Secondary preventive measures are directed at reducing the
strain on affected joints by weight reduction, use of back braces, abdominal
support for sagging abdomen (to take strain off the back), neck braces, and
adequate rest. Pain-relieving medication and local heat applications are
useful. Steroid injections of affected joints may be used in some cases.
Usually these measures work very well. In cases not adequately helped by them,
the arthritis may cause distortion of joint structure and may necessitate such
tertiary measures as replacement of a joint by a metal pros- thesis or surgical
removal of restricting diseased tissue.
In some cases of DJD,
bony over- growths may cause pressure on nerves. When this happens in the neck
region -a common site for DJD-it may cause pain and weakness in the hands and
fingers. Surgical removal of the bony spurs is the only effective treatment.
Gout is a disease thought lightly of by all except those who suffer from it.
Books are replete with cartoons of obese aristocrats suffering from painful
gouty toe, and the implication is that "high living"-overindulgence
in food and drink and lack of gainful work-is responsible for the disease. In
reality, gout is an inherited ailment related to abnormal metabolism of certain
important compounds, called purines, in foods.
As a result of the abnormal metabolism, an in- creased level
of a purine breakdown product, uric acid, builds up in blood and body tissues.
When excess uric acid is deposited in joints it may lead to inflammatory
reaction by the joint tissues. This produces severe pain, swelling, and
stiffness. The joints usually affected are those of the lower extremities,
particularly the great toe, but any other joint in the body can be involved.
The arthritis of gout can be severe and disabling if untreated and may lead to
permanent deformity.
Also, changes leading to impairment of vital organs such as
the kidney may occur. Not everyone with gout develops the chief clinical
symptom of arthritis; by far the great majority of cases are without symptoms.
People in sedentary work are more likely than manual laborers to have clinical
gout.
The physician suspects gout particularly when a middle-aged man-goutyarthritis is predominantly a disease of men- complains of pain and swelling in
one or occasionally two joints which are extremely sensitive to the slightest
pressure. He will confirm the suspicion by a test which measures the amount of
uric acid in the blood. The outlook is for recurrent arthritic attacks
involving great pain and leading to joint deformity unless adequate treatment
is instituted, in which case the patient can be free of all symptoms of the
disease.
The physician will perform tests to evaluate the function of
the kidneys, because uric acid can cause kidney stones and in other ways can
damage the kidneys. Kidney failure is a dreaded complication of gout and
fortunately an uncommon one that can be prevented. The physician also will be
alert for high blood pressure and heart disease, since, for unknown reasons,
many people with gout also have these ailments. Finally, he may ask blood
relatives to have their uric acid levels checked, since gout is an inherited
disorder. Because it is well known that stress or injury to joints can
precipitate an attack of gouty arthritis, the obese patient will be advised to
reduce weight.
