Gout – causes, symptoms, treatment. How to proceed in the case of a gout attack?

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Gout is a painful form of arthritis. It is caused by elevated levels of uric acid in the blood. The patient then crystallizes the acid, crystals of which are deposited in the joints, tendons, and the surrounding tissue. This causes episodes of swelling and pain called gout attacks. Gout can be treated with medications, and with dietary and lifestyle changes. Gout affects more and more people around the world and is the most common form of arthritis in men. Gout attacks can come on quickly and can recur over time. This constant rebirth can slowly damage the tissue in the inflamed area and can be extremely painful. Hypertension, cardiovascular disease, and obesity are risk factors for gout.

Gout – what is it?

Gout is a painful form of arthritis caused by uric acid crystals that form in and around the joints. It is the most common type of arthritis that males are most at risk, especially the elderly.

Gout occurs in people who have high levels of uric acid in their blood. Uric acid is produced every day when our bodies break down the purines. Purines are chemicals that are naturally produced in our body, but are also present in some foods. Of course, we all have uric acid in our blood, that’s natural. However, if its level is too high, it can lead to gout.

Each day, about three-quarters of the uric acid in our bodies comes from the breakdown of the purines that our body produces, while only about a quarter comes from eating and drinking. As acid levels increase, the body gets rid of excess acid through the kidneys and urine. However, if the body produces too much uric acid and the kidneys are unable to get rid of enough uric acid, levels start to rise.

If uric acid levels remain too high, this slowly leads to the formation of uric acid crystals. Crystals are found mainly in and around hard joint tissues, such as cartilage. However, they can also appear under the skin and even in internal organs such as the kidneys.

See also: Uric acid – the norm of serum testing

Gout – symptoms

The symptoms of gout are usually not noticeable until a gout attack occurs, which usually lasts five to seven days.

When a patient has gout, uric acid crystals can build up in his joints for years without his knowledge. When the amount of crystals in a joint is large, some of the crystals can overflow from the cartilage into the space between the two bones in the joint. Tiny, hard, sharp crystals can rub against the soft lining of a joint called the synovium, causing severe pain, swelling, and inflammation. When this happens, we talk about the so-called an attack or flare-up of gout. An exacerbation is a period when symptoms of the disease return or get worse.

During an attack, the diseased joint becomes very painful, soft, red, hot, swollen. The skin around the joint often appears shiny and may peel off once the attack has stopped. Seizures usually come very quickly, often at night. Doctors describe the sudden onset of symptoms as “acute”.

The attack usually goes away after about five to seven days, but may take longer. If gout is left untreated, attacks can become more common and can spread to new joints. Attacks usually affect the joint at the base of the big toe and often begin in the early morning hours.

Symptoms develop quickly. Usually patients feel worst in the first 12-24 hours when they notice that something is wrong. Any light contact with the affected joint is very painful – even the weight of a sheet or wearing a sock can be unbearable.

While gout most commonly affects the big toe, it can also affect other joints, including:

1. other joints in the feet;
2. cubes;
3. knees;
4. elbows;
5. wrists;
6. fingers.

It is possible to involve several joints at the same time. Gout usually does not occur in the joints towards the center of the body, such as the spine, shoulders, or hips. Gout attacks are especially common in the joints at the ends of the legs and arms, such as the fingers and toes. This may be because these parts of the body are cooler, and low temperatures increase the likelihood of crystal formation. Similar attacks can be caused by a condition called chondrocalcinosis (pseudogout).

Uric acid crystals can also build up outside the joints and can be seen under the skin, forming small, hard lumps called tophus. Sometimes you can see the white color of uric acid crystals under the skin.

The most common areas of lumps are above the toes, the back of the heel, the front of the knee, the backs of the fingers and wrists, and the areas around the elbow and ears. The gouty nodules are usually not painful, but they can interfere with your normal daily activities. Occasionally, they can become inflamed, disintegrate, and leak out as a fluid with a granular white material, these are urate crystals. Lumps can also grow in joints and damage cartilage and bone. This can lead to more regular, daily pain when using the affected joints.

Gout – causes

There are two different types of gout, that is, primary and secondary.

Primary gout is an inherited disorder of metabolism where the body produces too much uric acid when it cannot excrete it.

Secondary gout, in turn, results from chronic diseases (e.g. chronic kidney disease) or mistakes related to lifestyle and nutrition (e.g. the use of drugs that affect how well the kidneys can remove urine from the body), which disturbs the patient’s body. uric acid balance.

There are many things that can increase your risk of developing gout.

Gout – family history

Even though the kidneys may be perfectly healthy, sometimes the genes we inherit make it more likely that the kidneys are not flushing out urine as well as they should. It is the most common cause of primary gout, especially when it affects several family members such as parents or grandparents.

Gout and overweight

Gout is much more common in overweight people. The more we are overweight, the more urine our body produces. The body can make more uric acid than the kidneys.

Being overweight also increases the likelihood of:

1. high blood pressure;
2. type 2 diabetes;
3. high cholesterol;
4. blood fat.

All of these conditions can reduce the amount of urine filtered out by the kidneys.

Gout and gender and age

Gout is about four times more common in men than in women. It can affect men of any age, but the risk increases with age. Women rarely develop premenopausal gout. This is because the rise in the female hormone estrogen shows that large amounts of uric acid are being filtered out by the kidneys. However, after the menopause, estrogen levels decline and acid levels rise.

Menopause is a natural part of the aging process and typically occurs in women between the ages of 45 and 55. This is the point at which a woman stops menstruating and is no longer able to get pregnant naturally.

Gout and medications taken

Certain medications can reduce the ability of the kidneys to properly dispose of uric acid. These include diuretics and several medications for high blood pressure, including beta-blockers and ACE inhibitors. If such drugs are used, it is recommended to consult a physician about the possible risks.

Gout – other risk factors

There are several different things associated with high uric acid levels. This could be because they affect the way the kidneys filter urine or because they primarily cause more uric acid to be produced.

In some cases, the relationship to gout is less clear-cut and may be due to many different factors.

Common gout conditions include:

1. chronic kidney disease;
2. high cholesterol and blood fats;
3. high blood pressure;
4. type 2 diabetes;
5. osteoarthritis (osteoarthritis).

What can trigger a gout attack?

Several things can cause a gout attack, including:

1. impact or injury to the joint;
2. the disease that causes the fever;
3. operation;
4. eating an unusually large meal, especially a fatty one;
5. drinking a lot of alcohol;
6. dehydration;
7. start urate-lowering pharmacological therapy (ULT), especially in high doses, or not take these drugs regularly every day.

Gout – diagnostics

Diagnosing gout is usually straightforward, especially if you have the usual symptoms of the disease. For example, if the masses attack gout in the big toe. However, sometimes gout can be more difficult to diagnose. The doctor will need to know about the symptoms the patient has and will likely need to do some research.

Gout diagnosis – blood tests

Blood tests to measure urate levels can be helpful in the diagnosis of gout. However, they alone are not enough to confirm this.

High uric acid levels in blood tests may suggest that you have gout. However, this should be considered along with the symptoms. It is possible to have high uric acid levels, but without any other symptoms of the disease.

Gout diagnosis – imaging tests

Ultrasound and computed tomography (CT) scans can be good at detecting joint damage, joint crystals, and early signs of gout. X-rays are usually used for damage to bones and joints caused by a long period of gout.

Gout diagnosis – examination of synovial fluid

This is a good way to confirm the diagnosis and rule out other causes. Synovial fluid testing is performed by taking a sample of the synovial fluid. It is formed in the bags of some joints. It helps to nourish and lubricate the joints. The examination is carried out by inserting a needle into one of the joints. The fluid is then examined under a microscope for uric acid crystals. If a patient has gout, doctors may take a sample from one of them instead.

See also: Rheumatic profile, i.e. what tests will help detect rheumatic diseases

Gout – treatment

Gout treatment can be very effective and is divided into two categories:

1. treatment of an acute gout attack;
2. treatment to prevent future attacks.

Treatment of a gout attack

Treating a gout attack does not lower uric acid levels or stop future attacks. Treatment helps manage symptoms in the event of an attack.

The most common medications used in gout attacks are:

1. non-steroidal anti-inflammatory drugs (NSAIDs);
2. steroids;
3. kolchicina.

However, it will not be possible to use NSAIDs in all cases. The chosen method of treatment is not suitable for every patient. In cases where one drug does not seem to work on its own, your doctor may suggest combining the NSAID with colchicine or steroids.

Non-steroidal anti-inflammatory drugs (NSAIDs) for gout

Gout attacks are often treated with NSAIDs, which can help relieve pain and reduce some inflammation. Naproxen, diclofenac, and etoricoxib are three NSAIDs that can be administered. If a patient has been prescribed NSAIDs to treat an attack, they should start taking them as soon as they notice any signs of an attack. It should be remembered that the sooner treatment is started, the better.

NSAIDs are not suitable for everyone, so talk to your doctor about them first if you have any other medical conditions. These measures can also interact with other medications, so talk to your doctor before taking any new medications.

NSAIDs are usually not prescribed for a long time as they can cause problems with the digestive system. To reduce the risk of this happening and to protect your stomach, your doctor will also prescribe proton pump inhibitors.

Colchicine for gout

Colchicine is not a pain reliever, but it can be very effective in reducing inflammation caused by uric acid crystals.

As with NSAIDs, colchicine tablets should be taken as soon as you notice an attack coming, otherwise they may not work as well. Colchicine can interact with several other medications, including statins that are taken for high cholesterol. Your doctor will advise you on whether it is better to stop taking your NSAIDs or change other medications while you are taking colchicine.

It is recommended that you avoid taking colchicine if you have chronic kidney disease. Also, be aware that colchicine tablets may cause diarrhea or stomach pain.

Gout steroids

Steroids are very useful in acute gout attacks. They are usually taken in the form of tablets, in short cycles, lasting several days. However, they can also be taken as an injection into a muscle or joint affected by gout. This can be especially helpful if the gout affects only one joint.

What to do during a gout attack?

Keep the affected area cool – an ice pack wrapped in a cloth can be especially good at reducing pain and swelling.

Let the sick joint rest.

Think about using some kind of rack to isolate the affected joint from the sheet above our feet so that the affected joint can rest without weighing down the sheet.

Also check: Warm and cold fun

Treatments to prevent gout attacks

Drugs are available that can lower uric acid levels, prevent new crystals from forming, and dissolve crystals in joints. This is called pharmacological uric acid lowering therapy (ULT).

Treatment with ULT usually begins after the gout attack has completely subsided. There is no one fixed dose of ULT, and different people need different dosages to get adequate blood uric acid levels.

It may take several months or years for the medications to completely clear the body of uric acid crystals. However, when they do disappear, the patient will no longer have gout attacks, nor will the risk of joint damage from gout. It’s important to remember that ULT won’t stop gout attacks right away. You may have more attacks in the first six months of starting treatment. However, you should not stop treatment if you have seizures, as it actually means the medications are working. As the drugs begin to dissolve the crystals, the crystals become smaller and more likely to enter the joint cavity, triggering an attack.

Your doctor may suggest taking low doses of colchicine or NSAIDs as a precaution against attacks within the first six months of starting ULT therapy. ULT is usually a lifelong therapy and requires annual check-ups to monitor urate levels. If symptoms are not under control, consult your doctor as you may need to take a higher dose.

You should also try not to miss any of your doses, especially in the first year or two after starting treatment. This can cause uric acid levels to rise and fall, which can trigger an attack.

Drugs for gout

Less in medication — Allopurinol

Allopurinol is the most commonly used drug and at the same time very effective for most people with gout problems. It works by reducing the amount of urate your body makes. The patient starts with a low dose which may be gradually increased until the correct dose is reached. By gradually increasing the dose, you are less likely to trigger an attack. This also ensures that the patient receives the lowest dose needed to control gout.

Allopurinol is broken down and cleared from the body by the kidneys, so if you have a kidney problem it may not be suitable for you. If you are currently having a gout attack or are sensitive to allopurinol, you will be given allopurinol.

Drugs for gout – Febuxostat

Febuxostat is a newer drug that reduces the amount of urate in the body in the same way as allopurinol. This medicine will not be prescribed first unless your doctor determines that you cannot take allopurinol. Febuxostat is similar to allopurinol, but instead of being broken down by the kidneys, it is broken down by the liver. This is useful if you have kidney problems and cannot take enough allopurinol.

However, it is important to know that febuxostat is more likely to induce gout attacks than allopurinol at the start of treatment. So, as a precautionary measure, you will likely be prescribed a low-dose NSAID or colchicine for the first six months of taking febuxostat.

Also check: This is our “health factory”. How to effectively support the liver?

Drugs for gout – uricosuric drugs

Uricosuric drugs, including sulfinpyrazone, benzbromarone and probenecid, work by the kidneys to flush out more urate than normal. They are only prescribed by a rheumatologist if allopurinol and febuxostat have not worked or are not appropriate for the patient.

It should be added that it is unlikely that a patient will be able to take these drugs if he has serious problems with the kidneys or kidney stones. This is because uricosuric drugs encourage the kidneys to filter more urate. Thus, they all increase the risk of developing kidney stones.

Uricosuric drugs are usually prescribed without any other means. However, in the rare event that a patient has tried other ULT agents and none have worked, uricosuric drugs may be used together with other agents such as allopurinol or febuxostat.

Gout – treatment of joint damage

If gout has caused joint damage, treatment will be similar to treating osteoarthritis. Includes:

1. regular exercise;
2. reducing the burden on the affected joints;
3. maintaining a healthy weight;
4. taking painkillers.

People with joint damage related to chronic gout may need surgery:

1. Removal of gout nodules. In some cases, large uric acid lumps around the joints of the fingers and toes, tendons, or bursae may need to be removed as they remain painfully inflamed. The lumps can also rupture and drain, or become infected. If chronic gout has caused permanent joint damage, smaller joints may need to be joined together to restrict movement and relieve chronic pain.
2. Pond replacement. This procedure involves removing the painful joint and replacing it with artificial parts. The purpose of a joint replacement is to relieve pain as well as keep the joint moving. The knee is the most common joint that requires replacement due to gout.

See also: Knee and hip prosthesis

Gout – prevention

This lifestyle is not the main reason most people have gout. However, if you live a healthy lifestyle and take your prescribed medications, you have the best chance of lowering your disease levels. This, in turn, will reduce the chances of gout attacks.

Gout and physical activity

Not only is exercise important to your overall health and well-being, it also reduces the chances of an attack. It also doesn’t matter how much you exercise, because even a little activity is better than no activity.

A gradual, slow increase in activity is recommended. As confidence grows, you can increase the length and intensity of what you do. Exercising out of breath is especially good. You can try dancing, walking in mountainous areas.

It is good to find an activity or sport that you want to do with pleasure. Perhaps it would be a good idea to join a recreation center or sports club.

Also check: Walking is the way to health

Gout and healthy eating

You should try a balanced diet low in fat and added sugar, but high in vegetables and fiber.

Maintaining a healthy weight is important to your overall health and well-being, but it can also help with gout. This is because being overweight can put more strain on your joints. If you are overweight, lose weight gradually by following a balanced diet and staying active. Extreme weight loss or starvation diets are not recommended as they can raise uric acid levels. However, it is not a problem to fast during the day. Atkins diet diets are not recommended because they are high in meat and high in purines.

Be aware that the food and drink we consume can increase the amount of uric acid in our body. Some foods may be worse for us than others, but we shouldn’t completely remove anything from the diet.

Try to avoid consuming large amounts of:

1. red meat, game and offal (e.g. kidney, liver);
2. seafood, especially fatty fish and seafood (anchovies, caviar, herring, clams, crabs and sardines);
3. foods rich in yeast extracts (such as Marmite);
4. processed foods and drinks.

Protein is an important part of the diet, but it can be obtained from sources other than meat and fish. You can try replacing a portion of meat with other protein-rich foods, such as soybeans, eggs, dairy, and pulses.

Also check: Purines and the diet in gout

Gout and liquids

If you have gout and kidney stones, you should try to drink at least two liters of water a day to reduce the risk of stone formation.

You should also try to avoid sweetened soft drinks as they are high in sugar and can increase your risk of gout. While fruit and fresh fruit juices contain sugar, the benefits of eating fruit far outweigh any negatives. Reducing the amount of sugar you consume from other sources is a healthier option than removing it by not eating fruit.

Gout and alcohol

Drinking too much alcohol, especially beer and spirits, can increase uric acid levels and your chances of triggering a gout attack. Beer is especially bad because it contains a lot of purines. However, drinking small amounts of wine does not appear to increase the risk of inducing a seizure. As for the amount of alcohol you drink in case of gout, consult your doctor.

See also: Scientists have bad news for beer lovers. «The more you drink, the worse it gets»

Gout and diet

Vitamin C – Research has shown that vitamin C can slightly lower uric acid levels in people with gout. This is another reason to make sure your diet includes plenty of fruits and vegetables. However, if we are considering taking vitamin C supplements, we should speak to a doctor first as there is a very small risk that vitamin C supplements may interact with other medications.

Cherries – Studies have shown that cherries can reduce the risk of an acute gout attack, especially when taken with allopurinol.

Skim milk and low-fat yogurt Research suggests that drinking skim milk and consuming low-fat yogurt can help prevent gout attacks.

Complementary and alternative treatments – The use of complementary treatments such as herbal remedies is not recommended without discussing this with your doctor or pharmacist first, as some may react to the prescribed medicines for gout.

How to deal with gout in everyday life?

Gout and mental health

The emotional effects of gout can have the same effect as physical symptoms. Long-term damage and severe pain from gout attacks can affect your daily life, disrupt your sleep, and affect your mood. From time to time your gout might get us. If we feel unwell, let’s talk to our GP who can refer us further.

There are also many ways to promote mental well-being and build emotional resilience. You can, for example:

1. Practice deep breathing or meditation to reduce anxiety.
2. Write down your thoughts in a journal to help yourself understand your emotions.
3. Stay active – exercise can increase levels of the feel-good hormones called endorphins.
4. Make time for activities that you enjoy or that help you relax.
5. Meet with friends – drink coffee together or call a loved one.

See also: Depression hurts. Seven physical symptoms of depression you had no idea about

Gout and sleep and fatigue

Gout attacks can occur at night. This can cause sleep problems. You may also feel tired during attacks.

If your gout attack occurs at night, it may be helpful to:

1. lifting a sick joint on a pillow;
2. the placement of ice on the diseased joint;
3. taking medications prescribed by a doctor;
4. not allowing the sheets to touch the affected joint as this can worsen the pain.

Changing your bedtime habits can also help improve your sleep:

1. Make sure the bedroom is dark, quiet and with a comfortable temperature.
2. Try a warm bath before bed to relieve pain and stiffness.
3. Develop a regular routine where we go to bed and get up at a similar time each day.
4. You can try listening to soothing music before going to bed.
5. Some gentle exercise can help reduce muscle tension, but it’s probably best to avoid vigorous exercise too close to bedtime.
6. Keep a notebook by your bed – If you are thinking of something to do the next day, it’s best to write it down and then forget it.
7. Avoid caffeine eight hours before going to bed.
8. Do not drink alcohol before going to bed.
9. Avoid eating your main meals just before bedtime.
10. If you are a smoker, it is best to try to quit smoking, or at least not to smoke before going to bed.
11. Try not to sleep during the day.
12. Avoid watching TV and using computers, tablets or smartphones in the bedroom.
13. Do not check the time at night.