What Is Gout?

Overview:

Gout is a painful condition that needs immediate evaluation. Early treatment can help manage the condition effectively. Read the blog to know all about gout, its causes, symptoms and management.

Gout is a type of arthritis that is very painful. It is a common condition which can manifest suddenly. Caused by the accumulation of uric acid crystals in joints, its onset will be sudden and painful accompanied by swelling, redness and tenderness. More than one joint can be affected by gout with the joints of the foot, particularly the big toe, being the most commonly affected.

Patients often experience a gout attack in the night while they are asleep – they are woken up with a burning sensation in the big toe. The joint that is affected by gout will be so painful that even something light (like a bedsheet or blanket) resting on it will cause pain.

Changing lifestyle for the better and eating a healthy diet along with medications can help manage gout.

Symptoms

• Gout pain typically manifests suddenly at night time.
• Pain is usually severe in the first 4-12 hours.
• After that, the pain subsides a little but joint discomfort will continue.
• Subsequent attacks will affect more joints and will also last longer.
• The painful joints may appear red and warm to touch.
• As the condition progresses, joint mobility will be affected.

In cases of acute gout, the symptoms will manifest quickly after uric acid build-up. The pain will last for 3-7 days and will then subside. There won’t be any pain between two gout attacks. However, this does not mean that gout can be left untreated as it will lead to the condition becoming chronic. Uric acid crystals called tophi will get deposited on joints and surrounding tissues leading to irreparable joint damage.

Causes of Gout

• Purines are compounds that are produced in the body. In addition to that, some of the food we consume also contain purines. Examples include red meat, certain seafood, beverages like beer and sweetened drinks, etc.
• When the body breaks down purines, uric acid is produced.
• Under normal circumstances, this uric acid is removed from the body through urine.
• However, if the uric acid produced is excessive or if the body is not able to remove the uric acid, then urate crystals will build up and accumulate in joints leading to gout pain.

Risk Factors for Gout

• The diet that we consume plays a huge role. Red meat, shell fish and drinks that are sweetened with fructose increase the uric acid level in the body. The same is the case with alcoholic beverages.
• For overweight people, the risk of gout increases as the body produces more uric acid and the kidneys find it tough to remove it.
• Certain conditions like hypertension, diabetes, obesity, etc. increase the possibility of gout.
• Certain drugs that are used to control BP increase gout risk. So do the anti-rejection drugs that are given to organ transplant patients.
• Family history of gout too increases gout risk.
• Gout is more common in men than women as women have lower uric acid levels. Men in the age group of 30-50 years are commonly affected. However, after menopause, women’s uric acid level increases and they too are at risk.
• Sometimes, a surgical procedure or some kind of trauma can cause gout.

Diagnosis:

An orthopedic doctor can usually diagnose gout from a physical examination and the patient’s medical history, description of the pain and its onset. A few tests may be suggested:

• A blood test to determine uric acid level.
• A joint fluid test during which fluid from the affected joint is withdrawn with a needle and examined under a microscope to find out if urate crystals are present.
• X-rays may be suggested to rule out other conditions.
• An ultrasound test can help detect gout.
• DECT (dual energy computerized tomography) may be suggested if the joint fluid is too less or inaccessible for examination.

Treatment

There are two different treatment modalities and the orthopedic doctor will decide on which one to use depending on the gout attack severity and duration.

• One way to treat gout is to give medications to handle the pain.
• The other way is to give medications that will lower the body’s uric acid levels. This will prevent further complications.

Surgery is not usually suggested for gout. However, in cases of chronic gout, the joint and tendons might suffer damage and there might be infections in the joint. Tophi can accumulate in the joints and cause pain. In such cases, three surgical options may be recommended:

• Joint replacement surgery
• Joint fusion surgery
• Tophi removal surgery

Prevention:

• Reduce/stop alcohol consumption
• Limit purine rich food consumption
• Reduce dairy consumption
• Make sure to eat a lot of vegetables
• Watch your weight
• Stop smoking
• Work out regularly
• Drink enough water

As mentioned earlier, since certain drugs that are used to treat other conditions increase the risk of a gout attack, it is best to ask your doctor for advice on how to prevent a gout attack in such cases.

Managing Gout

• Gout attacks are painful and a person with gout should be prepared for a sudden flare-up.
• The flares will be more frequent if gout is left untreated.
• In some cases, gout attacks might be frequent immediately after starting treatment. This is because the uric acid levels are adjusting to the new medications and diet modifications.

Gout can be successfully managed with a combination of lifestyle changes and medication. Lowering uric acids levels to values less than 6 mg/dL will reduce gout attacks.

When experiencing a gout attack:

• Reduce consumption of alcohol and sweetened beverages.
• Drink water and stay hydrated.
• Keep the affected joint in an elevated position.
• Apply cold compress to the affected joint for 15-20 minutes various times a day.
• Gout attacks are painful so try to stay calm and avoid stressing yourself.

Takeaway Message

Consult your orthopedic doctor if you experience sudden intense joint pain with the joint appearing swollen and red. The symptoms of gout are similar to other joint infections which need immediate attention.