What is a gout attack?

La drop is a special form of arthritis that causes recurrent attacks of sharp pains to one or a few joints. Usually, gout attacks last for a few days, then symptoms go away for several weeks. All joints are likely to be affected, but most often the disease starts first in the one at the base of the joint. big toe. The joint then becomes purplish red and swollen.

An abnormally high level of uric acid in the blood, a condition called hyperuricemia, is the cause of gout. Uric acid is one of the wastes that the body’s metabolism normally produces. When there is a surplus, uric acid is gradually deposited in the body as crystals, among others in the joints. These deposits trigger inflammatory reactions.

Gout affects nearly 2% of adults, and especially men¹. The first attack normally occurs around the age of 30 to 45 for men, and after menopause for women.

Symptoms of gout

• A pain sudden, intense and pulsating in a joint. Crises mostly occur the night. The joints located at the extremities of the limbs are more sensitive than the others, in particular because they are colder. The cold can cause liquid uric acid to turn into uric acid crystals.
• A swelling and redness of the affected region.
• A big feeling cold to the affected joint.
• Rarely, generalized joint pain, accompanied by general malaise, fever (up to 39 ° C) and chills. In this case, go to the hospital urgently.

Causes

The excess table, if they are frequent, and the abuse ofalcohol (especially beer, whiskey, gin, vodka or rum), are the main risk factors.

Hippocrates, the “father” of medicine, who lived in Greece in the V^e century BC, had already noticed that gout mainly affected bon vivant. It was once called “the disease of kings” or “the disease of the rich”, because of the over-the-top, well-watered meals that only they could afford. As a result, it has long been known that the pleasures of the table are linked to this disease.

More rarely, the disease can be héréditaire or be caused by a drug or by another disease.

Risk factors

Here are some factors that contribute to increasing uric acid production or decreasing its excretion.

• The excess food, especially from protein from offal, white and red meats, fish and seafood. Likewise, a caloric intake that constantly exceeds the body’s needs increases the blood level of uric acid.
• THEalcohol abuse : half of people who suffer from gout have bad drinking habits. Ethanol increases the production of uric acid (without affecting its excretion). Beer is the alcoholic beverage that increases uric acid levels the most.
• Le stress : it depletes substances antionexydantes of the body. The radifree wedges then attack the cells more and precipitate cell death (resulting in the formation of uric acid).

People at risk

• The men, probably because after puberty, their blood uric acid level is naturally higher than that of women. On the other hand, at the menopause, women have uric acid levels similar to men, and the gender gap is narrowing. Before menopause, hormones estrogenGenoa activate the elimination of uric acid by the kidneys.
• Individuals with either of the health problems the following: kidney disease (kidney stones, renal failure), hypertension, metabolic syndrome, diabetes, obesity, high cholesterol, narrowing of the opening of the arteries (atherosclerosis).
• People who take certain pharmaceuticals, like the diureticues and aspirin taken regularly at low doses.
• People who have family history of gout. An inherited metabolic problem could cause the body to produce too much uric acid.

From too good food to the drop …

Here is what happens in the body of an affected person. THE’Uric acid is, in a way, a waste that the body must eliminate. It is the end product of the breakdown of purines. About two-thirds of the purines to be eliminated each day come from dead body cells, and one-third from the food we eat². Red meat, game and seafood, for example, are very high in purines.

It is normal for some uric acid to circulate in the blood. However, if too much uric acid is present and the waist do not succeed in eliminate this excess, its blood concentration increases. The body is then in hyperuricemia.

Over the years, excess uric acid is deposited in the tissues in the form of sodium urate crystals. Deposits form in the joints or elsewhere in the body (under the skin, in the cartilage, in the kidneys, etc.). The white blood cells then try to get rid of them by “eating” them through phagocytosis. However, because of this, the crystals damage the white blood cells, which triggers a violent inflammation that lasts up to 2 weeks, if left untreated.

For reasons we do not know, thehyperuricemia does not always cause symptoms. In fact, only a third of people with hyperuricaemia have the drop¹. It is estimated that 5% to 10% of the adult population is hyperuricaemic.

Evolution of gout

Since the drop is better known today and that there are several ways to control it, the quality of life of people who suffer from it has greatly improved. With early diagnosis and treatment, there is a way to reduce the number of seizures and prevent damage permanent joints.

In the absence of treatment, the first crisis resolves spontaneously within 1 to 2 weeks. During the first 24 to 36 hours, the pain is intense. The slightest pressure on the joint is unbearable, and it may even be impossible to put on a stocking. On the other hand, if the crisis is treated quickly, it lasts from 1 to 2 days. Often a new seizure occurs 6 months to 2 years later. Only a small proportion of people with gout will have one attack of gout in their lifetime.

Possible complications

This is rare these days, but if gout is not treated properly, the frequency of attacks and the number of joints affected tend to increase over time. THE’arthritis can then settle in such a way chronic in several joints (knees, ankles, wrists, elbows, etc.).

benefits deposits de crystals can be created under the skin : they are called tophi (or tophus, in the singular). They appear on the outer edge of the ear, on the elbows, on the fingers, on the toes, and near the Achilles tendon. They can damage tendons.

In case of neglect of the treatments, the excess uric acid can also be deposited in the waist, block its fine ducts and cause kidney stones or kidney failure.

Diagnostic

Depending on the case, the doctor will use one of the following types of sampling.

— Blood test : measurement of the level of uric acid in the blood (uricaemia).

— Urine sample : evaluation of the amount of uric acid excreted by the kidneys.

— Puncture of synovial fluid from the affected joint : search for uric acid crystals, to confirm the diagnosis. Uric acid crystals are not detectable by x-ray exams (x-rays or other), but are visible under a microscope in a sample of synovial fluid.

People at risk

• The men, probably because after puberty, their blood uric acid level is naturally higher than that of women. On the other hand, at the menopause, women have uric acid levels similar to men, and the gender gap is narrowing. Before menopause, hormones westrogenes activate the elimination of uric acid by the kidneys.
• Individuals with either of the health problems following:

  – kidney disease (kidney stones, kidney failure);

  – hypertension;

  – metabolic syndrome;

  – diabetes;

  – obesity;

  – hypercholesterolemia;

  – narrowing of the opening of the arteries (atherosclerosis).

• People who take certain pharmaceuticals, like the diureticues and aspirin taken regularly at low doses.
• People who have family history of gout. An inherited metabolic problem could cause the body to produce too much uric acid.
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