Men's Health, Pain, General | February 13, 2015 | Author: The Super Pharmacist
Gout, also known as hyperuricaemia, is a condition associated with increased concentrations of uric acid in the blood1. This may result in the accumulation of uric acid crystals (or monosodium urate) in many types of soft tissue and in joints2.
Gout may affect a number of joints in the body, resulting in a range of symptoms that resemble those of arthritis1. This is due to the accumulation of uric acid crystals in the protective synovial fluid within joints3. Gout is also associated with inflammation, or the release of inflammatory molecules into joints and other tissues, which may be associated with chronic pain3. Therefore, gout is often regarded as a rheumatological condition. The symptoms of gout may include:
Certain disorders and conditions may affect the probability of increased circulating uric acid in the body. These may include4,5:
Conversely, the presence of gout may increase the risk of other conditions. A study of approximately 54,000 patients found that the risk of developing diabetes was increased, and that this risk was greater in women with gout than in men with this condition6. Increased blood levels of uric acid are also associated with the increased risk of coronary artery disease and heart attack7. Gout is also associated with increased risks of kidney damage, and of death related to kidney failure3.
Gout may be hereditary, or passed on from generation to generation. An analysis of data on over one million patients found that the risk of the condition was significantly higher for those with first-order relatives who had gout8. The risk of gout may be associated with mutations in various genes. 12 of these variations have been found to be associated with the risk of gout in studies involving European participants9. Some mutations are related to the control of uric acid in the blood7. These include variants of the genes ABCG2 and SLC2A97. A mutation in NPT1, a gene expressing a urate-transporting protein, was found to be associated with gout that affects the kidneys10. Mutations in the genes CLNK and ZNF518B were found to be significantly associated with risk in a Chinese study including 145 patients and over 300 matched healthy control subjects9.
The risk of gout may also be associated with a range of dietary factors and deficiencies. These are in some cases related to foods rich in the 'building blocks' (e.g. purines) the body may use to produce uric acid. A study of over 47,000 men with no history of gout at the outset found that those who consumed the most meat and seafood were at a significantly higher risk of gout than those who ate the least of these foods11. Those who had an increased intake of low-fat dairy products had a significantly reduced risk of developing the condition11. The theory of purine-rich foods does not hold up in all cases, however; this study found no association between the consumption of high-purine vegetables and the risk of gout11. However, the theory that fructose increases uric acid concentrations may have some weight. A study including over 46,000 adult participants found that increased fructose (a common sugar used extensively in commercial food production, e.g. high-fructose corn syrup) intake from soft drinks, fruit juices or fruits was associated with an increased risk of gout12. Decreases in vitamin C levels may also be associated with the increased probability of this condition13. Coffee (but not necessarily caffeine) consumption was associated with a significantly reduced risk in another study of over 45,000 adult men14.
There are a number of options available to manage gout. This condition has become relatively easy to treat and manage. However, some factors may affect the efficacy of treatment in gout. These are mainly the difficulty in diagnosing the condition, and adherence to a treatment regimen once a diagnosis is made3. However, diagnosis of gout has improved recently, mainly through the use of non-invasive imaging techniques. Diagnostic methods that may aid detection of gout include3:
Treatment strategies may include15:
These are interventions that are directed at reducing the uric acid concentrations in the body. These are often in the form of drugs called xanthine oxidase inhibitors. These urate-lowering drugs include:
During flare-ups or attacks of gout, patients may require pain relief. The following chart shows appropriate management of attacks as directed by physicians.
This involves an ideally comprehensive programme of advice, educational material and information on the condition in question provided to the patient. The goal of patient education is that the individual in question fully understands their condition, treatment options and other information such as risk factors and how best to avoid them if possible. Patient education may reduce depressive symptoms and/or treatment apathy, if these are associated with the disorder, and improve management through lifestyle changes. This may also result in improvements in life quality. Some evidence indicates that patient education is a viable component of treatment in cases of gout4. This may improve the ability of patients with gout to manage, improve and live with their condition.