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Living in the "gourmet paradise" of Hong Kong, were you aware that enjoying delicacies everyday increases your risk of suffering from gout?
(Posted on 1 February 2008)
Gout, or as some call it "the Emperor's Disease", used to be the result of over-eating and drinking by high-class nobles. The condition is closely tied to personal dietary habits and with the improvement in modern living standards, has become very common. So, you and your loved ones should take advance steps to protect yourselves against getting gout!
Source: Quality HealthCare Medical Services
- What are the causes of gout?
- Are there other complications with gout?
- When I woke up today, I found that my big toe was swollen and it was very painful. I thought I was suffered from bunion, but my brother said it should be gout. Which is true?
- My big toe has suddenly become swollen. Is this a symptom of gout?
- How can gout be treated?
- My blood pressure is high. Is this related to gout?
- Vitamin-Drug Interactions
What are the causes of gout?
Gout is caused by deposition of needle-like crystals of uric acid in the connective tissue and joint spaces, resulting in an acute inflammation.
Uric acid is a normal metabolic product in the turn around of our body tissues. It also comes from the breakdown of a group of chemicals in the diet known as purines. Organ meats, such as liver, brains, kidney, asparagus and mushrooms, dried peas and beans are rich sources of purines.
Normally, uric acid dissolves in the blood and passes through your kidneys into the urine. But when you take in too much purines from the diet, or when your body produces too much or excretes too little uric acid, the latter can crystallize in the joint and precipitate an attack of gout.
| Gout and Uric Acid |
|---|
| Gout is closely related to purine, a nitrogenous hereditary compound found in the human body. The substance can also be obtained from foods such as animal organs, shell fish, red meat, sardines and lobsters, etc. After ingestion, purine is converted into uric acid by the body's metobolism. If too much purine is ingested into our bodies, uric acidity will increase. Uric acid that is not be expelled by the body may be crystalized at joints and cause gout. It is considered excessive if uric acidity is higher than 7mg per 100 mg in male blood and 6mg per 100mg in females. Recent years have also seen a rise in the incidence of gout-causing hyperuricemia. |
My big toe has suddenly become swollen. Is this a symptom of gout?
If uncontrolled, people with gout can develop into a chronic form of arthritis. Uric acid crystals gather into nodules or masses can erode into joints and bones which cause chronic pain and deformities.
Uric acid can also crystallize in the urinary tract. Patients with gout have a 1000-fold increased incidence of renal stones. Uric acid stones can cause obstruction and irritation to the urinary tract, resulting in bleeding and inflammation as well as inviting bacterial infections. Uric acid can also deposit inside the kidneys, causing a condition known as urate nephropathy.
When I woke up today, I found that my big toe was swollen and it was very painful. I thought I was suffered from bunion, but my brother said it should be gout. Which is true?
When you found that the big toe was swollen and painful, either bunion and gout can be true, since both carry common painful conditions that can affect the big toe.
Unlike gout, a bunion seldom appears overnight. The swelling with bunion is localized at the base of the big toes and the small toes are often misaligned. Patients are often aware of this existing deformity, and there may be thick callus developing beneath the bunion.
On the other hand, an attack of gout is notoriously acute and exquisitely painful. The foot looks and feels normal before the attack. Unlike bunion, which is often bilateral, the first attack of gout seldom affects both big toes at the same time.
My big toe has suddenly become swollen. Is this a symptom of gout?
Have you ever suffered from sudden acute pain in the big toe? If so, prepare yourself for the chance that you are suffering from extremely painful gout!
Why does gout often start from the big toe? With a temperature of just 34°C, the big toe is 3°C colder than the rest of the body and is effectively the human system's "South Pole". Just as water turns to ice, when the uric acid comes into contact with freezing air, the low temperatures at the big toe are perfect for the crystallization of uric acid trapped in the body. Our body's white blood cells will attack these crystals, causing the big toe to become swollen and weak. In the middle of the night while we sleep, our bodies' anti-inflammatory excretion is at its lowest. This is compounded by the fact that carbon dioxide is accumulated in the body, causing even higher uric acid levels in the big toe. Ultimately then, one is more at risk of suffering gout in the middle of the night.
How can gout be treated?
Some said that gout comes and goes like wind. Patient suffers from sudden pain; recovers and then gout can return again at anytime, so it becomes so important to learn more about the treatment.
Acute gout is often treated with a class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs). A powerful preparation is needed, because an acute attack of gout is relentlessly painful. Sometimes an injection is necessary to relieve the misery.
Once the acute attack is over, your doctor may recommend other drugs to slow the rate at which your body produces uric acid, or to increase the excretion rate. This is necessary if dietary measures cannot reduce the frequency of attacks.
My blood pressure is high. Is this related to gout?
High blood pressure is closely related to gout, especially when the kidneys are affected. Many patients with gout are also obese, and are predisposed to diabetes, hypertension, high blood cholesterol and are at risk of coronary artery diseases. Some call this condition "Metabolic Syndrome". The best prevention method is having regular exercise and maintaining a healthy diet.
Vitamin-Drug Interactions
Vitamins supplements are widely available on the market and consumed by the public. However, when certain vitamins and drugs are taken together, one should keep an eye out for any interactions between them. Here are a few examples for reference:
1. Vitamin A
Patients who take Retinoids (vitamin A derivatives), such as Isotretinoin and Acitretin, should limit their daily consumption of vitamin A to avoid the accumulation of excess vitamin A in the body which could result in poisoning. The symptoms include nausea, emesis, dizziness and visual disturbances etc. For example, a patient taking lsotretinoin cannot consume more than 4,000 to 5,000 units of vitamin A per day.
2. Vitamin B6
Since vitamin B6 (Pyridoxine) can reduce the effect of Levodopa, patients should avoid taking Levodopa and vitamin B6 together. Instead, they should consider taking compound preparations like Levodopa + Carbidopa or Levodopa + Benserazide, as vitamin B6 does not affect such preparations' efficacy.
One report states that high doses of vitamin B6 (200mg/day) can lower the blood concentration of anti-epileptic drugs, Phenytoin and Phenobarbitone, which may reduce their efficacy. Although there is only one report showing such interactions, patients taking Phenytoin or Phenobarbitone are advised to seek Doctor's advice before taking vitamin B6, especially on high doses.
3. Vitamin E
One report stated that a patient taking warfarin together with high dose of vitamin E (800 units/day) suffered from the side effect of bleeding. Despite being an individual case, for safety reasons, patients taking warfarin are advised to consult their doctors before consuming vitamin E.
4. Vitamin K
Vitamin K reduces the antithrombotic effects of warfarin and may increase the chances of thrombosis, stroke and heart disease. Patients who take warfarin should take a consistent amount of vitamin K, and should not take vitamin K supplements without medical advice.
5. Folic Acid
Folic acid can be used by rheumatoid arthritis or psoriasis patients who take Methotrexate to alleviate the side effects of Methotrexate. However, there are reports which stated that folic acid reduces the effects of Methotrexate as a treatment for cancer. Various cases showed that folic acid has increased the side effects of anti-cancer drug 5-FU. Some reports stated daily intake of 5mg or more of folic acid lowered the blood concentration and may impair the effects of anti-epileptic drugs, Phenytoin, Phenobarbitone as well as Primidone.
Patients who take Methotrexate, 5-FU, Phenytoin, Phenobarbitone or Primidone, should seek medical advice before taking vitamin preparations which contain folic acid.
Source: Hong Kong and Drug Education Resources Centre, The Society of Hospital Pharmacists of Hong Kong
