as ‘disease of the kings’

·         Gout dates back to 2,600 BC when Egyptians noticed gouty arthritis of the big toe.

·         Hippocrates (400BC) commented on gout.

·         Alfred Baring Garrod (1848) noticed that gout was due to excess uric acid in blood

Introduction

·         Gout is a medical condition that presents with recurrent attacks of acute inflammatory arthritis.

·         Gout is a medical condition that usually presents with recurrent attacks of acute inflammatory arthritis (red, tender, hot, swollen joint).

·         Gout affects the joints which appear red, swollen, tender and hot.

·         Gout usually affects the big toe first but can affect any joint in the body

Causes

·         12% of gout is attributed to dietary causes.

·         Gout is linked with the consumption of food high in purines like alcohol, sugar, meat and seafood

·         Gout presents as a complication of other medical conditions like hypertension and diabetes.

·         Gout may also occur as a result of kidney failure.

·         Gout is caused by a build up of uric acid in the body.

·         Uric acid is a waste product produced by a body’s metabolism.

·         People who kidneys do not excrete uric acid properly, or too much uric acid can have high levels of uric acid in their blood which forms crystals in the joints.

·         Crystals cause the joints to become inflamed and painful.

Who suffers?

·         Gout affects 4 times the amount of men than women. 1% of men in the UK will be affected by gout.

·         Gout usually affects men between the ages of 40 and 60 and women between the ages of 60 and 80.

·         Occurrence of gout is high among African Americans, Pacific Islanders and Maori.

Diagnosis

·         A blood test can measure the amount of urate in the blood.

·         Fluid can be removed from the joint with a needle.

·         X ray may rule out other conditions.

Prevention

·         Avoid food high in purines like red meat, seafood (mackerel and herrings), vegetables (Asaparagus) and food which contain a yeast extract (Marmite/Quorn).

·         Exercise helps decrease levels of uric acid in blood.

·         Allopurinol will help to lower your uric acid levels by disrupting the enzyme that is responsible for converting purines into uric acid.

Management

·         Ice applied for 20-30mins/day decreases pain.

·         NSAIDs reduce the level of pain and inflammation. (Diclofenac+Naproxen)

·         Colchicine helps reduce the level of Uric acid in the blood

·         Corticosteroids can also be used in more severe cases of gout

Gout Complications

·         Frequent and recurring attacks of gout may eventually damage joints permanently.

·         Small white lumps of crystal called Tophi form underneath the skin.

·         10-25% of people with gout have kidney stones which are crystals that collect in the urinary tract causing pain and UTI’s

Physiotherapy and Gout

·         Physiotherapists can help reduce joint stiffness and improve muscle tone through exercise.

·         Acupuncture

·         Laser Therapy

·         Coping Strategies (RICE)