Discussion in 'JF Doctor' started by mangoa, Jan 17, 2011.
Naomba kuzijua dalili na tiba ya ugonjwa wa gauti wa jf
Gout is considered one of the most painful types of arthritis. If not yourself, you likely know someone who has had a gout attack. The word attack suggests this is no laughing matter. What exactly goes on during a gout attack?
"Gout attacks cause sudden severe joint pain, sometimes with redness, swelling, and tenderness of the joint. Although an attack typically affects a single joint, some people develop a few inflamed joints at the same time. The pain and inflammation are worst within several hours, and generally improve completely over a few days to several weeks, even if untreated. It is not clear how the body "turns off" a gout attack."
What Causes a Gout Attack?
The first gout attack you will experience typically follows years of asymptomatic hyperuricemia (high blood uric acid level). Meaning, a gout attack occurs when excess uric acid accumulates in the body and deposits as crystals in and around joints. The big toe is often the first joint affected. But, what exactly triggers a gout attack in this setting is still unknown.
Who Typically Has a Gout Attack?
Men and women can both experience gout attacks. As for men, their first gout attack usually occurs between age 40 to 69. Women typically are older when the first gout attack occurs -- but other factors play a role, such as the age of menopause and use of thiazide diuretics. Other important risk factors include genetics, prescription medications, and diet.
How Does the Pain Feel During a Gout Attack?
Pain increases in intensity from a twinge to severe pain over an 8 to 12 hour period in a typical gout attack. As described in the excerpt above, usually a single joint is involved in a gout attack but it is possible that more joints are involved. In 50% of patients, the big toe is affected initially but the midfoot, ankles, heels, and knees can also be involved early on. Less commonly, wrists, fingers, and elbows are involved in a gout attack.
What Other Symptoms Can Occur During a Gout Attack?
Besides joint pain, a gout attack can cause inflammation of tissues next to the joint, such as tendons and skin, and even cause body-wide symptoms such as fever, chills, and malaise.
What Are the Expected Duration and Frequency of Gout Attacks?
Untreated gout attacks can range from mild (lasting only a few hours) to severe (lasting between 1 to 2 weeks). Early on, there may be years between gout attacks, but over time, gout attacks typically become more frequent, last longer, and involve more joints. You may progress from acute intermittent gout to the chronic inflammation of tophaceous
Typically, gout patients are about 95% men, 5% women. An initial attack of gout (50% of initial attacks involve the big toe) may last several days and disappear even if untreated. Subsequent attacks may not occur for weeks, months, years, or not at all. In severe cases, repeated attacks occurring over a long period may cause damage to the joints and loss of mobility. The big toe is eventually affected in 90% of cases. Knowing how to treat gout is important for preventing attacks.
Gout is often related to an inherited abnormality in the body to process uric acid. Uric acid levels can become elevated by eating a lot of purine rich foods such as meats, by the overproduction of uric acid by the body, or if the kidneys do not eliminate excess uric acid.
Treatment goals include terminating acute gout attacks, rapid and safe relief of pain and inflammation, preventing future attacks, and avoiding complications (formation of tophie, kidney stones, and joint destruction).
Though gout treatment is most often treated successfully and without complications, it becomes more of a challenge if other conditions exist along with gout or if there is poor patient compliance to recommended lifestyle changes or a medication regimen.
Dietary alterations are recommended, such as avoid purine rich foods. Other preventive measures include maintaining adequate fluid intake weight reduction reduction in alcohol consumption, and medications to reduce hyperuricemia
non-steroidal anti-inflammatory drugs (NSAIDS)
NSAIDS: specifically indomethacin, are commonly the first medication prescribed to treat acute gout. Other NSAIDS may be equally effective. NSAIDS are initially prescribed at maximum dosage and reduced as symptoms subside. The medication should be continued until pain and inflammation are non-existent for at least 48 hours. NSAIDS which are COX2 inhibitors may be useful for patients with gastrointestinal concerns but their use for acute gout has not been specifically reported yet.
Colchicine: is used to treat acute flares of gouty arthritis and to prevent recurrent acute attacks. Colchicine does not cure gout or take the place of other medicines that lower the amount of uric acid in the body. It prevents or relieves gout attacks by reducing inflammation. Colchicine may be used in 2 ways: some people take small amounts of it regularly for months or years, while others take large amounts of colchicine during a short period of time (several hours).
Corticosteroids or adrenocorticotropic hormone can be used for patients who cannot take NSAIDS or colchicine. Patients with acute gout typically receive daily doses of prednisone (20-40mg) or its equivalent for 3 to 4 days, then it is tapered gradually over one to two weeks. ACTH is administered as an intramuscular injection (an initial dose and subsequent doses over several days as needed).
Allopurinol: is prescribed for chronic gout or gouty arthritis and works by affecting the system that manufactures uric acid in the body. It is used to prevent gout attacks, not to treat them once they occur.
Probenecid: is prescribed for chronic gout and gouty arthritis. It is used to prevent attacks related to gout, not treat them once they occur. It acts on the kidneys to help the body eliminate uric acid. Probenecid is known as a uricosuric agent.
Analgesics: are also used to relieve the intense pain of gout. All of the aforementioned drugs can be used in combination, to control symptoms, prevent future attacks, and maintain healthy uric acid levels.