Gout: Symptoms, Causes, Risk factors, Diagnosis, Treatment & Prevention

One painful type of arthritis is gout. Sharp crystals may develop in your joints (usually your big toe) if your body has an excess of uric acid. Gout attacks are periods in which pain and swelling flare up and subside. Typically, treatment consists of both dietary changes and symptom management.

Anybody can get gout, a common and complex form of arthritis. Rapid, intense flare-ups of pain, swelling, redness, and tenderness in one or more joints—usually the big toe—are its defining feature.

Gout attacks can come on suddenly, and they frequently wake you up in the middle of the night with a burning feeling in your big toe. Even the weight of the bedsheet on the afflicted joint may seem unbearable due to its heat, swelling, and tenderness.

Although gout symptoms can fluctuate, there are strategies to control them and prevent flare-ups.

Also Read: Rheumatoid Arthritis, Symptoms, Causes, Diagnosis and Treatment

What is Gout?

Gout is a form of inflammatory arthritis that makes your joints hurt and swell. When your body accumulates uric acid, gout develops.

The big toe joint is most frequently affected by gout. However, it may also impact other joints, such as your:

• Knees

• Ankles

• Feet

• Wrists and hands

• Elbows

Flares or gout attacks are episodes in which gout symptoms flare up and then go away. To reduce your uric acid levels and the frequency of future gout attacks, a medical professional may suggest medication and changes to your diet.

Symptoms:

Gout symptoms almost always appear suddenly, and they frequently do so at night. Among them are:

• Severe pain in the joints. Although it can happen in any joint, gout typically affects the big toe. The ankles, knees, elbows, wrists, and fingers are among the other joints that are frequently impacted. Within the first four to twelve hours after it starts, the pain is probably at its worst.

• Persistent discomfort. Some joint discomfort may persist for a few days to a few weeks after the worst of the pain has passed. Subsequent attacks are likely to impact more joints and last longer.

• Inflammation and redness. Swelling, tenderness, warmth, and redness develop in the affected joint or joints.

• Limited range of motion. You might not be able to move your joints normally as your gout worsens.

Causes:

Urate crystals accumulate in your joint, resulting in gout attacks, which are characterized by severe pain and inflammation. When your blood contains high amounts of uric acid, uric acid crystals may form. Purines are naturally occurring substances that your body breaks down to produce uric acid.

Additionally, some foods, such as red meat and organ meats like liver, contain purines. Anchovies, sardines, mussels, scallops, trout, and tuna are among the seafood that are high in purines. Drinks sweetened with fruit sugar (fructose) and alcoholic beverages, especially beer, raise uric acid levels.

Uric acid normally dissolves in your blood and passes to your urine via your kidneys. However, there are instances when your kidneys excrete too little uric acid or your body produces too much of it. In a joint or surrounding tissue, this can result in uric acid accumulation and the formation of sharp, needle-like urate crystals, which can cause pain, swelling, and inflammation.

Risk factors:

If your body contains a lot of uric acid, you are more likely to get gout. The following factors raise your body's uric acid level:

• Eat a diet. Eating foods high in red meat and shellfish as well as beverages sweetened with fructose, a fruit sugar, raises uric acid levels, which raises the risk of developing gout. Drinking alcohol, particularly beer raises your risk of developing gout.

• Weight. Your body produces more uric acid and your kidneys have difficulty eliminating it if you are overweight.

• Medical conditions. Gout is more likely to occur in people with specific illnesses and ailments. These include chronic conditions such as diabetes, obesity, metabolic syndrome, heart disease, kidney disease, and untreated high blood pressure.

• Certain medications.  Uric acid levels can also be raised by low-dose aspirin and some medications used to treat hypertension, such as beta blockers, thiazide diuretics, and angiotensin-converting enzyme (ACE) inhibitors.  The use of anti-rejection drugs prescribed to recipients of organ transplants can also do this.

•  Gout in the family.  You have a higher chance of getting gout if other family members have had it.

•  Sex and age.  Because women typically have lower levels of uric acid, gout is more common in men.  However, women's uric acid levels start to resemble men's after menopause.  In contrast to women, who typically experience gout symptoms after menopause, men are more likely to experience gout earlier in life, typically between the ages of 30 and 50.

• Recent trauma or surgery. Gout attacks can occasionally be brought on by recent surgery or trauma. Some people may experience a flare-up of gout after receiving a vaccination.

Complication:

People with gout can develop more severe symptoms such as:

• Recurring gout. Some people may never again get the symptoms and signs of gout. Some people may get gout multiple times a year. For those who have recurrent gout, medications may help prevent attacks. Gout can erode and destroy a joint if it is not treated.

• Advanced gout. Urate crystal deposits may develop beneath the skin in nodules known as tophi (TOE-fie) if gout is left untreated. Your fingers, hands, feet, elbows, or Achilles tendons along the backs of your ankles are just a few places where tophi can form. Although tophi are typically painless, gout attacks can cause them to swell and become tender.

• Kidney stones. Gout sufferers may develop kidney stones as a result of uric acid crystals building up in their urinary tracts. Kidney stone risk can be reduced with the use of medications.

Diagnosis:

Gout is diagnosed by a medical professional after a physical examination. They will assess your affected joints and ask about your symptoms. Inform your healthcare provider about the onset of joint pain and swelling, as well as how frequently the symptoms occur.

To diagnose gout, what tests will be performed?
Your doctor may take pictures of your affected joints as part of a series of imaging tests. These tests can also reveal whether your joints have changed as a result of gout. You may require:

• X-rays

• Ultrasound

• MRI stands for magnetic resonance imaging

• The dual-energy CT scan, which is a type of computed tomography scan

Other typical tests for gout diagnosis include:

• Blood tests to measure your blood's level of uric acid

• Joint aspiration is the process of taking a fluid sample from inside a joint with a needle.

Treatment:

How does one treat gout?

 Reducing the consumption of high-purine foods and beverages and controlling your symptoms during a flare-up are usually among the main methods of treating gout.

 Medication for gout

 To help control your symptoms, your doctor may recommend the following drugs:

•  NSAIDs: During a gout attack, over-the-counter (OTC) NSAIDs such as naproxen and ibuprofen can lessen pain and swelling.  NSAIDs should not be taken by certain people who have stomach ulcers, kidney disease, or other medical conditions.  Consult your doctor before using NSAIDs.

• Colchicine: If taken within 24 hours of a gout attack, prescribed medication colchicine can help with pain and inflammation.

• Corticosteroids: Corticosteroids are anti-inflammatory prescription medications. Oral (by mouth) pills may be prescribed by your physician. Corticosteroids may also be injected intramuscularly (into a muscle close to your joint) or into the afflicted joints.

To help lower your uric acid levels, your doctor may prescribe medication. Among the most widely used drugs to reduce uric acid are:

• Allopurinol

• Febuxostat

• Pegloticase

• Probenecid

A diet low in purines for gout

 A low-purine diet may be suggested by your healthcare professional.  Consuming fewer foods and beverages with a high purine content is encouraged by a low-purine diet.  This will assist in lowering your body's uric acid levels.  Additionally, it promotes the consumption of specific foods that may lower your uric acid levels.

 Is it possible to cure gout?

 Gout has no known cure.  Working with a healthcare professional to identify treatments that control your symptoms and reduce your uric acid levels will help you have fewer attacks.

Prevention:

Limiting the frequency of high-purine foods and beverages is the best strategy to avoid developing gout. To help your kidneys work better and prevent dehydration, make sure you drink lots of water.

Regular exercise can lessen joint stress and lower your risk of obesity and other diseases that increase your risk of developing gout.

References:

• U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout (https://www.niams.nih.gov/health-topics/gout). Accessed 02/19/2023.

• American College of Rheumatology. Gout (https://www.rheumatology.org/i-am-a/patient-caregiver/diseases-conditions/gout). Accessed 02/19/2023.

• U.S. National Library of Medicine. Gout (https://medlineplus.gov/ency/article/000422.htm). Accessed 02/19/2023.

• Goldman L, et al., eds. Crystal deposition diseases. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 23, 2020.

• Gout. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout. Accessed Dec. 23, 2020.

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• Ferri FF. Gout. In: Ferri's Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 23, 2020.

• AskMayoExpert. Gout or pseudogout (adult). Mayo Clinic. 2020.