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Is your child experiencing joint pain? Might be a symptom of Pediatric Gout

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Sugary foods now dominate supermarket shelves and racks, attracting the attention of adolescents. However, as a parent, you may limit your children’s intake of candies, ice cream, and processed snacks due to the variety of disorders they can cause, one of which is paediatric gout. 

Gout is a form of inflammatory arthritis that develops when crystals of excess uric acid accumulate in the joints. It causes pain, swelling, and stiffness in and around the joints. Gout in children and teenagers is referred to as paediatric gout. Paediatric gout is very rare and may occur due to an underlying condition. 

The joints in our body facilitate movements and help us in carrying out our daily activities. Any disorder in the joints can make it very difficult for us to function normally. Disorder that affects the joints is known as arthritis. There are many forms of arthritis, one such type is known as gout. Although gout is more common in adults, it can also affect children. 

What are the symptoms of paediatric gout?

Paediatric gout is most commonly seen in the hallux (big toe) but can also affect other joints in the body. Symptoms of gout can be seen in the affected joints and include:

  • Swelling
  • Stiffness
  • Severe Pain
  • Redness
  • Discomfort
  • Restricted movement of joints

child experiencing joint pain

What are the underlying causes of paediatric gout?

Gout occurs due to hyperuricemia, a condition where the uric acid exceeds its normal range in the blood. Compounds known as purines break down to form uric acid. Purines are found in certain foods like red meat, seafood, beans, etc. Normally, the body eliminates excess uric acid through urine. But in the case of hyperuricemia, either the body is producing too much uric acid or is unable to excrete it.

Some underlying medical conditions can cause high levels of uric acid, which then leads to gout. These include:

  • Lesch-Nyhan Syndrome
  • Congenital heart disease
  • Kidney disease
  • Metabolic disease
  • Down syndrome
  • Obesity

How is paediatric gout diagnosed?

To diagnose gout, a doctor will physically examine the joints, ask for a full medical history to check for underlying disorders if any, and ask about the symptoms the patient might be experiencing. To confirm their assumptions, further tests may be conducted. These include: 

Imaging Tests: Tests like X-rays and ultrasound scans may be done to check for damage in the joints.

Fine Needle Aspiration: The doctor might take a needle biopsy (taking a sample of tissue for laboratory analysis) from the injured joint to look for urate crystals under a microscope. This test aids in the identification of hyperuricemia.

Blood Tests: These tests are done to measure the levels of uric acid in the body. In adults, hyperuricemia occurs when the uric acid levels exceed 7 mg/dl. Uric acid levels in children may fluctuate as they get older. In some cases, it is possible to have hyperuricemia and not have gout.

How is paediatric gout treated?

  • Lifestyle factors:In children whose underlying cause of gout is obesity, lifestyle changes are advised by the doctor. Losing weight, a healthy diet, and regular exercise may benefit such individuals in treating paediatric gout. The doctor recommends reducing the intake of foods that are high in purines in children who are not obese but still have paediatric gout. The patient is asked to consult a nutritionist or dietician who may ask the patient to avoid foods like seafood, red meat, soda drinks containing fructose, etc.

  • Medications: In the case of paediatric gout with an underlying cause, some medications like allopurinol (xanthine oxidase inhibitors), rasburicase (uric acid oxidase), etc may be prescribed. These drugs help in preventing or treating hyperuricemia in children. NSAIDs and corticosteroids are also prescribed to relieve pain. It is advised to always consult a doctor before starting on any medications.

In addition to the above mentioned treatment approaches, the doctor may also suggest a few ways in which one can reduce the pain and swelling from a gout flare-up. These include:

  • Drinking plenty of fluids
  • Elevating the affected joint
  • Avoiding strenuous activities
  • Applying ice to the affected joint
  • Reducing stress

What are the risk factors of paediatric gout?

Certain risk factors can increase the chances of gout in an individual. Researchers claim paediatric gout to be related to the following conditions:

  • Leukaemia 
  • Kidney transplant
  • Down syndrome
  • Glycogen storage disease
  • Methylmalonic acidemia

It is very disturbing for children to deal with such disorders at such an early age. Delay in the treatment can cause severe and potentially crippling pain and may even lead to chronic arthritis. Therefore, it is important to get a diagnosis at the right time followed by an appropriate treatment plan for addressing the underlying cause, managing symptoms, and preventing complications.

About Author –

Dr. D. Srikanth ,

Sr. Consultant Pediatrician & Neonatologist

Sr. Consultant Pediatrics & Neonatology

Dr. D. Srikanth

MD (Pediatrics), PGPN (Boston, USA)
Sr. Consultant Pediatrician & Neonatologist

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