The condition gout causes sudden and severe pain, swelling, and inflammation in the joints. It usually affects the big toe, but can also affect knees, ankles, feet, arms, hands, wrists, elbows, and knees. There are many factors that can trigger gout attacks, such as foods, drinks, medications, or other factors. Gout attacks result from excess uric acid in the blood, which forms sharp crystals that deposit in the joints. We will discuss the causes, symptoms, diagnosis, treatment, and prevention of gout in this blog post.
Several foods and drinks contain purines, which are substances that cause gout. Uric acid is a waste product produced by the body when purines are broken down. In normal circumstances, the kidneys remove most of the uric acid from the blood and excrete it in urine. However, sometimes the body produces too much uric acid or the kidneys do not remove it quickly enough. A high level of uric acid in the blood (hyperuricemia) can cause the formation of uric acid crystals in the joints.
Some factors that can increase the risk of developing gout include:
Eating foods that are high in purines, such as red meat, organ meat, seafood, and some vegetables (such as asparagus and mushrooms).
Drinking beverages that contain alcohol or fructose (such as beer, wine, liquor, and sweetened drinks).
Being overweight or obese.
Having certain medical conditions that affect the metabolism of uric acid, such as kidney disease, heart disease, diabetes, high blood pressure, or thyroid disorders.
Having a family history of gout.
Being male or being female after menopause.
Taking certain medications that affect the level or excretion of uric acid, such as diuretics (water pills), aspirin (low doses), niacin (vitamin B3), cyclosporine (an immunosuppressant), or some chemotherapy drugs.
Gout symptoms usually occur suddenly and without warning. They usually occur at night or early in the morning and can wake you up from sleep. The most common symptom of gout is intense pain in the joints. Even a light touch or bed sheet can cause pain, and the affected joint may also become swollen, red, warm, and tender. There may be shiny or peeling skin over the affected joint.
Typically, gout attacks last between a few days and a few weeks. Depending on the individual, gout attacks can vary in frequency and severity. Some people may only suffer from one or a few attacks in their lifetime, while others may suffer from frequent and chronic attacks that cause damage to their joints.
Typically, gout affects the big toe (called podagra), but it can also affect the knees, ankles, feet, hands, wrists, and elbows. Sometimes gout affects more than one joint at the same time (called polyarticular gout). There is a possibility that gout can cause tophi in the ears, kidney stones in the kidneys, and cellulitis in the skin.
To diagnose gout, your healthcare provider will ask you about your medical history, your symptoms, your diet and lifestyle habits, and your family history of gout. They will also examine your affected joint for signs of inflammation and damage.
Your healthcare provider may also order some tests to confirm gout and rule out other possible causes of joint pain and swelling. These tests may include:
Blood test: To measure the level of uric acid in your blood. A high level of uric acid does not necessarily mean you have gout, but it increases your risk of developing it.
Joint fluid test: To collect a sample of fluid from your affected joint using a needle and syringe. The fluid is then examined under a microscope for the presence of uric acid crystals. This is the most definitive test for gout.
X-ray: To check for any damage or deformity in your joint caused by chronic gout.
Ultrasound: To look for signs of inflammation or tophi in your joint using sound waves.
Dual-energy CT scan: To detect uric acid crystals in your joint using a special type of computed tomography (CT) scan.
The treatment of gout aims to relieve pain and inflammation during acute attacks and to prevent future attacks and complications by lowering uric acid levels in the body.
The treatment options for gout include:
Medications: Your healthcare provider may prescribe you one or more medications to treat gout depending on your symptoms and condition. These medications may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): To reduce pain and swelling in your joint. Examples are ibuprofen, naproxen, indomethacin, and celecoxib.
Colchicine: To prevent or treat gout attacks by blocking the inflammation caused by uric acid crystals. It is usually taken at the first sign of a gout attack or as a preventive measure for people who have frequent attacks.
Corticosteroids: To control severe pain and inflammation in your joint. They can be taken orally (such as prednisone) or injected directly into your joint (such as triamcinolone).
Uricosuric agents: To increase the excretion of uric acid in the urine by blocking its reabsorption in the kidneys. Examples are probenecid and lesinurad.
Xanthine oxidase inhibitors: To decrease the production of uric acid in the body by inhibiting an enzyme called xanthine oxidase. Examples are allopurinol and febuxostat.
Pegloticase: To lower uric acid levels by converting it into a harmless substance called allantoin. It is given as an intravenous infusion every two weeks for people who have severe or refractory gout.
You may be advised to follow a low-purine diet by your healthcare provider if you want to reduce your uric acid levels. Foods high in purines, such as red meat, organ meat, seafood, and some vegetables (such as asparagus and mushrooms), are limited or avoided on a low-purine diet. Beverages containing alcohol and fructose (beer, wine, liquor, and sweetened drinks) may also need to be limited or avoided. To help flush out uric acid from your body, drink plenty of water.
Weight loss: If you are overweight or obese, losing weight can help lower your uric acid levels and reduce your risk of gout attacks. You should aim for a gradual and healthy weight loss by following a balanced diet and exercising regularly.
Other lifestyle changes: You may also need to make some other lifestyle changes to prevent gout attacks and complications. These include:
Avoiding triggers: You should try to identify and avoid any factors that may trigger a gout attack, such as stress, injury, infection, surgery, fasting, dehydration, or certain medications.
Taking supplements: You may benefit from taking some supplements that can help lower your uric acid levels or prevent gout attacks. These include vitamin C, cherry extract, fish oil, and probiotics. However, you should always consult your healthcare provider before taking any supplements.
Monitoring your condition: You should regularly check your uric acid levels and follow up with your healthcare provider to monitor your condition and adjust your treatment plan as needed.
In addition to following the treatment options and lifestyle changes mentioned above, lowering your uric acid levels is the best way to prevent gout attacks.
Gout education: You should learn as much as you can about gout, its causes, symptoms, diagnosis, treatment, and prevention. This will help you understand your condition and manage it more effectively.
In case of a gout attack or if you have any questions or concerns about your condition, you should seek medical help as soon as possible. If you get your joints diagnosed and treated early, you will be able to prevent further damage and complications.
A support group for people with gout or other forms of arthritis may be helpful. You can share your experiences, learn from others, get emotional support, and find coping strategies.
