Gout is a type of arthritis. It is the most common inflammatory arthritis found in the world. The treatment of gout is very simple and least complicated among all arthritis treatment. Despite this, most patients of gout neither receive adequate information nor take adequate treatment. The biggest reason for this is that many health professionals including doctors and most patients don’t understand gout completely.
Gout is often misunderstood by patients and even by many health professionals. Gout can be very simply explained by assuming uric acid is similar to matchsticks.
Dr Robert Wortmann in 1999, first described the ‘matches (or matchstick)’ analogy of gout. Analogy means a comparison between one thing and another for the purpose of explanation. This analogy made it very simple for patients to understand gout treatment options. However, it hasn’t been widely used for patient education, even by doctors. We are using this ‘matchstick’ analogy in a pictorial (infographic) form to explain patients about gout, its causes, and its treatment (see image below). The analogy is explained by assuming one simple thing, ‘uric acid is like matchstick’.
How to manage gout without miserable diet restrictions ? Click here to know
Watch the infographic below before reading further. The image itself completely explains gout.
Please take this very short quiz about gout at the end.
1. What is uric acid?
Uric acid is normally present in the body. We don’t know its exact functions. Some theories suggest that it probably helps to maintain normal blood pressure in the body.
2. Uric acid is like a match which can light a fire.
The body does have uric acid normally present in the body (below 7 milligrams/decilitre or 420 micromol/decilitre). These low ‘match sticks’ or uric acid remains in the blood and does not deposit in the organs. They also do not ignite any fire (or inflammation) while they are in the blood.
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3. Unhealthy lifestyle increases uric acid
Excess alcohol, junk food, lack of exercise, weight gain, uncontrolled diabetes etc all increase these match sticks (uric acid) in the blood.
4. Increased uric acid can deposit into organs
Once these match sticks (uric acid) remain increased for a long time, they ‘might’ start coming out of blood and depositing into organs.
5. Genetics influences uric acid deposition into organs
Not everyone with bad lifestyle and excess alcohol intake develops gout. Gout usually develops only in those who carry ‘gout genes’. These ‘gout genes’ both increase uric acid and cause it to deposit into organs.
Still, most times a gout patient can’t blame genes alone. Gout genes are more likely to cause gout if associated with poor dietary and exercise habits.
6. Matches (uric acid) start lighting a fire (inflammation)
Gout starts with repeated joint pain attack episodes (usually foot first). Later, if not treated adequately, it starts causing inflammation and damage to multiple joints and other organs.
Gout develops when uric acid deposited into organs start causing inflammation. These lighting matches (inflammation) usually affects joint first, this causes gout attacks. That is why gout first starts with extremely painful joint episodes. But later, it affects other major organs like heart and kidneys. If left untreated these causes more inflammation and damage to organs.
If you understand this matches analogy, it is now very easy to understand how various gout treatments work.
(Don’t forget to take our gout survey and quiz at the end)
7. How do you treat gout ?
Gout can be easily treated by preventing uric acid deposition and inflammation (prevent matches depositing and lighting fire).
8. Eating right and exercising: Prevents matches from accumulating
This prevents from uric acid to increase in the blood. But this alone might not be enough, as gout patients might have genetic tendency for increased uric acid and deposition.
Can I have dairy and dals (or lentils) in gout ? Yes, click here to know more.
9. Gout attack treatment: Douse or extinguish the fire
Drugs like Steroids (Prednisolone, Omnacortil, etc), Anti-inflammatories (NSAIDS or painkillers – eg. Ibuprofen, Naproxen, etc.) or Colchicine (Colcrys, goutnil, etc.) work by immediately silencing the inflammation.
10. Colchicine given daily prevents gout attacks: Damp the matches, prevent them lighting up
Uric acid in organs will keep on lighting up if your uric acid remains above 6mg/dl (0r 350 umol/l). Colchicine can be given in low doses daily till there is a chance of gout attack. We can stop colchicine once uric acid remains below 6 continuously.
11. Allopurinol and febuxostat decrease uric acid: removes the matches & ‘Reach for six’
Usually, gout patients will have to take either allopurinol or febuxostat life long to keep uric acid below 6. Diet alone is not sufficient in gout patients because the risk is partially genetic.
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Author: Dr Nilesh Nolkha, Rheumatologist
Dr Nilesh Nolkha is a young and dynamic rheumatologist who keeps patients interests at forefront of everything he does.