; Gout -โรงพยาบาลแมคคอร์มิค เชียงใหม่ McCormick Hospital ChiangMai

Gout



        Gout is disease due to elevated uric acid in the blood leading to variety of disease condition, most notable sudden onset of gout pain. It most commonly affects the joint of the big toe, about 50%. It can also cause kidney stone, disease of the kidney. In the chronic case the uric acid crystal precipitates and deported in the joint as a knot call Trophi and cause bone destruction.

Cause

        Due to combination of diet and genetic factors, some disease conditions which lead to elevation of uric acid level and precipitation of the crystal in the joint, tendon, tissue around it causing acute inflammation.

        - Possible high purine diet: meat, sea foods, animal organs.
        - Alcohol and beers.
        - Beans, nuts, spinach.
        - Combination of metabolic syndromes: Diabetes, high cholesterol, obesity.
        - Cancer of the blood elements especially after treatment.
        - Water pill such as Hydrochlorothiazide.

Signs and symptoms

        Acute gout
        
Sudden onset, usually at night, of painful joints. Most commonly the bone of big toe.  It can also affect fingers, wrist, ankle, and knee

        Chronic gout
        
- Formation of uric acid crystal ball (tophi) at the joint with bone destruction, ulceration.
        - Formation of kidney stone.
        - Kidney damage.

Diagnosis
 
        - By chemical presentation.
        - Blood uric acid level.  Mostly elevated but it can be normal.
        - Urate crystal in joint fluid, Tophi.

Treatment

        Acute gout  
        - Rest the affected part.
        - Ice pack for 20-30 minutes, three-four times daily.
        - Take anti-inflammatory medication: NSAIDs Recurrent gout and other complication.
        - Diet control to reduce high purine diet.
        - Stop drinking alcohol, beers.
        - Avoid trauma.
        - Weight reduction and treatment of other metabolic syndromes.
        - Varieties of medication the doctor can prescribe to lower the uric acid blood level.

Diet recommendation : Purine content

Avoid high purine diet
(+150 mg./100 gm.)
Moderate consumption diet
(50-100 mg./100 gm.)
Recommend consumption diet
(0-50 mg./100 gm.)
Meats
Organ meats
Duck
Goose
Mackerel
Sardine
Tuna
Gravies
Meat extract
Nuts
Beans
Avocado
Yeast
Mussels
Pork
Other fishes
Meat (beef ; soup)
Legumes
Seafood (crab, shrimp, oyster)
Vegetables (spinach, mushrooms, asparagus, cauliflower)
Chicken, other poultry products
Milk and dairy product
Eggs
Other fruits
Coffee
Tea
Other vegetables
Rice
Gelatin
Bread