GOUT
It is a disease that causes recurrent severe joint pain, especially in men over the age of 30, that can damage the joints if not treated, that can cause kidney stones and disorders, and more importantly, accelerate arteriosclerosis and trigger problems such as heart attack and stroke.
Gout is a disease known since Hippocrates. Roman physicians Galen and Celsus, who first described gout tophi, reported that gout was seen in the wealthy. The term gout is derived from the Latin gutta (drop).
IT IS FIRST OF MEN’S DISEASE
This disease occurs as a result of the collapse of the substance called URIC ACID, which is normally found in the body and which is a product of PURINE metabolism from proteins, in the joints and tissues. These precipitated substances are called Mono sodium urate (MSU) crystals. Gout is classically known as the disease of middle-aged men. It is the most common cause of recurrent joint inflammation (arthritis) in men over the age of 40. It is unusual for gout to start before the age of 30 in men and before menopause in women. In other words, if there is no additional factor in the woman, it usually starts after menopause.
THE BIG TOE IS THE MOST COMMON JOINT
Acute gouty arthritis starts in a single joint in 80% of cases. It most commonly causes involvement of the big toe. Gout should come to mind when we have severe big toe pain, especially after midnight. Apart from the big toe, the ankles, fingers, wrists and elbows are frequently affected areas. Sometimes it affects more than one joint and can be difficult to distinguish from other inflammatory rheumatism. Attacks often last up to a week and go away on their own. However, any situation that makes a sudden change in the uric acid level can cause the attack to recur.
FREQUENTLY CHANGE OF THE URIC ACID LEVEL TRIGGERS AN ATTACK
The agents provoking acute gout attack are frequently heavy consumption of alcohol, especially beer, infections, trauma, surgery, alcohol intake, fasting, foods with high purine content, intensive nutrition with intravenous route (hyperalimentation), cyclosporine, heparin, thiazide diuretics (diuretics). ) as drugs. Sudden rise or fall in uric acid level is in question in a significant part of them. Diuretics, which are included in the blood pressure medications that most of the patients use compulsorily, can trigger gout attack by increasing the uric acid level. Patients with high uric acid levels should not change their medication without consulting their physician. Alcohol, especially beer, triggers an attack.
IT CAN CAUSE ORGAN AND JOINT DISORDERS IF NOT TREATED
In untreated cases, attacks tend to recur in the long term. These attacks tend to occur more frequently and to be polyarticular and febrile. Joints heal completely after the attack, but in some cases, joint destruction develops. If the disease is not treated and the uric acid level is high, subcutaneous lumps called tophi occur over the years. These lumps can sometimes be located in the joints and even in the internal organs. In this case, they can lead to organ dysfunction and joint damage.
Gout with tophus formation is called tophaceous gout. Tophaceous gout often occurs in people with early onset, poor treatment, frequent attacks, high uric acid levels, and tends to involve the upper extremities and have a polyarticular course. Alcohol use and the use of drugs such as diuretics are also more common in this group. The occurrence of tophi in osteoarthritic joints is more common in elderly patients. The classical localization areas of tophi are the ear canals, as well as the elbows, fingers, toes, anterior knees, forearm, and Achilles tendon are other areas that are frequently involved. Tophus can also be located in the joints and internal organs.
NOT EVERY URIC ACID RISE IS GUT:
If the uric acid level is above the normal range and does not cause joint pain, swelling, kidney dysfunction and stone formation, it is called high uric acid level (asymptomatic hyperuricemia). The frequency of asymptomatic hyperuricemia in the adult American population is between 5-8%. The most important factor determining the transition from asymptomatic hyperuricemia to symptomatic hyperuricemia is the level of uric acid. The annual incidence of gout was 4.9% in people with a uric acid level of 9mg/dl and above; If it is between 7-8.9mg/dl, the annual incidence is .0.5%; If it is under 7mg/dl, it is only 0.1%. In other words, the higher the uric acid, the higher the chance of disease.
GUT IS NOT ALSO ALSO
Gout and hyperuricemia often accompany other important metabolic disorders. The main ones are obesity, hyperlipidemia, hypertension, fatty liver and reduced glucose intolerance (Diabetes susceptibility). One study found obesity under the age of 35 to be a major risk factor for gout. Abnormal glucose intolerance was found in 48% of gout cases. Obesity increases the occurrence of gout in many ways. In some cases, increased uric acid formation, and in some cases, decreased renal uric acid excretion is detected. Weight reduction provides a decrease in serum uric acid level.
The coexistence of hypertriglyceridemia and hyperuricemia is well known. While 80% of patients with hypertriglyceridemia are also hyperuricemia, hypertriglyceridemia is detected in 50-75% of patients with gout. Again, especially in the majority of these cases, high alcohol consumption is detected.
Hypertension is another common disease in patients with gout. Hyperuricemia was detected in 22-38% of untreated hypertensive cases. The incidence of gout in the hypertensive population was found to be between 2-12%. Hypertension was found in 25-50% of cases with classical gout. Hypertension was not found to be associated with the duration of gout, but it was found more frequently in obese gout cases.
Again, in many pedestrians, a risk has been found between a continuous increase in uric acid level and cardiovascular diseases. Problems such as heart attack and stroke are more common in gout cases.
DIAGNOSIS:
Gout should be considered in anyone with high uric acid who has recurrent single joint swellings. However, gout is very rare in men before the age of 20 and in women before menopause. Gout is best diagnosed by the demonstration of uric acid crystals in the tissues or fluid of the swollen joint, more significantly phagocytosed by neutrophils. However, this is often not possible, and fluid cannot be taken from every joint. In this case, it is necessary to consider other clinical features and make a diagnosis.
Treatment: Treatment goals include termination of acute attack, prevention of relapse, correction of accompanying pathologies, and long-term hypouricemic treatment. Since this disease often carries other metabolic problems together, gout cases should be treated by an internist and rheumatology specialist.
Termination of the Attack: Colchicine and anti-inflammatory drugs are the drugs of choice for classic gout. They are used with caution, taking into account the patient’s age, kidney functions, and other accompanying diseases. Colchicine is not well tolerated by most elderly patients and often causes side effects such as nausea, diarrhea and abdominal pain. Using the paint by removing water can reduce this side effect. During an acute attack, treatments to change the uric acid level are not given if not already taken. Prophylaxis is essential because the probability of relapse within weeks after an acute attack is high. 1 or 2 doses of colchicine a day largely prevent relapse.
Gout is a disease that requires long-term follow-up. Here, after the end of the attack, the patient should be careful because the attacks tend to recur. Diet is perhaps the most important of the main components of treatment. He should take a restricted diet of a type of protein that pierces purine. It must be evaluated from a metabolic point of view and must be under the control of a dietitian. Cutting protein and feeding only carbohydrates can raise uric acid. Avoid alcohol, especially beer.
PURINE POOR FOODS
•Milk and its products
•Egg
•Cereal and its products
•Pasta
• Fruits, tomatoes
•Hazelnut
•Candies, sweets
•Gelatine
• Beverages: Water, tea, coffee, cola, carbonated drinks…
PURINE-RICH FOODS
•All meats: Especially organs (Spleen, Liver, Kidney, Brain..)
•Seafood (Anchovies, Sardines, Herring, Mussels, Lobster (some allowed))
• Leavened products (beer, bread)
•Vegetables:
•Pea
Pods/Beans
•Lentil
•Asparagus (some may be allowed))
Spinach (some allowed)
Mushroom (some allowed))
Beer and other alcoholic foods
