Gout: Things you need to know

Gout is a common form of arthritis, which causes severe joint pain, swelling, and stiffness. It normally affects the big toe joint.

Gout attacks can happen rapidly and keep coming back over time, gradually destroying tissues in the inflammation area, which can be extremely painful. Gout risk factors include hypertension, cardiovascular and obesity.

It is the most common type of inflammatory arthritis in men and while it is more likely to affect men, after menopause, women are more vulnerable to it.

The Centers for Disease Control and Prevention (CDC) estimates that between 2007 and 2008, 8.3 million Americans suffered from gout.

Fast facts on gout

  • Gout is a form of arthritis caused by excess uric acid in the bloodstream.
  • The symptoms of gout are due to the formation of uric acid crystals in the joints and the body’s response to them.
  • Gout most classically affects the joint in the base of the big toe.
  • Gout attacks often occur without warning in the middle of the night.
  • Most gout cases are treated with specific medications.

Treatment

A parson with leg gout
Gout patients often have acute inflammation around their joints.

Most cases of gout are treated with medicine. Medication can be used to relieve gout attack symptoms, avoid future attacks and reduce the risk of gout complications such as kidney stones and tophi growth.

Medications widely used include non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids. These alleviate inflammation and pain in gout-affected areas, and are usually taken by mouth.

Medications may also be used either to minimize uric acid production (xanthine oxidase inhibitors such as allopurinol) or to enhance the ability of the kidney to extract uric acid (probenecid) from the body.

The acute gout attack should be at its worst between 12 and 24 hours after it starts out without medication. A individual should expect to recover without treatment within 1 to 2 weeks but severe pain can occur during this time.

Tests and diagnosis

Gout can be difficult to diagnose as the signs are close to those of other disorders when they do occur. Although the majority of people who develop gout have hyperuricemia, it may not be present during a flare. On top of that, gout does not occur in most people with hyperuricemia.

One medical examination that physicians can perform is the joint fluid check, in which fluid is removed with a needle from the affected joint. Then, the fluid is analyzed to see if there are any urate crystals.

Given that joint infections may also cause gout to occur with similar symptoms, a doctor can look for bacteria when performing a joint fluid test to rule on a bacterial cause. The fluid can need to be sent to a laboratory, where analysis will take several days.

Doctors may also do a blood test to determine levels of uric acid in the blood, but people with high levels of uric acid may not necessarily experience gout, as stated. Similarly, some people can experience gout symptoms without having elevated uric acid levels in the blood.

Using ultrasonic scans, doctors can eventually check for urate crystals around joints or inside a tophus. X-rays are unable to diagnose gout but they may be used to rule out other causes.

Types

Gout develops through multiple phases and these are often referred to as specific forms of gout.

Asymptomatic hyperuricemia

A person may have elevated levels of uric acid with no visible symptoms. Treatment is not needed at this point, though urate crystals that deposit in tissue and cause minor damage.

People with asymptomatic hyperuricemia can be recommended to take action to resolve any potential causes that lead to the build-up of uric acid.

Acute gout

This stage occurs when the unexpectedly deposited urate crystals cause acute inflammation and severe pain. This sudden attack is called a “flare” and normally will subside within 3 to 10 days. Stressful activities, alcohol and narcotics, as well as the cold weather, may often cause flares.

Interval or intercritical gout

This stage is the time in between the acute gout attacks. Subsequent flares may not occur for months or years while they can last longer and occur more often if not handled over time. More urate crystals are introduced into tissue during this time.

Chronic tophaceous gout

The most painful form of gout is the Recurrent tophaceous gout. Permanent damage at the joints and kidneys may have occurred. The patient may suffer from chronic arthritis, and develop tophi, large lumps of urate crystals, in cooler body areas such as the finger joints.

It takes a long time to hit the stage of chronic tophaceous gout without treatment-around 10 years. A patient receiving adequate care is extremely unlikely to progress to this level.

Pseudogout

Pseudogout is one disease that’s easily mistaken with gout. Pseudogout symptoms are somewhat similar to gout symptoms while thr flare-ups are usually less severe.

The main difference between gout and pseudogout is that rather than urate crystals, the joints are irritated by calcium pyrophosphate crystals. Pseudogout needs a particular kind of gout treatment.

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Causes

Gout is initially caused by an excess of uric acid, or hyperuricemia in the blood. Uric acid is formed in the body during purine breakdown-chemical compounds contained in large concentrations in some foods such as beef, poultry and seafood.

Uric acid is usually dissolved in the blood, and excreted by the kidneys from the body in urine. If the uric acid is too strong, or not e

Risk factors

There are a number of factors that can increase the risk of hyperuricemia, and hence gout:

Age and gender: men produce more uric acid than women, although women’s uric acid levels exceed men’s after menopause rates.

Genetics: A family history of gout raises the risk of developing a disease.

Lifestyle choices: Drinking alcohol interferes with eliminating uric acid from the body. Eating a diet rich in purine often increases the amount of uric acid in your body.

Lead exposure: Some cases of gout have been related to chronic lead exposure.

Medications: Some medicines can increase uric acid levels in the body; these include some diuretics and salicylate-containing drugs.

Weight: being overweight raises the risk of gout, as there is more body tissue turnover, which means more uric acid production as a metabolic waste product. Higher body fat levels also increase systemic inflammation levels, as fat cells produce pro-inflammatory cytokines.

Recent trauma or surgery : Increases risk.

Other health issues: Renal insufficiency and other kidney disorders can affect the ability of the body to efficiently eliminate waste products, leading to elevated levels of uric acid. Many gout-related disorders include the high blood pressure and diabetes.

Symptoms

Gout usually unexpectedly becomes symptomatic without warning, sometimes in midnight.

The key signs are severe joint pain that causes swelling, inflammation and redness to subside.

Gout mostly affects the big toe’s broad joint but can also affect forefoot, ankles, knees, elbows, wrists and fingers.

The pain can be unbearable. A veteran who visited Birmingham hospital, AL said:

“I’ve been shot, beat up, stabbed, and thrown out of a helicopter, but none of that compared to the gout.”

Complications

In some cases, gout can develop into more serious conditions, such as:

  • Kidney stones: If urate crystals collect in the urinary tract, they can become kidney stones.
  • Recurrent gout: Some people only ever have one flare up; others may have regular recurrences, causing gradual damage to the joints and surrounding tissue.

Prevention tips

There are several lifestyle and nutritional recommendations which can be attempted to defend against flares or avoid gout from first occurring:

  • maintain a high fluid intake of around 2 to 4 liters a day
  • avoid alcohol
  • maintain a healthy body weight

Home remedies

Those with gout can manage flare-ups by moderating their diet. A healthy diet can help to relieve symptoms.

To insure that the levels of uric acid in the blood do not get too high, decreasing foods which are rich in purines is fair to try. Here’s a list of high-purine foods to protect against:

  • anchovies
  • asparagus
  • beef kidneys
  • brains
  • dried beans and peas
  • game meats
  • gravy
  • herring
  • liver
  • mackerel
  • mushrooms
  • sardines
  • scallops
  • sweetbreads

Although decreasing or avoiding such foods is acceptable, a high purine-rich diet has been shown not to increase the risk of gout, or worsen symptoms in research studies.

Asparagus, beans, several other plant-based foods, and mushrooms are also sources of purines, but evidence shows that these do not cause gout attacks and do not affect levels of uric acid.

Various epidemiological studies have shown that purine-rich vegetables, whole grains, nuts and legumes, and less sugar fruits, coffee, and vitamin C add to lower levels of uric acid in the blood, but do not reduce the risk of gout. Red meat, beverages containing fructose, and alcohol can add to the risk.

A good description and understanding of the role of uric acid in gout has been made. Gout is a very controllable type of arthritis, as a result of this and the wide availability of appropriate medications.

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