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Gout Englisch |
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A disease that is defined by high levels of uric acid in blood (hyperuricaemia) is called gout. Uric acid in humans is one of the final products in protein metabolism. If levels of uric acid get to high ,the kidneys are not able to eliminate those high levels, the uric acid settles in form of small crystals in the synovial fluid. This kind of precipitation is called tophus. If those tophi are being attacked by white blood cells, inflammatory transmitters are being freed causing the inflammatory reaction and the pain, this is the acute gouty arthritis.
Gout is a multifactorial event, that means, several factors have to come together to cause it. A connection with nutrition and other food related diseases like diabetes and obesity does exist. A strong family tendency is also present.
Four different stages are being distinguished:
1. elevated plasma uric acid levels without symptoms
2. acute gouty arthritis
3. the stages in between the acute period
4. the chronic tophaceous gout.
The acute gouty arthritis is defined by sudden pain, often starting at night-time, in one or several joints. For some reason, the first metatarsophalangeal joint (big toe) is affected in most of the cases, other areas can be the knee or the ankle joint as well as the thumb. The episode eases off spontaneously within days, but can be treated through drugs. The chronic tophaceous gout is defined by tophi, depositions of urate, in soft tissues as well as in bone mass often causing malformation of joints.
How is gout being treated?
The most important in treating gout is diet. Body weight should be within normal limits and nutrition should be free of purine, that means low in meat and free of offal and alcohol. Extreme diets and fasting should be avoided because plasma levels of uric acid would be increased. When taking diuretics, one should notice that a decrease in renal clearance of uric acid is possible.
If symptoms persist in spite of diet or if plasma levels are still above normal, medical treatment should be considered. There are two different types of substances available: uricostatic agents, that interfere with the purine metabolism in a way that purine secretion is decreased and uricosuric agents that lead to an elevated renal clearance of uric acid.
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