Signs
And Symptoms Of GoutGouty arthritis hits the patient without any warning.
With foot gout usually only one joint is affected, most commonly the base of the
big toe (metatarsophalangel joint) with big toe joint pain. Alternatively a knee, elbow, wrist or one of the
joints in the
hand is afflicted with gout. The overlying skin is discolored (red
or purplish), often under tension from underlying swelling or an effusion and
extremely tender to the point where even skin being touched by a bedsheet causes
severe pain. There might be an associated fever with chills and a feeling
of intense sickness. The classical case of gout of the great toe (metatarsophalangeal
joint) is called podagra in medical circles (Ref. 1).
In industrialized countries the patient with an acute gouty arthritis attack
is treated by a physician and then followed to prevent further attacks. This has
now lead to a certain complacency among the population.
| Signs and
symptoms of gout | | Signs
or symptoms: | Comments: |
| acute joint pains | from
deposits of uric acid crystals | | high
uric acid levels | serum uric acid levels
exceed 7.0 mg/dL (or 0.41 mmol/L) | | podagra | gout
of great toe (metatarsophalangeal joint) |
| tophi around joints or in earlobes | "tophi"
are uric acid crystals deposited in subcutaneous tissue or around joints |
| kidney stones | in
20% of gout patients | | fever,
chills, sickness | non specific reaction of
vegetative system to kinins released by white blood cells |
| other contributing diseases worsen gout | diabetes,
hypertension, kidney disease, cancer treated with chemotherapy all worsen gout |
| crippling joint stiffening
| very rare now with appropriate
therapy; common in Middle Ages in royalty ( e.g. Henry VIII-th ) |
| gout more common in
males | male to female ratio is
20:1 | However, in less fortunate countries
where poverty is abundunt, medicine might not reach these patients and after the
initial gouty attack several more will likely follow with a rate of 2 or more
per year. Gout becomes chronic subsequently and all joints can get affected.
The joints undergo erosions and severe deformities, which leads to severe losses
of range of motion with resulting stiffness of the joints. Urate is deposited in the walls of tendon sheaths and bursae.
They are called tophi and usually occur on hands,
feet
and around the outside (extensor side) of the elbow joints. If the tophi get big
enough they can erupt and discharge the chalky content of urate crystals (Ref.
2). Only about 20% of patients with gout develop kidney
stones with either uric acid or calcium oxalate
stones. These patients often have concomitant other health problems such as high
blood pressure, chronic kidney disease such as pyelonephritis or diabetic nephropathy.
It is important that these patients are carerfully monitored so that their kidney
function stabilizes and the uric acid level is brought into a normal range where
further kidney deterioration is prevented.
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