Gouty Arthritis

Introduction

Arthritis gout attack on bone joints

Gout is a painful inflammatory condition that can affect a variety of joints and cause significant distress. It can also be associated with a number of co-morbidities. It is characterized by sudden, severe attacks of joint pain with redness, warmth, and swelling in the affected area. Usually, it attacks only one joint at a time and most commonly affects joints of the big toe.

According to research published in the Journal of Trends of Urology and Men’s Health, Gouty arthritis most commonly affects adult men above 50 years of age. The incidence of the condition has increased by more than double in the last two decades. The researchers mention that Gout can be triggered due to following factors:

  • Rampant use of diuretics
  • Increased prevalence of hypertension
  • Frequent use of Aspirin
  • Obesity and metabolic syndrome
  • Excessive alcohol consumption
  • Chronic renal disease
  • The Incidence of the condition in India is not yet clear. But, according to a study, conducted in Vellor, it is discovered that about 15.8% of the patients are below the age of 30 years, and urban population is more affected than the rural population. The researchers also said that the reason for having the problem of Gout before the expected age (50 years) is, the increased prevalence of metabolic syndrome in the early age. Many studies also proved that it can also be triggered by the high uric acid level in the blood. Gout is commonly known as the “disease of kings” or “rich man’s disease” because often a protein rich diet in combination with Uric Acid metabolism disorder can cause this painful inflammatory condition.

    Some of the Facts of Gout:

  • Even though, it is often considered a preferential male disease, but it can also be seen in women, in the post-menopausal period.
  • It is more common in the countries of higher standards of living where diet plays a trigger factor in the development of the disease.
  • It affects about 1% of the population globally.
  • Pain and joint swelling of a gout attack are mainly due to uric acid crystals accumulation in the joints which leads to inflammation (pain). The body normally forms a uric acid when breaking down cells and proteins and releases that into the bloodstream.
  • Uric acid usually remains dissolved in the blood and ends up being flushed by the kidneys. If there is excess uric acid in the blood, called hyperuricemia, or if the kidneys cannot get rid of it quickly enough, crystals of uric acid begin to form and get collected in the joints and even in kidneys, skin, and other soft tissues. In severe cases, deposits of uric acid are so large that they can extend to the skin and beyond.
  • You may need blood tests and x-rays to diagnose the type of arthritis or gout. A sample of liquid (aspirate) can be taken from the joint to detect infection and gout crystals.
  • Treatment

    There are two key concepts essential for the treatment of gout.

  • First, it is critical to stop the acute inflammation (pain) of joints affected by gouty arthritis.
  • Secondly, it is important to address the long-term management of the disease in order to prevent future attacks of gouty arthritis and reduce uric acid crystal deposits in the tissues.
  • Treatment of an acute attack of gouty arthritis involves measures and medications that reduce inflammation. Prevention of future occurrence of gout is as important as the treatment of acute arthritis.

    Doctors use various medications to treat an acute attack of gout such as:

  • Anti-inflammatory drugs (NSAIDs)
  • Corticosteroids such as prednisone
  • Colchicine (an anti-inflammatory drug), which works best when taken within the first 12 hours of an acute attack.
  • PHYSIOTHERAPY MANAGEMENT

    Physiotherapy can play an important role in the treatment or management of arthritis. It is certainly an important step to keep joints working. But it should be done under the guidance of the physiotherapist. Actually, in Gout, patients are benefitted with physiotherapy when they are recovering from the condition. Physiotherapy helps improve the blood flow without causing any harm to the patients. Specific exercise and massage therapies work great in reducing the symptoms of Gout.

    EXEXCISES

    Physioptherapry to keep Gout and other Arthritis at bay

    One of the best ways to prevent Uric acid excess formation and recurrence of gout is exercise. Apart from helping you to keep fit and maintain a healthy body weight, exercise also helps in increasing blood flow to the diseased joints.

    Stretching exercises

    Stretching increases flexibility in your body, and a physiotherapist can help you participate in certain moderate exercise, to reduce stiffness and increase the blood circulation. For example, pushups help relieve stress on the joints and reduce inflammation by its stretching effect. Pushups are done by bending, with a slight bend in the knees, and try to touch your toes. Some physical therapists also recommend exercises which help in regaining the range of motion like yoga, tai chi, and pilates.

    Endurance program

    A physical therapist will have to start resistance exercises to improve blood circulation, heart function and relieve symptoms of gout. Because gout often attacks the feet, it is important to participate in low-impact exercises that will not put any extra pressure on your lower extremities. Physical therapy that includes swimming or stationary cycling program are helpful low impact exercises. With the improvement of the condition, the intensity of such exercises can be gradually increased.

    Force program

    Force programs like strengthening exercises condition and tone your muscles, giving you healthy and strong joints. Physical therapy involves the use of light weights to perform simple leg exercises such as squats and lunges. These exercises promote circulation in the legs and feet and prevent joints from becoming inflamed.

    Hold a pair of dumbbells at your sides, and bend your knees, keeping your back straight. Stay in the position until your hamstrings are parallel with the floor and then stand slowly.

    Lunges are initiated in the same way, but instead of bending step forward. While the upper body stays upright, tilt your front foot forward until the back knee is just off the ground. Take a step back and repeat with the other leg. A physical therapist will recommend appropriate weights and repetitions and ensure that you are doing the exercises correctly.

    High intensity exercises for Gout that don't impact lower body

    Water aerobics

    Exercising in water can help gout in several ways. First, the natural resistance that water creates helps amplify your workout without increasing the pressure on the joints. Secondly, the buoyancy of water can help reduce stress on your joints.

    Arthritis (Gout) exercises in swimming pool.

    Cardio exercise

    Cardiovascular or aerobic exercise increases the heart rate and promote a greater flow of oxygen to the body. It also helps burn calories, to promote weight loss.

    Because gout often attacks large areas of the toe and foot, talk to your doctor before engaging in aerobic exercise. High-impact aerobics and other activities can aggravate your symptoms. Low-impact exercises such as swimming may be best for your particular case.

    Physiotherapy cardio for Gout

    Prevention of acute gout involves maintaining

  • Adequate fluid intake
  • Dietary changes
  • Weight reduction
  • Reduction in the consumption of alcohol and drugs to lower the level of uric acid in the blood (reduce hyperuricemia).
  • Maintaining adequate fluid intake helps prevent acute gout attacks. Adequate fluid intake also decreases the risk of kidney stone formation in patients with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism to cause hyperuricemia. Therefore, alcohol has two main effects that degrade the excretion of uric acid from kidneys and cause dehydration, which can then contribute to the precipitation of uric acid crystals in the joints.