What is Gout?
Gout is a condition which falls under the arthritis umbrella. It causes inflammation as a result of increased uric acid levels in your body, a form of waste substance found in your body.
Gout manifests in episodes called flares. These onslaughts have a tendency to come and go, in some cases they can occur months or even years apart from each other.
It can be sparked off because of injury, medication or infection. However, gout can also rear up as a result of lifestyle choices, including: excessive alcohol consumption and certain foods in your diet. It is also more common in men over the age of 40. (1, 2)
Uric acid is the waste product that results from purines. These are chemical compounds found naturally in your body and inside certain foods, like meat. (3)
Normally, uric acid is harmlessly removed from your body through your urine. However, if your kidneys are unable to get rid of uric acid as they should, it begins to build up.
When uric acid levels are abnormally high, the substance begins to deposit in your tissues. Typically, uric acid will form small needle-like crystals inside your joints. These deposits are what causes gout. (4)
The symptoms can be described as follows: (5)
Extreme Joint Pain
Gout usually manifests as extreme pain in the joints. Although gout can affect any joint, it tends to attack those in the lower part of your body. The big toe is most likely to be impacted.
Gout pain may occur after a period of illness, or an injury. During initial attacks, pain can subside within 10 days.
If the condition progresses, you may experience constant joint pain.
Joint Swelling and Tenderness
Gout can cause the affected joint to swell intensely. The joints attacked by gout can become so tender, even light contact can be unbearable.
As attacks subside and the swelling decreases, your skin may flake and peel.
Swollen, painful joints can actually feel warm to the touch.
The skin over your joints may turn red due to inflammation.
Gout is classified according to severity and frequency of attacks. The four stages of gout are as follows: (6)
Your uric acid levels are normal. You are not at risk of gout.
The level of uric acid in your blood is over 6 mg/dL (milligrams per deciliter).
Your uric acid can remain elevated for a lengthy period of time before you experience a gout attack.
Not all individuals with high uric acid levels will contract gout. However, you will be more at risk for the condition.
At this stage, deposits of uric acid crystals exist in your joints. These result in acute attacks of gout, causing extremely painful swelling of affected joints.
The symptoms will generally resolve within a maximum of 10 days. You may be free from another gout attack for months or even years, but it will depend on the individual.
Gout at stage 3 is referred to as intercritical. This is the period of remission between flare ups of symptoms.
Your joints will be functioning unimpaired and you will not experience pain.
However, uric acid crystals are accumulating silently in your joints. Unless you take steps to lower your levels of uric acid, future attacks will likely occur.
By now, gout is considered late stage. It is also referred to as chronic tophaceous gout.
Kidney damage may occur in some individuals at this stage. The condition has advanced to a chronic form of arthritis.
Your joints can become deformed, plus both cartilage and bone can suffer permanent damage.
Your doctor will have a better chance of diagnosis when you are in the middle of an episode.
Your medical history will be reviewed to rule out other conditions, such as a different form of arthritis.
Your doctor will also ask about which joints are being affected and how long the attacks last for to gauge severity. A physical examination will need to be performed.
A blood test will measure the level of uric acid in your blood. You may also receive imaging tests such as an x-ray to examine affected joints.
Fluid from one of your joints may also be taken. This will allow your doctor to check for uric acid crystals under a microscope.
Treatment for gout aims to manage symptoms and reduce uric acid levels to prevent future attacks. (7)
Treatment options can include:
Diet and Lifestyle Changes
If you have gout, it is important to follow a healthy diet. This means avoiding processed foods and foods high in purines.
Purines are a compound which can provoke attacks of gout. Purine-rich foods include red meat, alcohol, organ meats and shellfish.
The most suitable diet for a gout patient is one high in vegetables and whole grain products. This type of regime can reduce your uric acid levels and improve overall health and well-being.
Losing weight can also contribute to lowering uric acid in your blood. Exercise can also reduce your risk of stroke and heart disease, common afflictions of gout patients. (8)
Non Steroidal Anti Inflammatory Drugs (NSAIDs)
NSAIDs are drugs which help to relieve inflammation and pain. If you take them within the first day of a gout flare, you can shorten the duration of the attack.
They can also alleviate the intense swelling and pain typical of gout.
Corticosteroids are steroids that work to lower inflammation. They are usually prescribed to individuals with many joints affected by gout.
These steroids can be taken orally or injected directly into inflamed joints. You may also receive corticosteroids if your gout attack does not respond to NSAIDs.
Medications to Reduce Uric Acid Levels
There are forms of medication which reduce chances of future attacks by lowering uric acid levels. They are usually prescribed in six week to 12 month courses.
However, as levels of uric acid decline you may suffer another attack. This is due to the uric acid crystals moving around inside your joints.
Medications in this category include:
Allopurinol reduces uric acid production. Your dosage will gradually increase with time.
Febuxostat is similar to allopurinol. It is prescribed to individuals with kidney disease, or those who do not tolerate allopurinol well.
Probenecid encourages uric acid elimination in your body. It can cause kidney stones, headaches, gastric upset, or a rash in some people.
Lesinurad is prescribed alongside febuxostat or allopurinol. It is given to individuals who do not respond well to either drug.
As with probenecid, lesinurad promotes the elimination of uric acid from your body. Side effects can include flu, kidney stones and a higher risk of cardiovascular events.
Pegloticase is an option when all other forms of medication are unsuccessful. It rapidly reduces levels of uric acid and is administered intravenously every two weeks.
Gout flares, nausea, vomiting and chest pain are all potential side effects. (9)
What is gout? Gout is a type of arthritis which results in inflammation of your joints caused by excess levels of uric acid in the body.
What are the signs of gout? The signs of gout include intense pain on the affected joint. You may also notice swelling, tenderness and redness.
How do you develop gout? Gout develops when uric acid builds up in your body. It forms crystals inside your joints, which results in inflammation.
How are you diagnosed for gout? Your doctor will diagnose gout during a flare. A physical examination, blood tests and imaging tests such as an ultrasound may be performed. Your doctor may examine fluid from a joint affected by gout to check for uric acid crystals.
What is the best treatment for gout? Treatment for gout can include changing your lifestyle and diet. NSAIDs and corticosteroids can help manage the pain. Medication which reduces uric acid levels include: allopurinol, febuxostat, probenecid, lesinurad, and pegloticase.
What are the long term complications of gout? If gout becomes chronic, you can suffer joint damage, which means loss of movement can occur as a result. (10)
Is gout considered a disability? If your gout becomes severe, you may be eligible for disability. To qualify, the gout has to impair your capacity to complete tasks, function socially and complete daily activities. (11)
Is there any cure for gout? No, gout does not have a cure. It can be managed with treatment. (12)
Is gout life threatening? Gout in itself is not fatal. However, it increases your overall risk of death from other causes, particularly cardiovascular disease. (13)
If you experience symptoms of gout, consult your doctor as soon as possible. Even if your gout attacks are spaced out over months or years, it is important to get treatment.
Gout can advance and become a chronic condition if left to its own devices. This can result in irreparable damage to your joints.
As uric acid crystals accumulate, affected areas can become visibly deformed. You can also lose mobility over time.
However, gout is a manageable condition with medication and a healthy lifestyle. You can also reduce your chances of contracting the condition by prioritizing good health practices. (14)