Gout

Gout

is a form of arthritis characterized by a sudden and severe attack of pain and redness of the joints. The base of the big toe is most often affected.

Gout occurs in both men and women, but it is more common in men and women are more susceptible to the disease after menopause.

An acute attack of gout is very characteristic in its symptoms: you may wake up in the middle of the night due to the feeling that your big toe is “burning” as if on fire. The joint is hot, swollen, and so sensitive to pressure that even the touch of a sheet seems intolerable.

Fortunately, gout is treatable, and there are ways to reduce the risk of another attack.

Symptoms of gout

If you experience sudden intense pain in a joint, you should consult a rheumatologist. Gout, if left untreated, can lead to worsening and more frequent attacks of pain and joint destruction. Immediate and immediate consultation is indicated if you have a fever and the joint is hot and inflamed: this may be a sign of infectious arthritis.

The signs and symptoms of gout are almost always acute, starting suddenly at night, in the absence of any warning. These include:

1. Intense pain in the joint. Gout causes intense pain and swelling around one or more joints. The joint most commonly affected is the joint at the base of the big toe. Gout usually affects the big joint of the first toe, but gouty arthritis can occur in other places: the knees, ankles, wrists, small joints of the hands and feet. The pain is especially severe during the first 12-24 hours after the onset of the attack.
2. Discomfort for some time after the attack. After a severe attack has passed, there may be a feeling of discomfort in the joint that lasts from several days to several weeks. As the disease progresses, attacks become longer and affect more joints.
3. Inflammation and redness of the joint. The affected joint or joints become swollen, painful, and red.

Causes of gout

Gout occurs when uric acid crystals accumulate around a joint, causing the inflammation and intense pain of a gout attack. Uric acid crystals form when there are elevated levels of uric acid in the blood. Uric acid is produced by the body as a result of the breakdown of purines. Purines are normally found in the human body, and they are also present in certain foods: animal meat, anchovies, herring, mushrooms, asparagus, etc.

Normally, uric acid is dissolved in the blood and enters the kidneys and is excreted in the urine. But when uric acid is overproduced or not eliminated enough by the kidneys, it accumulates and forms sharp, needle-like crystals in the joints or surrounding tissues, which cause pain, inflammation and swelling.

Risk factors for gout

People with high levels of uric acid in the blood are more susceptible to gout. An increase in the concentration of uric acid is promoted by:

• Lifestyle. Certain eating habits, especially excess alcohol and meat foods.
• Other diseases that can increase the likelihood of developing gout: high blood pressure (hypertension), existing for a long time without treatment, diabetes, high levels of cholesterol and fats in the blood (hyperlipidemia), narrowing of the walls of arterial vessels.
• Medications. The use of thiazide diuretics, commonly prescribed to treat hypertension, and low-dose aspirin may increase uric acid levels.
• Hereditary predisposition. If other family members have had gout, you are more likely to inherit the disease.
• Gender and age. Gout most often develops in men between 40 and 50 years of age. Women’s uric acid levels initially are lower than men’s, but they become higher after menopause, so gout in women usually occurs after menopause.

Complications due to gout

People suffering from gout may have several forms, for example:

• Recurrent gout. The course of gout varies: some may have only one gout attack in their entire life. For others, attacks may occur several times a year. Medicines help prevent recurrence of gout attacks.
• Gout, accompanied by gouty nodes. Untreated gout can manifest itself as subcutaneous nodules, or tophi. They are painless, but may become swollen and tender during a gout attack.
• Stones in the kidneys. In gout, uric acid crystals can accumulate in the urinary tract, forming stones. Medicines that lower uric acid levels help reduce the risk of stones.

Diagnosis of gout

Tests that will help establish the diagnosis:

• Analysis of synovial fluid. Having obtained synovial fluid through a puncture of the inflamed joint, the doctor can analyze it under a microscope and detect uric acid crystals.
• Blood test.

Your rheumatologist may recommend a blood test to determine your uric acid levels. However, this test does not always confirm the diagnosis: some people with elevated uric acid levels may never develop gout, and, conversely, those with typical signs of gouty arthritis may have normal uric acid levels.

Treating gout

Treatment for gout usually requires specific medications, the choice of which depends on several factors, including your comorbidities and treatment preferences.

Treatment of gout has several goals:

• Treating an acute gout attack and preventing new attacks
• Reducing the risk of complications of gout, such as the deposition of uric acid salts (urates) under the skin in the form of tophi.

The following medications are usually prescribed to treat an acute attack of gout:

• Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs help suppress inflammation and pain. The doctor may prescribe a high dosage to stop an acute attack and then reduce it to prevent a recurrence of the attack.
• Glucocorticoids. These drugs can be prescribed in tablets, and they may also be indicated for intra-articular treatment. They are usually prescribed in cases of intolerance to NSAIDs.
• Medicines to prevent frequent attacks and complications of gout
• Drugs that block uric acid production are most often used to reduce the concentration of uric acid in the blood, thereby reducing the risk of gout complications.

Lifestyle with gout

Medications have been proven to be the most effective treatment for gout symptoms. However, certain dietary changes may also help.

Recommendations from nutritionists during a gout attack:

• Drink 8 to 16 cups (2 to 4 liters) of fluid daily, at least half of which should be water.
• Avoid alcohol
• Eat moderate amounts of protein, mostly low-fat foods, including low-fat dairy products.
• Limit the amount of meat, poultry and fish (140 – 170 grams per day).