Gout

Gout is a type of inflammatory arthritis that usually affects people with high levels of uric acid in their blood, which leads to the formation of needle-shaped crystals in the joints. The body sees them as foreign and reacts by sending white cells to the problematic area, which inevitably causes inflammation. The symptoms, which include severe pain, swelling, redness and tenderness manifest suddenly and return in time harming the tissues in the respective area, especially in the bit toe. Because a large number of individuals develop this condition, it has become a major health concern. Gout is more frequently associated with men over 30 but women after menopause are also susceptible. Moreover, gout increases the possibility of metabolic and cardiovascular diseases. Fortunately, patients not only benefit from an adequate treatment, but they can also use preventive methods for reducing the chances of developing this type of arthritis. On the other hand, in the lack of medical attention, this condition can irremediably damage the joints, cause kidney issues and tophi. Consuming foods or drinks with high fructose and high levels of sugar, undergoing surgery or dehydration represents triggers for gout attacks.

 

Stages of Gout

Asymptomatic hyperuricemia is the stage before the first gout attack. The crystals start to form in the joints due to the high levels of acid uric in the blood, thus causing minor damage. However, the person does not experience symptoms so treatment is not necessary but becoming aware and making changes that might contribute to the formation of uric acid helps.

Acute gout: In this stage, the needle-like crystals in the joints provoke acute inflammation and unbearable pain, thus triggering the gout attack. The symptoms strike at night and worsen over the next hours. Most people are prone to a second attack within one or three years. Cold weather, stressing situations, alcohol and drugs are triggers for gout attacks. On the other hand, a small percentage of people never experience another attack throughout their life.

Interval gout represents the period between gout attacks when the person no longer feels the excruciating pain but the gout does not disappear and without a proper treatment, joints can suffer great damage due to the low-grade inflammation. This interval represents the ideal opportunity for battling the condition through medication and lifestyle adjustments in order to prevent possible attacks in the near or distant future.

Chronic gout is the final and the most harmful stage of gout, which occurs because of high uric acid levels in the blood remaining constant over several years. Permanent damage in the joints and kidney may lead to a loss of mobility. Nevertheless, the person with gout can easily prevent this dangerous stage with professional management and medical treatment.

 

Causes of Gout

The excess of blood uric acid generally leads to the appearance of gout and it comes from the person’s diet or the body simply produces it. The kidneys have the mission to maintain normal levels of uric acid by filtering it and eliminating it through urine. However, if the body fails to expel it or it produces too much uric acid in the first place, crystals begin to form in the joints as well as tendons causing intense inflammation. Even though gout can affect everyone, certain risk factors associated with gout significantly contribute to its appearance.

Genetics:  Apparently, gout runs in the family so genetics increases the possibility of developing this condition.

Medications: Certain types of medications can increase the levels of uric acid in the blood, thus resulting in the appearance of gout. They involve diuretics for treating high blood pressure and low-dose aspirin, niacin for high cholesterol, beta-blockers and some medications used for chemotherapy.

Medical conditions: If the person has underlying medical conditions, such as diabetes, obesity, high blood pressure, metabolic syndrome, kidney disease as well as osteoarthritis, the chances of developing gout escalate considerably.

Diet: Following the natural breakdown of purines, the body creates uric acid. The consumption of foods containing high levels of purines increases the risk of gout. These foods include seafood and red meat, more specifically, shellfish, oily fish, pork, beef and lamb. Alcoholic beverages also negatively influence the uric acid level in the blood. Beer and wine in large quantities are very harmful so moderate consumption meaning no more than two glasses a day is necessary. Researchers include sugary drink sin the same category.

 

Signs and Symptoms of Gout

The primary symptom of gout is sudden and excruciating pain in the joints, particularly in the big toe. Patients also experience tenderness and stiffness in the area. Other symptoms of gout refer to swelling in the affected joint, a warm feeling during touch along with red, shiny, peeling and itchy skin. Even slight pressure on the area can prove to be unbearable for the patient and he might encounter difficulties getting around. A gout attack can last up to several weeks in a row and it can affect more than one joint simultaneously. The ends of the limbs usually affected by gout include fingers, toes, wrists, ankles, elbows and knees.

The person with gout experiences characteristic symptoms at night, which last several days. Even though at the end, the affected area looks normal, the gout persists in the lack of a proper treatment. The symptoms develop fast, in just a few hours and happen more frequently. If the gout comes back, the attacks may occur within a few months or even years. The patient needs to seek medical care immediately if the pain in the joints is severe and does not show signs of lessening as well as having a high temperature. It may represent a sign of joint infection.

 

Signs and Symptoms of Gout

 

Complications of Gout

If left untreated, gout can lead to serious conditions, such as permanent joint damage, tophi and kidney stones.

  • Joint damage: If the person does not seek medical advice, she may experience prolonged gout attacks more frequently, thus increasing the chance of developing permanent damage to the joints. In certain severe cases, surgery represents the only resort doctors use in order to recover or even replace the affected joint, if necessary.
  • Tophi: This term refers to white or yellow lumps resulting from the crystals buildup in the joints. Although they do not cause pain, their formation alters the appearance of fingers or toes and patients encounter difficulties when performing simple and normal everyday tasks including getting dressed. Following their inflammation, the person with gout will notice a discharge of a toothpaste consistency. Tophi generally appear years after the first gout attack, but in a small percentage of people, they appear before having any experience in relation to gout attacks.  Medical treatment prevents the progression of tophi and it even shrinks them.
  • Kidney stones: Sometimes, a person with high blood levels of uric acid may develop kidney stones, which results in discomfort or even pain during urination. The person may also notice alterations in the flow of urine. Following this complication of gout, the doctor prescribes medications with the purpose to dissolve the kidney stones in the patient’s body.  Self-care is equally important when facing this problem.

 

Tests and Diagnosis for Gout

Because gout symptoms are similar to symptoms characteristic of other conditions, doctors know that establishing an accurate diagnosis can be tricky. For this reason, they first acquire details concerning medical history and symptoms, carefully and closely examine the area in question and then perform various tests. Diet questions are quite common for patient with gout because it gives the doctor a clue regarding possible causes or triggers of the condition.

Blood test: Requiring this type of test is imperative for doctors who intend to measure the amount of blood uric acid. Obviously, a high level of uric acid represents a clear sign that the patient might have gout. Sometimes, the results are not reliable because high uric acid levels in the blood can happen in the absence of gout and the other way around, people with symptoms of gout may not show increased levels of blood uric acid. Doctors generally carry out this test on the patient several weeks following a gout attack.

Joint fluid test: Doctors use this common test for gout in order to examine joint fluid with the help of a microscope. Practically, it consists in taking a sample of fluid from the affected area using a needle. The goal of the doctor when checking the fluid is to discover the presence of small crystals that might explain the condition and to eliminate the possibility of joint infection.

X-ray imaging: Even though this test is not very popular among patients with gout because it cannot detect the condition, doctors still use it when they consider necessary for eliminating similar conditions that might cause joint inflammation or to determine the amount of damage provoked by gout on the joints.

Ultrasound scans: An ultrasound scan represents a safe technique that starts to gain popularity among doctors who use it with the purpose of discovering crystals in the joints. It provides more clear and accurate results than a physical exam because it allows the doctors to analyze the area in depth.

 

Treatment for Gout

After diagnosing gout, the doctor provides a treatment focusing on pain relief, medication and lifestyle changes. This has the mission to help the patient deal with present gout attacks and avoid other gout attacks in the future.

  • Non-steroidal anti-inflammatory drugs (NSAIDs): These medicines are helpful during a gout attack because they reduce the inflammation and pain in the respective area. They refer to over the counter medications like ibuprofen and more powerful medications like indomethacin. The side effects involve stomach ulcers, bleeding and indigestion so the doctor may prescribe something else to fight these negative effects.
  • Corticosteroids: Doctors use these medications when dealing with severe cases of gout where other treatments simply do not provide satisfying results. The patient can take them orally or through injections. These types of medications do relieve the pain, but the patient cannot enjoy their beneficial effects on the long term because at some point they will experience side effects including easy bruising, weight gain, weakness in the muscles and osteoporosis, which implies the presence of thin bones.
  • Colchicine: These pain relievers are very effective when NSAIDs do not work because they reduce the swelling associated with gout attacks and implicitly the pain. However, common side effects like vomiting, nausea and diarrhea may prove to be intolerable for the patients when taking high doses. The doctor may recommend or prescribe colchicine following an acute attack of gout for avoiding future attacks.

The doctors may also recommend other medications for preventing complications related to gout, more specifically, drugs that block the production of uric acid or impede the body to produce great amount of uric acid and drugs that improve the removal of uric acid. Patients may experience side effects like reduced liver function, rash, stomach pain, kidney stones and nausea.

Lifestyle changes: Although medications represent the most effective treatment method for gout, the patient also needs to contribute to the process and make some alterations in relation to his lifestyle.

  • Regular exercise is very beneficial because it allows weight loss while maintaining a healthy body, thus reducing the chances of developing gout. The patient must engage in certain types of activities that do not put a strain or pressure on the joints.
  • Limiting certain foods with high levels of purine including offal, seafood, red meat and foods with yeast extract also helps because it helps the patient maintain a somewhat control over the uric acid level in high blood. The consumption of sugary snacks represents another risk that patients must eliminate from heir diet.
  • Limiting alcoholic drinks and those beverages containing lactose is ideal for decreasing the chances of gout. Instead, the patient should drink more water in order to keep his body well hydrated and reduce the possibility of crystals appearing and forming in his joints.
  • Vitamin C represents an ally for people with gout because apparently, following some evidence, it has the power to reduce attacks of gout, although it does not have a powerful effect. In order to make sure that vitamin C supplements are suitable for his condition, the patient must consult with a doctor.

 

Treatment of Gout

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