Monday, September 17, 2018

Podagra: Gout and Psuedogout

Spare a thought for those who live with gout. The old medical term for the disease of Kings and the King of Diseases was Podagra. The pain is "exquisite” and sadly affects about 0.3% of the population. First described in the fifteenth century the cause of gout is a defective purine (protein) metabolism resulting in the accumulation of monosodium-urate crystals in the tissues. The disease is common in males and characterised by recurrent episodes of acute arthritis. Gout can affect any joint but commonly it appears in the big toe but can also be found in the mid-foot. Primary gout appears as a result of inherited error of metabolism causing either over production of uric acid or retention of uric acid due to a disturbance in purine synthesis and/or renal uric acid excretion; or secondary to gout where there is diseases of the blood forming tissues, occurring in leukemia and other states of excessive tissue turnover. It may occur in renal failure and following administration of certain drugs. The condition is uncommon before the age of 40 and often associated with post menopause in females. Attacks commonly begin at night, pain is sudden, severe and excruciating. This pain is often described as exquisite and is unbearable and so severe nothing can be held against the surrounding skin. Joints becomes hot, red, and swollen and untouchable. Pain subsides and episodes recede with time. Between attacks the condition is usually asymptomatic. With repeated attacks the joint becomes progressively more damaged and other joints may become involved.

Chronic gouty arthritis with joint deformities develop as a result of cartilage erosion caused by inflammation. The first metatarsophalangeal joint of a great toe is the site of the first attack of acute gouty arthritis in 70% of sufferers.

(Video Courtesy: Nucleus Medical Media Youtube Channel)

Pseudogout is a form of arthritis, which causes similar symptoms to gout but commonly affects the knee or wrist, It can affect other joints and may present in one or more joints at once. Damage is caused by the abnormal formation of calcium pyrophosphate (CPP) crystals in the cartilage. When the crystals are released into the joint fluid it causes a sudden attack of arthritis, with symptoms similar to gout. The cause is unknown and affects both men and women. Older people with a thyroid condition, kidney failure, or disorders that affect calcium, phosphate, or iron metabolism are at increased risk of pseudogout. Treatment of gout includes drugs which help lower serum urate in the blood stream. Non steroidal anti-inflammatory drugs are important in the acute phase but corticosteroids are seldom prescribed for gout and pseudogout.

An interesting quirk with gout is Aspirin, which is a common analgesic but should never be taken by people suffering from gout because in low doses it blocks uric acid excretion and this will more than likely cause a painful attack.

Probably the most famous person in history to suffer from gout was Henry VIII, King of England. Perhaps this was rather kind to the Royal Person for he more than likely suffered syphilis instead. However the popular image of a well fed affluent individual with their foot excessively bound and rested is still a popular image of gout sufferers. Contrary to popular belief a diet of rich foods and drinks is unlikely to be the sole cause of gout but people living with gout should avoid purine rich foods.

Medline Plus

The above does not constitute actual medical advice but is shared in good faith and for general information purposes only. Should you experience symptoms associated with gout and psuedogout, then please consult your physician.

Reviewed 17/09/2018

1 comment:

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