Gout is a type of painful arthritis caused by hyperuricemia or high levels of uric acid in the blood. It usually affects the big toe, but can occur in any joint including ankles, knees, elbows, wrists, and fingers.
Quick Facts
- Gout is one of the causes of inflammatory arthritis in the United States.
- This is a chronic condition.
- Laboratory results show a high level of uric acid in the blood also called hyperuricemia.
- (MSU) Monosodium urate monohydrate crystals are found deposited in the tissues.
- The patient can feel sudden severe attacks of pain, swelling, and redness.
- There’s tenderness that usually affects the big toe.
- This condition can be managed through diet by avoiding high purine food such as red meat.
Signs and Symptoms
- Occurs often at night.
- Intense joint pain: Severe pain is felt within 4 to 12 hours after the attack.
- Lingering discomfort: Joint discomfort may last for a few days or a few weeks. The next attacks tend to get longer than before.
- Inflammation and redness on affected joints.
Untreated gout: Tophi becomes swollen and tender during gout attacks. It is a deposit of urate crystals. These develop in areas of your fingers, hands, feet, elbows, or Achilles tendons. Also, along the backs of your ankles in the form of nodules.
Risk factors
- Diet: Consumption of foods and beverages that increase uric acid levels (e.g., red meat, shellfish, drinks sweetened with fruit sugar (fructose), alcohol like beer, etc.).
- Weight: Our body produces more uric acid when we are obese or overweight
- Medical conditions such as:
-
- Hypertension
- Diabetes
- Obesity
- Metabolic syndrome
- Heart disease
- Kidney diseases
- Medications that increase uric acid in the blood such as:
- Low-dose aspirin
- Including thiazide diuretics
- Angiotensin-converting enzyme (ACE) inhibitors
- Beta-blockers
- Anti-rejection drugs: These are prescribed for people who have undergone an organ transplant.
- Family history of gout.
- Age and sex: Gout more often develops in men. It occurs between ages 30 and 50. Women usually have lower uric acid levels, until the end of menopause.
- Surgery or Trauma: these are triggering factors of a gout attack or flares. Vaccination can also trigger attacks.
Diagnosis
Doctors assess patients through physical examination. Laboratory tests are also needed in diagnosing gout, this includes the following:
- Joint fluid test: Fluid is drawn on the affected area using a needle. Then examined in the microscope for the presence of urates crystals.
- Blood test: is done to measure uric acid level in the blood. Yet it can give false results. For example, some patients may feel symptoms of gout but their lab results don’t show levels that are high.
- X-ray: imaging of joint to rule out other causes of joint inflammation.
- Ultrasound: is performed to see the presence of urate crystals on joints or in tophi.
- DECT: also known as dual-energy computerized tomography. This is done on the different angles of the joints to visualize urate crystals.
Treatment
Gout is best treated when diagnosed earlier. There are two types of medications that are given to address two different problems. One is through rest with icepack which can greatly help with managing gout flares, then medications such as NSAIDs to stop the pain.
NSAIDs are given to gout patients. Yet, this is contraindicated in patients taking colchicine.
Medications are given depending on the frequency and severity of the symptoms, also considering other health conditions that the patient is experiencing.
Nursing Interventions
- Assess patient’s history of gout.
- Nurses should check patient’s usual diet avoiding food such as lean meat.
- Educate patients about the benefits of a healthy lifestyle.
- Encourage patient to use stress manegement techniques to lower the level of stress.
- Check patient’s toes, hands, and knees. Take note if there are inflamed areas.
- Track patient’s laboratory test results for higher levels of urates.
- Assess patient’s verbal and non-verbal cues on pain.
- Administer medications as prescribed.
- Apply cold packs as long as it is indicated.
- Assisting with physical therapies such as whirlpool baths.
