Gout is an inflammatory joint disease that occurs as a result of the deposition of monosodium urate crystals in the joints, leading to severe pain and swelling of the joint. This disease is most often seen in people whose diet is high in purines. For this reason, this disease was called the disease of kings in the past.
In this disease, serum uric acid levels are often high. This disease has been known for thousands of years and was first described by the Egyptians. After that, Greek doctors called it the Unwalkable Disease, because in this disease, severe pain in the joints of the legs severely impairs the ability of a person to walk, and finally, Roman doctors found that this disease is related to excessive consumption of alcohol and fatty and meat foods. Today, we know that this disease does not occur in all people who consume excessive amounts of the aforementioned foods, and there must be a genetic predisposition for its occurrence.
Symptoms and signs of the disease
Very severe and sudden joint pain:
During an attack of the disease, the affected joint becomes swollen, inflamed and painful and is very sensitive to touch. Movement restriction in the affected joint occurs due to inflammation and pain.
Recurrent attacks:
This disease is accompanied by frequent relapses if not treated and dietary principles are followed. Attacks become more severe and debilitating over time.
Formation of tophi:
In chronic patients, uric acid crystals accumulate under the skin, creating sharp-pointed accumulations called tophi, and these objects cause destruction of the joint surface.
Disease prevalence
This disease has a significant prevalence worldwide and its prevalence has increased compared to the past due to dietary changes, increased prevalence of obesity, hypertension and diabetes.
The age of onset of the disease is often over 40 in men and in postmenopausal women, and it is observed at younger ages in people with a very positive family history or in people with certain metabolic diseases. This disease is more prevalent in men, and in women, due to the protective role of the hormone estrogen, it is very low in prevalence until menopause, and it is more common with age and during menopause, but in men, the
Diagnosis
The diagnosis of gout is often based on a combination of clinical symptoms, laboratory tests, and imaging.
Synovial fluid analysis: The gold standard for diagnosing gout is to obtain a sample of joint fluid and directly observe it under a microscope to see monosodium urate crystals.
Serum uric acid level: Although high uric acid levels are often diagnostic of gout, high levels are not always associated with the disease in individuals.
Imaging methods such as X-ray, CT, and ultrasound can show urate crystals and joint destruction, especially in chronic patients.
Treatment
The treatment of gout focuses on relieving attacks, preventing future attacks, and reducing uric acid levels to minimize disability and joint damage and speed up the person’s return to normal life.
Treatment of the acute phase of the disease
1-NSAIDs: Nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen to reduce pain and inflammation
2-Colchicine: An anti-inflammatory drug that effectively reduces inflammation and destruction, especially when used in the early stages of the attack.
3-Corticosteroids In cases where the two above drugs are not effective or are prohibited, we use corticosteroids.
Long-term treatments
Serum uric acid-lowering treatments
Xanthine oxidase inhibitors such as allopurinol and febuxostat that reduce uric acid production.
Uricosuric agents: such as probenecid that cause renal excretion of uric acid.
Lifestyle adjustment
Diet
Reducing the consumption of purine foods such as red meat, snails, alcohol, sweet drinks
Weight control to have a fit body without being overweight reduces the risk of the disease. Drinking plenty of water helps the kidneys excrete excess uric acid. Regular exercise, while not putting too much pressure on the joints, helps improve the condition by controlling weight and strengthening muscles.
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