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A gout is a form of arthritis that causes sudden, severe attacks of pain, tenderness, redness, warmth, and swelling (inflammation) in some joints.
It often affects one joint at a time but may affect a few or even many.
The large toe is most often affected, but gout can also affect other joints in the leg (knee, ankle, foot) and less often in the arms (hand, wrist, and elbow). The spine is rarely affected.
Sudden, intense joint pain, which often first occurs in the early morning hours
A swollen, tender joint that’s warm to the touch
Red or purple skin around the joint
Although diet and excessive drinking of alcohol can contribute to the development of gout, they are not the main cause of the disorder.
Gout results from abnormal deposits of sodium urate crystals around the joint cartilage and their later release into the joint fluid.
Urate crystals can also form in the kidney, causing kidney stones.
Sodium urate is formed from uric acid, a natural chemical in the body.
Uric acid comes from the natural breakdown of RNA and DNA (the genetic material in cells). Some foods contain large amounts of uric acid, especially red meats and internal organs (such as liver and kidneys), some shellfish, and anchovies.
Patients who eat more meat and fish (and less dairy) or drink more beer and liquor seem to be more prone to gout.
But changing these habits may only partially reduce the likelihood of stopping gout attacks once they have started.
Uric acid in low amounts remains dissolved in the blood, passes through the kidneys and gastrointestinal system, and leaves the body as waste.
Uric acid in high amounts (higher than 6.7 mg/dL) will settle out of the blood and deposit in joints and make a person more likely to develop gout.
The amount of uric acid in your blood can change depending on
How efficiently your kidney gets rid of the uric acid in the blood (the main cause of elevated levels)
Not everyone with high levels of uric acid will develop gout. The Kidney’s ability to rid the body of uric acid is partly determined by heredity.
Yet, just because someone in the family has gout does not mean everyone in that family will have the disorder.
Often, the effect of heredity is modified by the risk factors mentioned above that affect uric acid, as well as male sex and age. All of these factors increase the risk of gout.
Gout attacks can recur from time to time in the same or different joints.
The initial attack may last several days to two weeks unless it is treated.
Over time, gout attacks may occur more often, involve more joints, have more severe symptoms, and last longer. Repeated attacks can damage the joint.
Lumpy collections of uric acid called tophi can develop near joints, in the skin, or within bones.
Some people will only have a single attack. However, about 90 per cent of patients who have one gout attack will have at least a second attack, although it may not occur for several years after the initial attack. Others may have attacks every few weeks.
Men (usually over age 40) and women after menopause
People who are overweight
People who frequently drink alcohol
When gout affects women, it is usually after menopause, especially in women who are taking certain medicines.
Younger patients may be affected by gout if they have been taking certain medicines for long periods of time, frequently drink alcoholic beverages, or have certain genetic disorders.
Gout cannot be diagnosed simply from a blood test since many people have elevated blood uric acid levels but never develop gout. Rather, gout is diagnosed from the fluid withdrawn from an inflamed joint.
The fluid is observed under a microscope for sodium urate crystals.
Fluid is removed through a needle from the inflamed joint during a procedure called arthrocentesis.
Removing the fluid may reduce pressure within the joint and thereby reduce pain.
A lack of crystals does not necessarily rule out a diagnosis of gout. Occasionally, crystals may not be observed the first time but maybe seen if additional fluid is removed at another time during a subsequent attack.
Since gout can cause chronic joint pain and involve other joints, it is extremely important that an accurate diagnosis be made. Then, your doctor can prescribe the appropriate specific treatment.
How is gout treated?
There is no cure for gout, but it can be treated and controlled. Symptoms are often dramatically improved within 24 hours after treatment has begun.
Attacks can be prevented with appropriate therapy to lower the blood uric acid level.
The goals of treatment are to:
Relieve pain and inflammation
Prevent future gout attacks that could lead to permanent joint damage
The type of treatment prescribed will depend on several factors, including the person’s age, type of medicines he or she is taking, overall health, medical history, and severity of gout attacks.
Gout is mainly treated with medicine.
NSAIDs usually reduce inflammation and pain within hours.
Anti-inflammatory drugs will reduce the pain and swelling of attacks. They are usually continued until the gout attack completely resolves.
Corticosteroids may be prescribed for people who cannot take NSAIDs. Steroids also work by decreasing inflammation. Steroids can be injected into the affected joint or given as pills.
Colchicine is sometimes used in low doses for a long period of time to reduce the risk of recurrent attacks of gout.
If side effects from the therapy occur, treatment may be changed to a different medication. Your health care provider will discuss the potential side effects with you.
If you have kidney disease, heart failure, diabetes, ulcer disease or other chronic conditions, the choice of therapy to treat the gout is affected.
Drugs that lower the level of uric acid in the blood. (Examples are allopurinol, probenecid and febuxostat).
These drugs are recommended for patients who have had multiple attacks of gout or kidney stones due to uric acid.
The goal of treatment is to reduce the uric acid level to less than 6 mg/dL.
The goal of lowering the blood uric acid is to slowly dissolve joint deposits of sodium urate. Lowering the uric acid will not treat an acute attack but will, over time, prevent additional attacks from occurring. A sudden lowering of the uric acid level may cause an acute attack of gout.
To prevent acute attacks in people who are taking uric acid lowering drugs, colchicine or an NSAID is temporarily prescribed. If an attack occurs while taking a medication to lower the uric acid, this medicine should NOT be stopped; stopping and starting the uric acid lowering medication may cause additional attacks.
Not all patients will develop side effects from gout medications. How often any side effect occurs varies from patient to patient. The occurrence of side effects depends on the dose, type of medication, concurrent illnesses, or other medicines the patient may be taking.
If any rash or itching develops while taking allopurinol, the medicine should be stopped immediately, and your physician notified.
Dietary changes for most people do not play a major role in controlling their uric acid levels.
However, limiting certain foods, such as fructose-containing corn syrup, that cause increased production of uric acid and reducing alcohol intake is often helpful
RAJESH KUMAR AGGARWAL5 October 2023Dr. Himanshu Aggarwal is very humble and experience doctor in his field.Vinay Gupta4 October 2023Really an eminent doctor..His diagnosis helped me a lot, ..May God bless him...Ritik Singh.22 September 2023Dr. Himanshu Aggarwal (Rhemutologist)is good in nature. he gives enough time to patient to satisfaction, and clear all the quarries of the patient.Vishesh Singla22 September 2023I visited Dr himanshu aggarwal for my relative's arthritis nd within few weeks she start getting relief.. Thanks to himYogendra Singh13 September 2023डॉक्टर हिमांशु अग्रवाल जी मैक्स अस्पताल में जो हड्डी ज्वाइंट का इलाज करते हैं मेरा भी इलाज किया और मैं अपने को शत प्रतिशत ठीक महसूस करता हूं डाक्टर साहब जी को कोटि कोटि प्रणाम करता हूंJai Rawat29 August 2023Excellent Doctor, Great humanitarian Dr Himanshu Aggarwal listens very patiently & gives sufficient time to say his problem.He studies the patient and disease meticulously.He is very cheerful and gentle in his behavior.I think he is best rheumatologist in Dehi,Ghaziabad NCR.Hikmat Bahadur Aidei13 August 2023He is god for us.Ran Singh Chauhan10 August 2023First of Thankyou very very much Dr for given to valuable tratement to my disease ankylosing spondylitis.. I suffering from last five years ankylosing spondylitis and I started tratement to dr last six months before. After tratement my body pain or stiffness are ok and I sleep on bed easily.... .Yashas Bhatt27 July 2023Dr Himanshu is very humble, Knowledgable and understanding doctor. I have went to him for my mothers treatment. At first when my mother went for her check up we thought it's gonna take a lot of time for my mother to get better as she was unable to walk and was on wheel chair, but when she got consultation from him and he made us understand what's the cause of it and started my mothers treatment and within a few days my mother started getting better and now she is able to walk also. Excellent doctor for Arthritis related diseases.Saurabh Agrawal21 July 2023I met Dr Aggarwal with my mother in law on 12th Aug 2022 on Friday. Her age is 78 years and 4 months and she is suffering from Rheumatoid Arthritis, Ankylosing Spondylitis , Asthma and Diabeties. But we went to Dr Aggarwal for the treatment of RA and AS. Personality and Characteristics: Dr is very young, smart, dynamic, humble, polite and very down to earth. Listening : His listen, every single problem shared by me and my Mother in law. She gave ample amount of time and understand the history. Diagnosed: He had seen all the past 5 years reports, Prescriptions which we were carrying at least for 10-15 mins . He did not ask us to do all the tests again those my last Dr conducted just 15 days back. He considered all tests and reports. Treatment: He had given some injections initially with oral tabs and ask to come weekly then by monthly after wards once it is required. Initial first or second week the pain and swelling of my mother in law had declined like anything. My in law started moving with the help of stick before that she was not able to move from the bed. This is the first line of faith developed in my and in law mind . You dnt believe it now almost 1 year completed and my mother in law is walking without stick easily. Her medications are limited and orally only. I again insist you to meet the Dr Aggarwal if you are or near one or dear one suffering from joint pain. Thank you Dr Aggarwal!