What is Gout?
Gout is a term commonly used for any condition which is caused by the buildup of uric acid. It is a type of painful inflammatory arthritis. This complex condition can affect anyone. It causes pain and swelling in the joints due to the formation of uric acid crystals in the joints.
The affected joint is swollen, hot, and so tender that even the weight of the bed sheet on it may seem intolerable.
A gout attack is a term used for the episode of gout. The attacks are very painful and can occur suddenly or mostly overnight.
When we talk about the symptoms, then there might be no symptoms at times which is called remission. Also, the symptoms might get worse at times and the condition is known as a flare.
Gout can be treated with certain self-management strategies, lifestyle changes, and medications. One can also opt for the measures to prevent gout and other conditions associated with it.
In this article, we will learn everything about gout, right from its cause, and symptoms, to diagnosis, treatment, prevention, tests, foods, etc. So, read it till the end to get the overall knowledge of this health illness.
What Causes Gout?
A condition namely hyperuricemia is responsible for causing gout. It is the condition where there is the presence of a high quantity of uric acid in the body.
The purines in the body break down to form uric acid. These purines are found in the body on their own or gained by the body by certain foods you eat.
In a normal situation, the uric acid gets dissolved in the blood and it gets passed out through the kidneys into your urine.
But, there are times when the kidney might not be able to excrete enough uric acid or the body keeps on producing more uric acid. This can result in an increased quantity of uric acid in the body; it causes the buildup of uric acid crystals (monosodium urate) in the tissues, fluids, and joints. The condition is then known as gout. There is also a possibility that a person has hyperuricemia but not gout.
What are the Symptoms of Gout?
In most cases, Gout does not show any symptoms in the body, which is known as asymptomatic hyperuricemia. This illness usually resolves on its own and does not require any sort of treatment. The symptoms only get visible when the gout attack occurs.
In the case of acute gout, the symptoms might be visible so quickly right from the time uric acid crystals build up in the joint. The symptoms remain visible for 3 to 10 days.
Most Common Symptoms of Gout
The most common symptoms of gout are:
Intense Pain in the Affected Joint
Gout generally affects the big toe, but it can affect any joint. Other commonly affected joints are knees, ankles, wrists, elbows, and fingers. The pain in the joint is usually most severe within the first 4 to 12 hours after its beginning.
Inflammation and Redness in the Affected Joint
The affected joint becomes warm, red, swollen, and tender.
Limited range of motion
As gout progresses, you may not be able to move your affected joint normally.
Some discomfort may last from a few days to a few weeks in the affected joint, even after the most severe pain subsides. Later attacks are likely to affect more joints and last longer.
If you don’t treat gout, then it can become chronic and tophi can develop. A tophus is a hard lump that is the buildup of needle-shaped crystals and can develop in and around the joints and other organs. These deposits start out as painless, but over time, they can become painful and can cause bone and soft tissue damage. These can permanently damage your joints.
Early treatment is essential to prevent gout from turning chronic.
How Often Do Gout Attacks Happen?
Sometimes, people might have frequent gout attacks (often termed as episodes of gout) or they might not have any attacks for many years after the first one. If the gout is left untreated for a long time, then these attacks may become more frequent and last longer. The gout attacks can occur repeatedly in the same joint or affect different joints.
what are the Risk Factors for Gout?
There are certain situations including health issues, medications, genes, and environmental factors which can increase the risk of developing gout. Here, we will discuss all the risk factors for gout.
Gout occurs more often in older adults and rarely affects children.
Gout is more common in men, mainly because of the reason that women tend to have lower uric acid levels. However, after menopause women’s uric acid levels approach those of men. Men are also more likely to develop gout usually between the ages of 30 and 50, while women generally develop its signs and symptoms after menopause.
A family history of gout can increase the person’s risk of developing the condition.
If uric acid is formed faster than it can be evacuated from the body, it will begin to accumulate and eventually leads to hyperuricemia and gout.
Certain foods and beverages are common causes of increased formation of uric acid in the body, such as:
The risk of gout is greater as beer, wine, or liquor intake goes up.
Purine-rich foods are considered a major risk factor for gout. These foods include red meat, organ meat, and certain types of seafood, like mussels, sardines, trout, scallops, and tuna (1).
High-fructose beverages, such as corn syrup, soda, sweetened fruit drinks, etc. can lead to hyperuricemia because the concentrated sugars present in them may impair the excretion of uric acid from the kidneys.
Genetics can play a significant role in your risk of gout. Mutations in the SLC22A12 and SLC2A9 genes (involved in the excretion of uric acid into the urine) can cause hyperuricemia and gout (2).
Other genetic disorders associated with gout are:
- Kelley-Seegmiller syndrome
- Hereditary fructose intolerance
- Medullary cystic kidney disease
- Lesh-Nyhan syndrome
Medications or Drugs Causes
Taking certain medications or drugs also increases the risk of gout. These medications include:
- Drugs that are used to treat some autoimmune diseases or used by people having organ transplants, such as cyclosporine.
- Excess consumption of vitamins such as Niacin (vitamin B3).
- Medications that are used to treat Parkinson’s disease (such as levodopa).
- Medications used to eliminate excess fluid from the body such as diuretics (like furosemide, or hydrochlorothiazide).
Certain medical conditions can also predispose you to gout. Some conditions directly or indirectly affect renal function, whereas others are characterized by an abnormal inflammatory response, which is believed to promote uric acid production.
Some of these medical conditions are:
- Congestive heart failure
- Chronic kidney disease
- Hemolytic anemia
- Hypothyroidism (low thyroid function)
- Hypertension (high blood pressure)
- Psoriatic arthritis
Other medical events are also known to trigger a gout attack, including recent surgery, an infection, a traumatic joint injury, and a crash diet (possibly because of rapid changes in blood uric acid levels).
Lifestyle Risk Factors
Lifestyle factors can also play a significant role in your risk of gout. These are:
Being obese or overweight and having high levels of visceral body fat is linked with an increased risk of gout (3). However, being obese or overweight cannot directly cause this condition.
Many of the same factors associated with chronic diseases like cardiovascular disease and type 2 diabetes are associated with gout. These are:
- High blood pressure (above 130/85 mmHg)
- Excess visceral fat (abdominal fat)
- Regular alcohol use
- Insulin resistance
- High LDL (‘bad”) cholesterol and low HDL (“good”) cholesterol
- Sedentary lifestyle
- High triglycerides
Diagnosis of Gout
Sometimes it is difficult to diagnose gout as some other health conditions also can mimic and show symptoms like gout. So, the doctor or health care provider diagnoses gout based on several factors. You should follow a Rheumatologist for the diagnosis of gout, as they are doctors who specialize in treating gout and other diseases related to arthritis.
The Gout specialist i.e. Rheumatologist will ask and perform the following in order to diagnose gout in a person’s body:
1). They will ask you for the details of the following:
- Your symptoms.
- Your medical history.
- Consumption of any drugs or medications.
2). Check the affected joint carefully.
3). Suggest a lab test for checking the level of uric acid in the blood.
4). Examine the urate crystals with the help of a microscope. For this, they take the fluid sample from any of the affected joints, a tophus, or swollen bursae.
5). They might recommend an ultrasound for checking the buildup of urate crystals in the affected joint. Also, the ultrasound will help to recognize any other health condition that might be leading to symptoms.
Tests For gout
|Test||How It Is Done||What it Helps to Determine|
|Joint fluid test||Fluid from the affected joint is drawn out by using a needle. The fluid is then examined under the microscope.||To visualize the presence of urate crystals.|
|Blood test||Blood is taken from the veins.||Help measure the level of uric acid in the blood.|
|X-ray Imaging||An X-ray image of the affected joint is taken.||To diagnose other possible reasons for joint inflammation.|
|Ultrasound||Sound waves are used.||To check or to rule out the presence of urate crystals in joints or in tophi.|
|Dual-energy computerized tomography (DECT)||A combination of various X-ray images captured from different angles.||To check or to rule out the presence of urate crystals in the joints.|
Prevention of Gout
Gout can be prevented by making certain lifestyle changes. Here are a few steps that can help you to prevent gout:
- Increase your intake of water and maintain your hydration.
- Do exercises regularly.
- Avoid or quit smoking.
- Consume and maintain a well-balanced and healthy diet.
- Follow a veggie-rich diet.
- Consume non-dairy products which are low in fat.
- Limit or avoid the consumption of purine-rich food which includes organ meat, pork, beef, lamb, shellfish, etc.
- If you are an alcoholic, quit it or reduce it to the least.
- Maintain a healthy weight.
- If you have medical conditions or you take medications that increase your risk of gout, then consult your doctor for lowering your risk of gout attacks.
What is the Treatment of Gout?
The treatment of gout includes some changes in diet, lifestyle changes, medications, etc. Also, sometimes some sort of surgery might be needed or helpful.
Gout treatment mainly focuses on 2 varied problems and is available in 2 different types:
- In the first type of gout treatment, pain and inflammation caused due of gout attacks are reduced.
- In the second type of gout treatment, the aim is to reduce the quantity of uric acid in the blood in order to prevent any complications.
Also, the treatment of gout depends upon various factors including symptoms, etc. Firstly, along with medications, your doctor may suggest some lifestyle changes to aid manage your symptoms and reduce your risk of future gout attacks, such as:
- If you are a smoker, quit or reduce smoking.
- If you are obese, reduce obesity.
- If you are an alcoholic, reduce or quit your intake.
Medications Used in the Treatment of Gout Attacks
Following medicines are used to treat gout flares and prevent future attacks:
The health care provider usually prescribes Corticosteroids in order to control or reduce pain and inflammation. Corticosteroids include prednisone etc. These drugs can be given either as pills or in the form of injections. There are some effects of corticosteroid drugs which include elevated BP, increased blood sugar levels, mood swings, etc.
Colchicine is an anti-inflammatory drug being prescribed to reduce gout pain. Some side effects of using these drugs include diarrhea, vomiting, and nausea.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Naproxen sodium, ibuprofen, diclofenac, Indomethacin, etc. are examples of NSAIDs. These drugs can reduce pain and swelling. Some side effects of NSAIDs are ulcers, bleeding, stomach pain, etc.
Medications that Help in the Prevention of Gout Complications
Your doctor may recommend medication to lower your risk of gout-related complications, if you experience several gout attacks every year, or if your gout attacks are less frequent but mainly painful.
Also, if you already have an indication of damage to your joint because of gout in joint X-rays, or you have kidney stones, chronic kidney disease, or tophi then medications to lower your uric acid levels in the body may be recommended.
1) Medications that improve uric acid removal
Certain drugs like probenecid work to improve the ability of your kidney to remove uric acid from the body.
There are some side effects of using these medications including stomach pain, rash, kidney stones, etc.
2) Medications that block the production of uric acid
Certain drugs such as febuxostat and allopurinol limit the formation of uric acid in the body. These medications also have some side effects.
Some side effects of allopurinol are rash, fever, kidney problems, and hepatitis.
Side effects of Febuxostat include nausea, rash, and reduced liver function; and it may also increase the risk of heart-related death.
Surgery Required for the Treatment of Gout
Normally, there is rather any need for surgery in order to treat gout. But, if it lasts for many years, it can make the condition even more critical. It can cause infections in the skin over the joints, tear the tendons, and even damage the joints.
Hard deposits known as tophi can build up in your joints and other places of your body (such as the ear, etc.). Such hard lumps are swollen and painful, and may also cause permanent damage to your joints.
In such cases, surgeries are needed to remove tophi and deal with the condition. The surgical procedures which are usually done in these cases are:
- Joint replacement surgery
- Joint fusion surgery
- Tophi removal surgery
The doctor or specialist can recommend which surgical procedure can be needed or effective for you, depending on your personal choices, the extent of the damage, and where the tophi are located.
What are the Complications of Gout?
Gout is not always a condition that causes only pain and inflammation and doesn’t cause any serious illness.
But, if left untreated it can also cause some serious illness and damage, which we will discuss below:
Tophi are deposits of urate crystals under your skin. These can form on most joints of your body including feet, ankles, fingers, and hands. This condition may be painless, but if it is not treated properly and on time, it can cause damage to the cartilage, bones, and joints.
Joint Damage and Deformity
Regular swelling of the joints is most common if you are suffering from chronic gout. In such cases, tophi and chronic inflammation may lead to permanent joint damage, stiffness, and deformity. Surgery to fix joint damage or joint replacement is the option if the case of chronic gout gets worse.
The risk of developing kidney stones in a person is high if he/she has gout, as urate crystals can build up in your urinary tract and can lead to kidney stones.
Kidney Disease and Kidney Failure
The kidney stones formed from the buildup of urate crystals can lead to scars and damage to the kidney. If the gout is not treated on time then in such cases, it may also cause kidney disease and failure.
Psychological and Emotional Problems
Chronic gout may lead to the chronic and sometimes constant pain. It causes difficulties in working, walking, and even doing some normal tasks. Living with pain can lead to emotional and psychological problems.
Diet in Gout
A gout diet is helpful in reducing uric acid levels in the blood. A gout diet is not a cure for this condition. But it can reduce the risk of recurring gout attacks and also slow down the progression of joint damage.
Following are the recommendations of specific foods or supplements for a gout diet:
According to researchers, cherries are meant to reduce the risk related to gout attacks.
The pigments called anthocyanins are present in them to give you an antioxidant boost and help reduce inflammation in the body.
The moderate consumption of coffee, mainly caffeinated coffee leads to reducing the risk related to gout. But, if you also have some other medical conditions, consult with your doctor before using coffee for the treatment of gout.
Oranges, strawberries, grapefruit, and pineapples, are all great sources of vitamin C, which reduces your uric acid levels in the body and helps prevent gout attacks. But here you should note that if you are taking colchicine for your gout, then skip the grapefruit, as it can interact with your medicine.
Low-fat yogurt is beneficial for gout, because certain proteins in milk may help your body get rid of uric acid.
Research has shown that drinking skimmed milk may help in lowering your uric acid levels and reduce gout flare-ups. It increases the excretion of uric acid in your urine and also reduces the inflammatory response of your body to uric acid crystals in your joints.
Fresh Fruits and Vegetables
Fresh fruits and vegetables are also meant to lower the risk of gout. Asparagus and spinach are known as high-purine veggies but according to research, they do not increase the risk related to gout or its attacks. Potatoes are also good to be consumed while you have gout.
People who drink approximately eight glasses of water a day are less likely to experience gout symptoms. So, stay well-hydrated by drinking water, as your kidneys use water to excrete uric acid in your urine.
Foods That Cause Gout
The top 10 foods and drinks which should not be consumed and are recommended to get avoided in case of gout are:
- Yeast and yeast extracts.
- Gravy and meat sauces.
- Sugary drinks and sweets.
- High fructose corn syrup can be found in all varieties of packaged food products.
- Red meats such as bacon, lamb pork, and beef.
- Certain kinds of seafood such as haddock, trout, tuna, codfish, mussels, scallops, herring, etc.
- Game meats such as venison, veal, goose, etc.
- Organ meats such as kidneys, brains, tripe sweetbreads, liver, etc.
What is the Outlook for People With Gout?
Gout is a type of arthritis that affects the joints and can lead to intense pain, swelling, and stiffness. If untreated, it can lead to permanent joint damage.
The buildup of urate crystals in the joints and soft tissue is known as tophus. A few individuals with gout can also develop other health problems, like severe arthritis, kidney disease, and kidney stones.
It’s important to talk about your symptoms with a doctor. The doctor may prescribe medications that help lower your uric acid levels and reduce inflammation and pain.
So, hope you have got all the necessary information about gout. There is no need to panic in any condition. There is always a way for every condition. Stay calm and contact your health care provider to get the best advice for any medical condition.
2) The genetics of gout: towards personalized medicine?
3) Estimation of Primary Prevention of Gout in Men Through Modification of Obesity and Other Key Lifestyle Factors
Disclaimer: This article is intended for informational purposes only. Any information associated with this article should not be considered as a substitute for prescriptions suggested by local health care professionals.