What is gout?
Gout is a common form of arthritis that can cause sudden, severe attacks of pain, swelling, and redness in the joints, especially the joint at the base of the big toe.
Gout slowly damages the tissues in the region of its occurrence and can cause very painful symptoms. The symptoms of gout may come and go, but there are certain ways to deal with them and prevent flare-ups.
What are the symptoms of gout?
The signs and symptoms of gout always occur suddenly, often at night. They include:
- Severe joint pain. Gout commonly affects the large joint at the base of the big toe, but it can occur in any joint. Other joints that can be affected by gout include the ankles, knees, elbows, wrists, and fingers. The pain is likely to be most intense within the first 4 to 12 hours after it begins.
- Constant discomfort. After the severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to continue and affect more joints.
- Inflammation and redness. Affected joints become swollen, painful, warm, and red.
- Limited range of motion. When gout progresses to advanced stages, you may not be able to move your joints normally.
What is the cause of gout?
Gout is caused by the build-up of urate crystals in the joints, causing inflammation and severe pain associated with gout attacks. Urate crystals form when the level of uric acid in the blood is too high.
Your body produces uric acid by breaking down purine molecules – a naturally occurring substance in the blood.
Purine is found in many foods as well, such as meats and seafood. Some other foods may increase uric acid, such as alcoholic beverages and drinks rich in fruit sugar (fructose).
Normally, uric acid dissolves in the blood and is excreted in the urine from the kidneys. But sometimes your body produces too much of it or your kidneys eliminate only a small amount. It then accumulates as pointed crystals that collect in joints or around tissues, causing pain, inflammation and swelling.
What are the risk factors of gout?
You are more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the level of uric acid in your body include:
- Diet. Eating a diet rich in meat and seafood and drinking fluids sweetened with fructose and alcohol increases uric acid levels, which increases your risk of gout.
- Obesity. If you are overweight, your body produces more uric acid, and your kidneys struggle to eliminate it.
- Medical conditions. Certain diseases and conditions increase your risk of developing gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney disease.
- Family history of gout. If members of your family have had gout before, you are at greater risk of developing the disease.
- Age and gender. Men are more likely to have gout than women because women have lower levels of uric acid initially. After menopause, uric acid levels in women rise to converge the levels in men. Men are more likely to develop gout at a young age while women experience signs and symptoms after menopause.
What are the complications of gout?
- Recurrent gout. Some people may never experience gout signs and symptoms more than once. While others may suffer gout multiple times per year. Taking medications may help prevent gout attacks in people with recurrent gout. If the condition is left untreated, gout can erode and destroy the joint.
- Advanced gout. Left untreated, gout may lead to the formation of deposits of urate crystals under the skin in nodules called tophi. Tophi can develop in several places, such as in your fingers, hands, feet, elbows, or Achilles tendon, along the back of the ankles. Tophi is not usually painful, but it can become swollen and painful during gout attacks.
- Kidney stones. In people with gout, urate crystals may collect in the urinary tract, causing kidney stones. Taking medications can help reduce the risk of developing kidney stones.
How is gout diagnosed?
Tests to help diagnose gout may include:
- Joint fluid analysis. Your doctor may use a needle to draw fluid from your affected joint. Urate crystals (uric acid salt crystals) may appear when this liquid is examined under a microscope.
- Blood test. Your doctor may recommend a blood test to measure the uric acid and creatinine in your blood. However, the results of this blood test can be misleading. Some have high uric acid levels, but they never develop gout. Some people develop signs and symptoms of gout without having abnormal blood uric acid levels.
- X-ray imaging. X-ray imaging tests may help rule out other causes of arthritis.
- Ultrasound. A musculoskeletal ultrasound examination can detect urate crystals (uric acid salt crystals) in the joints.
How is gout treated?
Gout can lead to arthritis and cause permanent damage to your joint if left untreated. Medical treatment is the preferred option to treat gout. There are two types of medications, the first relieve the pain and reduce inflammation and the second prevent future gout attacks by reducing the levels of uric acid.
Relieving pain medications include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
Preventing gout attacks medications include:
- Xanthine oxidase inhibitors. These drugs limit the amount of uric acid that the body produces and eventually reduce the risk of gout attacks.
- Probenecid. This type of medication improves your kidneys’ ability to eliminate uric acid and lower the risk of gout attacks.