What is Gout? Gout Stages, Causes, Symptoms, Diagnosis and Treatments
What is Gout?
- Gout is a form of arthritis in which a chemical called Uric Acid, a waste product made in the body, builds up in the joints and the kidneys, where it can form stones. Usually this disease will show itself as a sudden pain, redness and swelling at the base of one of the big toes. It can start in any joint but it is excruciatingly painful.
- Gout is caused by deposits of Uric Acid in connective tissue, often in joints of the feet and ankles, and can lead to inflammatory arthritis. Symptoms include swelling, redness, stiffness and severe pain. Although attacks of gout can subside in a few days, repeated attacks can cause permanent joint damage and the disease frequently results in substantial disability.
Foods rich in purines, like red meat, have been associated with an increased risk of gout. Purine can lead to high levels of uric acid, which can build up in the joints and crystallize, causing an attack.
What is uric acid?
Uric acid is naturally present in small amounts in the body. It is a waste product that results from the body's normal process of cells dying and releasing purines, as well as the body absorbing purines contained in certain foods. Uric acid is normally dissolved in the blood and passes through the kidneys into the urine. When too much uric acid is produced, or the kidneys are unable to eliminate an adequate amount of uric acid, it may lead to a condition known as hyperuricemia. Hyperuricemia is a precursor to gout, but it is important to note that hyperuricemia does not always result in developing gout.
Causes of Gout:
As a result of high levels of uric acid in the blood, needle-like urate crystals gradually accumulate in the joints. Urate crystals may be present in the joint for a long time without causing symptoms. Infection, injury to the joint, surgery, drinking too much, or eating the wrong kinds of foods may suddenly bring on the symptoms, which include pain, tenderness, redness, warmth, and swelling of the joint. In many cases, the gout attack begins in the middle of the night. The pain is often so excruciating that the sufferer cannot bear weight on the joint or tolerate the pressure of bedcovers. The inflamed skin over the joint may be red, shiny, and dry, and the inflammation may be accompanied by a mild fever. These symptoms may go away in about a week and disappear for months or years at a time. However, over the course of time, attacks of gout recur more and more frequently, last longer, and affect more joints. Eventually, stone-like deposits known as tophi may build up in the joints, ligaments, and tendons, leading to permanent joint deformity and decreased motion. (In addition to causing the tophi associated with gout, hyperuricemia can also cause kidney stones, also called renal calculi or uroliths.)
Gout and Diet:
The ideal diet for gout should consist mainly of complex carbohydrates such as whole grains, fruits, and vegetable. Anything low in purines . Protein should only comprise about fifteen percent of the diet of anyone with gout, and no more than ten percent of the total caloric intake should come from animal fats. In the end, the foods that predispose a person to develop gout are the same as emerge as risk factors for cardiovascular disease.
Foods to Avoid:
Red meat increases your chances of developing gout by forty percent. Seafood is even worse, with a fifty percent increase in incidence rates. It is best to eat these meats sparingly. If you choose to eat them, eat them infrequently and make sure you’re only eating small portions.
Alcohol has also been linked to gout. Alcohol can quickly raise uric acid levels in the blood and set off an attack of gout. It is best to avoid alcohol entirely. If you do have alcohol, make sure to drink plenty of water with it. Water helps flush excess uric acid out of your system, and it is a good idea to drink plenty of water if you have gout, even if you don’t drink alcohol.
As the joint pain is sudden and there is Redness and swelling, it is vital to ensure that it is not an infected joint, where symptoms may be very similar. Blood tests should be taken as soon as possible and if it is gout these will reveal a high level of uric acid in the blood. If there is fluid in the joint, it may be withdrawn and sent to the laboratory for analysis. In the case of gout, crystals of uric acid maybe seen in the fluid. In suspected cases of infection the laboratory will look for bacteria. If it is the first attack the joint will usually be X-rayed.
Symptoms of Gout:
The first symptom of gouty arthritis is typically the sudden onset of a hot, red, swollen joint. The most common joint involved is at the base of the big toe, but almost any joint can be involved. In some people, the acute pain is so intense that even a bed sheet on the toe causes severe pain. Acute gouty arthritis at the base of the big toe is referred to as podagra.
Even without treatment, the first attacks stop spontaneously after one to two weeks. While the pain and swelling completely go away, gouty arthritis almost always returns in the same joint or in another joint. With time, attacks of gouty arthritis can occur more frequently and may last longer. While the first attacks usually involve only one or two joints, multiple joints can be involved simultaneously over time. Kidney stones are more frequent in patients with gout.
Uric acid crystals can form outside joints. Collections of these crystals, known as tophi, can be found in the earlobe, elbow, and Achilles tendon (back of the ankle). Typically, these tophi are not painful but can be a valuable clue for the diagnosis as the crystals that form them can be removed with a small needle for microscopic examination.
Complications of gout:
It's uncommon for gout to cause any further problems but you may get:
- gout spreading to other joints.
- inflamed tophi, which can cause more damage to joints.
- formation of kidney stones if urate crystals collect in your urinary tract.
- Damage to the kidneys if crystals collect in your kidney tissue.
Diagnosis of Gout:
Usually physicians can diagnose gout based on the physical examination and medical history (the patient's description of symptoms and other information). Doctors can also administer a test that measures the level of uric acid in the blood. While normal uric acid levels don't necessarily rule out gout and high levels don't confirm it, the presence of hyperuricemia increases the likelihood of gout. The development of a tophus can confirm the diagnosis of gout. The most definitive way to diagnose gout is to take a sample of fluid from the joint and test it for urate crystals.A physical examination of the joints shows acute arthritis.
Gout Diagnosis tests:
- Synovial fluid analysis shows uric acid crystals.
- Uric acid (blood test).
- Joint X-rays.
Gout Treatment :
Treatment of Gout:
There are a number of steps you can take to reduce the pain and swelling of the gout attack.
- Raise and rest your limb - for example you shouldn't do vigorous physical exercise. Sometimes a splint is used to immobilise the joint.
- Keep your joint cool and don't cover it. Apply ice or a bag of frozen peas wrapped in a towel to your joint for about 20 minutes to help reduce swelling. You shouldn't apply ice directly to your skin as it can damage your skin. If you need to repeat this, let the affected part return to normal temperature first.
There are also medicines that your GP can prescribe to help ease the pain and swelling of acute attacks of gout. These can also prevent further attacks and complications. You should start treatment as soon as possible and keep taking the medicine for a couple of days after you feel better.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen (eg Arthroxen) may relieve pain and inflammation. If you have a heart condition, high blood pressure, kidney disease, lung disease or if you are over 65, these drugs may be harmful so you should talk to your GP about taking them.
- If NSAIDs aren't suitable for you, colchicine is an alternative. It works by reducing the build-up of urate. But many people who take it have side-effects such as feeling sick, vomiting and/or diarrhoea.
- Steroid tablets are occasionally prescribed if you can't take NSAIDs or colchicines.
- Steroid injections are sometimes used for large joints (such as the knee).
The drugs given to relieve an acute attack have little effect on urate levels in the blood. They can do little to prevent further attacks, or stop urate being laid down in the joints. Should your attacks become more frequent, or if blood tests show you are accumulating too much urate, your doctor may decide to prescribe one of the drugs that reduce the quantity of urate in the blood. These have to be taken every day, whether you have an attack or not,
as a preventive measure.
The aim of preventive treatment is to keep urate levels controlled. Reducing urate levels means that attacks of gout are avoided because urate crystals are no longer deposited in the joints and other parts of the body, where they may do damage.
There are now several drugs which will do this satisfactorily, but it must be appreciated that you may have to persist with the daily treatment for the rest of your life. Should you stop, urate will begin to accumulate again. The tablets are therefore prescribed to be taken regularly. Taken consistently over a period, the treatment ensures that the level of urate in your blood stays normal. However, don’t expect to notice anything happen immediately.
The most common of these tablets is allopurinol. This reduces the amount of urate made by the body. It is remarkably safe even when taken for years – the only sideeffect that occurs at all frequently is a rash, which disappears when the tablets are stopped.
There are other types of drug used to control urate levels. These flush out urate through the kidneys.
Sometimes acute attacks of gout may actually become more common when these drugs are started, so it may be necessary to take colchicine or an NSAID as well.Whichever drug proves right for you, drinking plenty of water will help to get rid of urate through the kidneys. Depending on the amount of urate you have it can take a long time (perhaps 2 years) to fully clear your body of urate crystals.
- Preventive treatment is a life-long treatment.
- Drink plenty of fluids.
- Treat any acute attacks in the usual way.
Questions and Answers about Goat
What is secondary gout?
This is gout that is predominantly due to a well-defined underlying cause. Diuretics (water tablets) have already been mentioned; other causes include certain rare blood diseases that raise the level of urate. Low-grade lead poisoning seen in plumbers and painters during the nineteenth century was once a cause of secondary gout. Usually, however, it is impossible to identify such causes, and the condition is then referred to as ‘primary’ gout.
Will gout go away on its own?
While the symptoms of a gout attack will generally go away within three to 10 days, an attack signals a person has gout. Some people may only experience a few attacks in their lifetime. However, if left untreated there is the possibility that repeated attacks could lead to the formation of tophi, joint deformity and potential crippling.
How can you prevent gout attacks?
If you are at risk for developing gout, start by asking your physician to monitor your uric acid level. They can order a simple blood test to do so.
Consider a diet low in purine-rich foods. Drink plenty of water and avoid or limit alcohol. Review all prescription and nonprescription medications with your physician to see if any of your medications that may increase your risk for hyperuricemia can be adjusted.
Always check with your physician to determine the best treatment option.
Can gout cause serious joint disease?
Occasionally. This can happen if the condition is left untreated. At first the attacks are acute, and the joint returns to its normal state afterwards, but eventually the deposits of urate can cause severe deformity and disability. Fortunately this is preventable with proper treatment, as described earlier.
What Is Uric Acid?
Uric acid is a substance that results from the breakdown of purines. A normal part of all human tissue, purines are found in many foods. Normally, uric acid is dissolved in the blood and passed through the kidneys into the urine, where it is eliminated.
If there is an increase in the production of uric acid or if the kidneys do not eliminate enough uric acid from the body, levels of it build up in the blood (a condition called hyperuricemia). Hyperuricemia also may result when a person eats too many high-purine foods, such as liver, dried beans and peas, anchovies, and gravies. Hyperuricemia is not a disease, and by itself it is not dangerous. However, if excess uric acid crystals form as a result of hyperuricemia, gout can develop. The crystals form and accumulate in the joint, causing inflammation.
What Research Is Being Conducted To Help People With Gout?
Scientists are studying which NSAIDs are the most effective gout treatments, and they are analyzing new compounds to develop safe, effective medicines to lower the level of uric acid in the blood and to treat symptoms. They also are studying the structure of the enzymes that break down purines in the body to achieve a better understanding of the enzyme defects that can cause gout.
Scientists are studying the effect of crystal deposits on cartilage cells for clues to treatment. They also are looking at the role of calcium deposits in pseudogout in the hope of developing new treatments. The role genetics and environmental factors play in hyperuricemia also is being investigated.
Who Is Likely To Develop Gout?
Gout occurs in approximately 840 out of every 100,000 people. It is rare in children and young adults. Adult men, particularly those between the ages of 40 and 50, are more likely to develop gout than women, who rarely develop the disorder before menopause. People who have had an organ transplant are more susceptible to gout.
How Is Gout Diagnosed?
Gout may be difficult for doctors to diagnose because the symptoms may be vague and often mimic other conditions. Although most people with gout have hyperuricemia at some time during the course of their disease, it may not be present during an acute attack. In addition, hyperuricemia alone does not mean that a person has gout. In fact, most people with hyperuricemia do not develop the disease.
To confirm a diagnosis of gout, doctors typically test the fluid in the joint, called synovial fluid, by using a needle to draw a sample of fluid from a person’s inflamed joint. The doctor places some of the fluid on a slide and looks for monosodium urate crystals under a microscope. If the person has gout, the doctor will almost always see crystals. Their absence, however, does not completely rule out the diagnosis. Doctors may also find it helpful to examine joint or tophi deposits to diagnose gout. A doctor who suspects a joint infection may check for the presence of bacteria.
How is gout treated?
The aim of treatment is to minimize the formation of uric acid crystals. A high liquid intake that increases daily urine output is usually recommended. An acute attack of gout is usually treated with nonsteroidal anti-inflammatory drugs, such as indomethecine or naproxen, or the corticosteroid prednisone.
Do women get gout?
Rarely. The disease is very occasionally found in older women, particularly if they are taking diuretics (water tablets which are used in the treatment of high blood pressure or heart disease). This is because these drugs can cause the body to retain urate. Gout in young women is extremely rare and needs special investigation.
Is gout a common condition?
out has the distinction of being one of the most frequently recorded medical illnesses throughout history, as far back as 5 B.C. More than two million people in the United States live with the condition today. Gout also is the most common form of arthritis in men over 40.