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Gout - Medical Malpractice
The disease of gout begins with a chronically elevated uric acid content in your blood. Uric acid is a by-product of meat metabolism and is in the blood to a low degree at all times. If, through your diet or heredity, you have chronically elevated uric acid levels, you are at risk for gouty arthritis. Gouty arthritis is very painful and can come on suddenly as a burning pain you can't get rid of easily with over the counter medications. Gout is more common in men than in women.
As mentioned, gout is caused by an elevation of uric acid in the blood. The uric acid builds up in the joint tissue and forms crystals. The crystals in the joints are very painful. Risk factors for gout include being overweight, eating too much meat and fish containing purines, taking certain diuretics, heredity and alcohol consumption to excess.
The main symptoms of gout include night-time attacks of tenderness, redness, swelling and pain in the big toe or ankle. Other joints, such as the knee, are less commonly involved. The attacks can last a few days or many weeks before the pain dissipates. Attacks can occur months or years apart.
Gout usually develops after a number of years of build-up of uric acid in the system. There can be mild attacks lasting one to two days or severe attacks that last up to a month. Second attacks occur between six months and two years of the first attack. The frequency tends to increase over time.
There are four stages of gout. The first is just having higher than normal uric acid levels in the blood but you have no symptoms. Some people never go past this stage but can get uric acid kidney stones instead. The second stage of gout is acute gouty arthritis, when the crystals begin to form in the joints. The big toe is the most common site of the arthritis but other sites are possible. After the first attack, the joint feels normal again. The third stage is called "interval gout". This is when you have no symptoms between gouty arthritis attacks. The uric acid level remains elevated. More than one joint can be involved in subsequent cases. The fourth stage is chronic tophaceous gout. This involves chronic pain in the joints and nodules under the skin of the fingers and other areas called tophi. Gouty tophi are cream-coloured and difficult to get rid of. The tophi are usually found in the elbow area, the fingers, the toes or on the outer aspect of the ear.
Gout is diagnosed through a careful history and physical examination. Doctors ask about heredity and diet and about prior pain similar to the pain the person is having. The joint appears red, swollen and is quite painful. Usually the ankle, knee or great toes are involved as a mono-arthritis. The uric acid level is almost always elevated.
There are several treatments for gout. If you have an acute attack, a shot of corticosteroids can be given or oral prednisone can be used to settle the inflammation. Strong pain medications-even narcotics-a are prescribed because the pain is usually terrible. If you begin treatment immediately, the pain can be resolved within one to two days. Anti-inflammatory medication can be used to block inflammation as well.
Doctors use medications to block the elevation in uric acid to be used when the acute attack is over with. This can include allopurinol, which lowers uric acid. You can work on weight reduction, which should help the symptoms. You should eat less meat and seafood, and should drink less alcohol. Flush out the uric acid by drinking plenty of water.
During an attack, the main treatments are rest of the joint, nonsteroidal anti-inflammatory medications, avoiding aspirin as it can make the situation worse, taking colchicine or corticosteroids. Colchicine lowers the uric acid level in the joints without making the symptoms worse.
To prevent further attacks, you need to take drugs like uric acid, which decreases uric acid production. You need to watch your weight and try to lose weight through a low fat diet, and avoid beer and other alcoholic beverages. Cut back on meat and seafood. Exercise moderately to help in weight loss and reduce the chances of recurrences.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here