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)
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