Thursday, April 21, 2011

My big toe hurts: It must be Easter !

Easter has become a holiday filled with good food and wine and way too much chocolate. According to medical experts Easter is also associated with attacks of gout and people should be careful not to overindulge. Gout describes an upset in purine (protein) metabolism which can result in deposits of small crystals in the joints which leaves them exquisitely painful. The resulting damage may painful osteoarthritis.

Gout appears to affect men between the ages of 40 and 50, women too can suffer from gouty attacks and is caused by a build-up of uric acid, which crystallise. In women the incidence increases after menopause and it is very rare in children and young adults. The incidence of gout increases when alcohol and certain foods, including processed meats, organs such as kidney and liver, yeast, anchovies, sardines and some vegetables are consumed in quantity.

A common site for crystal deposits is in the big toe joint which renders the main pivot point of the foot inoperable due to the tremendous pain experienced. Many people who develop gout have a family history but other diseases may increase the risk. These include diabetes mellitus, obesity, kidney disease, and sickle cell anemia.

Alcohol adversely interferes with the removal of uric acid from the body as can other factors including, a purine rich diet (e.g., cream sauces, red meat, sardines, liver, scallops), medications which interfere with remove of uric acid from the body and exposure to lead in the environment. Demographic surveys indicate a significant rise in reported cases of gout. Painful symptoms are often sudden and come on, overnight. The effected parts such as the great toe is swollen and tender with touching or moving the big toe intensely painful. Frequently gout sufferers will report extreme discomfort even from a bed sheet. If left untreated, gout can damage joints and cause osteoarthisis. People with gout have elevated blood levels of uric acid, but this condition may not always be present during an acute attack. A simple set of tests and physical examination will confirm diagnosis. Treatments involve reducing the levels of uric acid in the joints and the physician may prescribe non-steroidal anti-inflammatories (NSAIDs) to treat the pain. Until recently treatment for acute gout consisted of colchicine which was effective early in the attack. However, colchicine can cause nausea, vomiting, diarrhea and other side effects and now most physicians prefer to use anti-inflammatories. However, they too have side effects for some. Pharmaceutical care also depends on co-morbidities and polypharmacy. Small doses of NSAIDs, colchicine, or allopurinol may prevent continued accumulation of uric acid in the joints and further attacks. Avoiding alcohol and rich foods that are high in purine are also recommended to normalise blood uric acid levels. What works well for one person may not work as well for another, so decisions about when to start treatment and what drugs to use have to be tailored by the physician, and depend on kidney function and other factors. According to experts it is possible in almost all cases to successfully treat gout.

Pseudogout (calcium pyrophosphate deposition disease) is a type of arthritis where calcium crystals accumulate in joints capsules causing severe localised pain and swelling, similar to gout. Pseudogout is a condition which is often mistaken for gout and diagnosis is important if treatment is to be effective. The incidence of pseudo gout increases with age and diagnosis depends on analysis of the crystal found in affected joint. Treatment usually involves prescribed anti-inflammatory medications. Unlike gout which tends to affect the feet and ankle, pseudogout affects the knees, wrists, shoulders, ankles, elbows or attacks can last for days or weeks. The cause of calcium pyrophosphate deposition disease remains unknown. The condition sometimes runs in families and hence genetic factors are suspected of contributing to the disorder. According to medical text severely underactive thyroid (hypothyroidism), excess iron storage (hemochromatosis), an overactive parathyroid gland, and other causes of excessive calcium in the blood (hypercalcemia) may contribute to the development of pseudogout. In some people, attacks of pseudogout may develop following joint surgery or other surgery. Because many older people have calcium crystal deposits in their joints, any kind of insult to the joint can trigger the release of the calcium crystals, which then induce a painful inflammatory response. Unfortunately, there is no treatment to dissolve the crystal deposits but symptoms may be relieved and the progress of the condition slowed down by small doses of prescribed anti-inflammatories.

Reviewed 29/03/2016

No comments: