Gout is a form of arthritis that causes redness, swelling and pain in joints. It has been known for more than 2000 years. It usually affects a single joint with each episode, most often the big toe, but can affect other joints also. Gout is known as a condition that affects primarily older people but there are cases of it causing trouble for young people too (Harry Kewell at the last world cup for example). Around 90% of Gout attacks occur in men over the age of 40, with most attacks occurring in men closer to 70. Fortuneately gout is the one form of rhuematism that has the most satisfactory treatment.

What Causes Gout?

Gout occurs when there is a build up of uric acid in the blood stream, and it accumulates in the fluids around joints. Uric acid is a waste product from many foods that we eat, and is transported via the blood stream to the kidneys, where it is excreted in urine. When this process is impaired, gout can result. Uric acid crystals can also collect in the kidneys, causing kidney stones. Gout does not always occur in people who have hyperuricemia, and people who have gout do not always have excessive levels of uric acid. There are a number of risk factors, but in most cases the cause of gout is unknown.

Many conditions are strongly associated with gout including diabetes, high blood pressure, heart disease, obesity and kidney disease. There are also a number of triggers that may cause acute attacks including stress, infection, minor trauma, heavy consumption of alcohol or surgery.

Some of the risk factors associated with hyperuricemia (too much uric acid) and gout:
•    Genetics- the impairment in the excretion of uric acid is thought to be heridetary.
•    Gender and age- it is more common in men, and also becomes more likely as you get older.
•    Weight- being overweight means there is more tissue available for breakdown or turnover and can lead to excissive uric acid production.
•    Alcohol consumption- excessive consumption can interfere with the removal of uric acid.
•    Diet- eating too many foods that are rich in purines has been thought to cause or aggravate gout in some people.
•    Kidney problems- will impact on your ability to excrete uric acid
•    Long term use of certain medications- diuretics, aspirin, immunosuppressants may act on the kidneys affecting the excretion of uric acid.
•    Anemia- low number of red blood cells
•    Psoriasis- skin condition causing inflammation
•    Exposure to lead- has been linked to gout

Signs and Symptoms

Gout generally has four stages.

In the first stage the patient has elevated levels of uric acid with no other signs or symptoms. No treatment is required in this stage and not all patients with the increased levels of uric acid will go on to develop gout.

The second stage is called acute gouty arthritis. In this stage the patient experiences a sudden onset of heat, redness, swelling and pain in a joint, caused by the formation of uric acid crystals within the joint. This usually occurs in the big toe, and can be so painful that even a bed sheet resting on the toe can be excruciating. If left untreated, the symptoms usually clear up within 10 days; however immediate treatment can provide relief within hours. The pain and swelling will disappear, but an acute attack almost always strikes again in the same or another joint.

After the initial attack of acute gouty arthritis, signs and symptoms usually disappear and the patient goes into the third stage of gout, which is interval or intercritical gout. The patient usually has another attack within 2 years. If left untreated, the interval between the attacks can shorten and it can start to affect more joints.

If left untreated for several years the condition can progress to the final stage of chronic tophaceous gout. In this stage there is chronic inflammation and swelling and permanent damage to the joints caused by the formation of uric acid crystals in the joints. These masses of crystals are caused tophi and can cause disfigurement.

Diagnosis

Diagnosis usually involves a physical examination and question about family and personal medical history. Gout is often suspected if the patient describes some of the classic symptoms of gout such as a sudden swelling and pain in joints, particularly in the big toe.

To confirm, gout or rule out other conditions, some synovial fluid can be taken and examined for the presence of uric acid crystals.

Urine can be analyzed to see how much uric acid is being excreted. This can also be used to detect kidney stones.

Blood test can also be done to measure the amount of uric acid in the blood. This is not a definitive diagnosis, as hyperuricemia does not always correlate to gout, but it can give an indication and help to rule out other conditions.

X-ray is used to assess joint damage, particularly in patients with repeated episodes of acute gouty arthritis.

Diagnosis can be difficult, especially as someone with gout may not necessarily have an elevated level of uric acid in the blood. However, once gout is diagnosed it is important to start treatment immediately to ensure the best possible outcome for the patient.

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But what else can we do?

Acupuncture is basically inserting small needles into the skin in order to relieve various pains and symptoms. It has been around for years and is quite popular. There isn’t much information around on the use of acupuncture in conjunction with arthritis,but there should be.

A study in 2004 showed that acupuncture can be of benefit to arthritis sufferers. The study was searching for evidence of acupuncture reducing the pain and symptoms of osteoarthritis. 570 patients with osteoarthritis of the knee were involved. Patients were measured for pain and function scores at week 8 and week 26 of the program (in comparison with a sham acupuncture group). They were also measured on a 6 minute walk and a physical health score.

Participants in the true acupuncture group experienced greater improvement in their pain and function scores than the sham group at week 8. By week 26, the acupuncture group had significantly better scores in all areas.

Our Conclusion:

Acupuncture is a great secondary treatment for osteoarthritis. If you are suffering pain, it is something that can be done alongside exercise and medication. It may not be for you, but give it a try, don’t put all your eggs in one basket when it comes to treatment. Acupuncture is alternative, but it has been around for a very long time and there is a lot of evidence it does relieve pain and symptoms of various conditions. I have had acupuncture treatment before for back issues and it worked wonders.

• Range of Motion Exercises
• Strength Exercises
• Hydrotherapy

What are Range of Motion Exercises?

Range of motion exercises help maintain normal joint function by keeping normal joint flexibility and range. Keeping a joint in a bent position may temporarily help to relieve the discomfort of osteoarthritis  but holding it in that position can cause long term loss of joint mobility and hinder daily activities. Range of motion exercises are basically bending or stretching the joint to a point that is comfortable to go to. Comfort must be maintained. Range of motion are also a great form of warm up for other forms of exercise.

Why do Strength Exercises? 

Some people with arthritis really avoid doing any strength exercises as they fell its going to cause them great pain. However these have some really important benefits for arthritis sufferers. A strong joint is going to be a more stable one. Strong muscles surrounding a joint can act as protection, easing the load placed on the damage cartilage, helping to stop further damage. There are a few ways you can train these muscles. Isometric exercises are done without moving the joint. Basically you are contracting the muscles. these are good as introduction exercises for people who have significant pain and have deteriorated in strength. The other form is the one that springs to most people mind when they think of strength exercises. These are more effective in strengthening muscles, however can cause a little more pain if the arthritis is advanced. Exercises for the quadriceps are important for people with arthritis of the knee, this is the main muscle that will help stabilize and strengthen the joint.

What about Hydrotherapy? 

Hydrotherapy is basically doing exercises in water. this is a great way to do simple range of motion exercises. It is very low resistance, no stress on the joint, and you can safely move your joint through its range of motion relatively pain free. There are many exercises that can be performed in the pool. From range of motion to resistance training. Doing resistance exercises in water takes a lot of the load off and is a safer and less painful way to introduce your jonts to strength training!

Those shock-absorbing athletic shoes and clogs designed to protect and cushion the feet may be bad for arthritic knees.

When researchers examined the effects of different types of footwear on people with knee osteoarthritis, they found that going barefoot put less stress on knee joints than wearing foot-stabilizing walking shoes or clogs.

Flip-flops and a flexible walking shoe were also better choices for minimizing impact to the knees during normal walking.

The researchers determined this by assessing a standard measure of knee joint impact, known as knee load.

“Knee loads play an important role in the progression of knee osteoarthritis,” researcher Najia Shakoor, MD, of Rush Medical College, says in a news release. “Shoes have traditionally been engineered to provide foot comfort and little previous attention has been directed to the effects that shoes may have on loading of osteoarthritic knees.”

She notes that flat, flexible shoes were best for minimizing the impact on knee joints.

The findings were presented at the annual meeting of the American College of Rheumatology in Boston.

Impact of Shoes on Osteoarthritis

According to the Arthritis Foundation, 21 million Americans have osteoarthritis, a chronic disease in which the cartilage that serves as a shock absorber in the joints is broken down over time.

Also known as degenerative joint disease, osteoarthritis is a leading cause of disability among adults. Obesity, age, and joint overuse or injury are risk factors for the condition.

In a 2006 study with a similar design, Shakoor and colleagues reported that going barefoot put less stress on knee joints than wearing everyday walking shoes.

In their latest study, the researchers examined knee loads among 13 women and three men (average age 56 years) with knee osteoarthritis while they were barefoot, and then while they wore a popular brand of clogs, a foot-stabilizing walking shoe, a flat, flexible walking shoe, and flip-flops.

Compared to walking barefoot, the clogs and foot-stabilizing walking shoes were associated with significantly higher knee loading.

“These results highlight the importance of re-evaluating the design of modern day shoes in terms of their effects on knee loads and knee osteoarthritis,” the researchers write.

More Study Needed

Rheumatologist Dennis Boulware, MD, says he was surprised by the finding that shoes that are good for ailing feet may not be good for ailing knees.

“This does make me a bit concerned about advising patients about certain types of footwear,” he says. “I will certainly pay more attention to knee complaints when I put someone in [foot-stabilizing] shoes for foot problems.”

Boulware, who is chief of rheumatology for Kaiser Permanente, Honolulu, adds that larger studies are needed to confirm the findings.

“I am somewhat skeptical because of the small size of the study,” he says. “But this is clearly something we need to know more about.”