Chronic gout is caused by a buildup of uric acid crystals in the joints, leading to pain and inflammation. Purines, found in certain foods, can contribute to excess uric acid. Treatment includes rest, anti-inflammatory drugs, and long-term management of uric acid levels through medication and diet.
Chronic gout is a recurring form of arthritis caused by a buildup of uric acid crystals in the fluid around the joints. These crystals can irritate the cartilage and cause inflammation in the joint. Patients suffering from chronic gout may initially experience sharp attacks of pain, swelling and limitation of movement. After several untreated acute episodes of gout, the condition can become chronic.
Uric acid is a metabolic breakdown product of purines, the nitrogen-containing bases found in the nucleic acids DNA and RNA. Upon cell death, purines are released from cell nuclei and uric acid is formed. Excess purine can be present after DNA or RNA synthesis and this purine is also broken down into uric acid. Molecules such as adenosine-5′-triphosphate (ATP) and guanosine-5′-triphosphate (GTP) that carry energy to cells also contain purines.
Purines are also ingested as part of the diet. They are found in high concentrations in foods of animal origin such as liver, brain, herring and sardines. Some plant-based foods, such as oatmeal and mushrooms, also contain purines.
Patients suffering from chronic gout usually have several outbreaks of acute gout with each outbreak followed by a period of remission. As this condition progresses, the periods between episodes become shorter and shorter. Chronic gout can develop because the patient produces too much uric acid or because the patient is unable to excrete enough uric acid from the body.
Chronic gout symptoms can appear in any joint, but most commonly occur in the first joint of the big toe. Diagnosis is made by taking a patient history of symptoms and outbreaks. A blood test that can measure uric acid levels may be done. To confirm the diagnosis, fluid may also be extracted from the joint and examined for crystals under a microscope.
During a gout attack, the patient should rest the joint, drink fluids, and eat a diet rich in fruits and vegetables. Anti-inflammatory drugs can relieve pain during an outbreak. A drug called colchicine can help reduce inflammation by interfering with the ability of immune cells to ingest uric acid crystals.
Long-term treatment should focus on reducing blood uric acid levels and preventing any future gout attacks. The drug allopurinol may be prescribed because it inhibits the enzyme that converts purine to uric acid. Eating a diet high in fruits and vegetables and low in purines can help ease the symptoms of chronic gout.
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