Gout

Introduction

Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate crystals and the progression of gout is categorized into four stages. Asymptomatic hyperuricemia is a condition with a high uric acid level in the blood and there are no symptoms, therefore treatment is not needed at this stage. Acute intermittent gout characterizes the swelling, redness, and pain caused by the accumulation of uric acid in joints. Intercritical gout is the condition of the duration between the asymptomatic phase and normal functioning of the joints, however, the crystals are continuous deposits that make another attack or reduce the uric acid level. Chronic tophaceous gout is the final stage that is persistent damage to the cartilage bones and it can be prevented by using medications and dietary modifications.

Causes

Gout is caused by high levels of uric acid in the blood that is naturally produced in the blood. The accumulation of uric acid in the blood can cause the deposition of uric acid crystals in the joints resulting in gout.

Pacific and Maori people are highly affected by gout because of their genes that make it difficult to remove uric acid from the body.

There are several other factors related to the development of gout that includes −

• High consumption of alcohol

• Injurious joints

• Obesity

• Long-term kidney disease

• High intake of purine-rich foods

• Certain fluid medicines

• Genetic predisposition

Signs and symptoms

The symptoms of gout can be confused with calcium pyrophosphate deposition which is called pseudogout, however, this is calcium accumulation in the joints. Women may get an attack of gout after menopause.

Gout symptoms may develop within 12 to 24 hours including −

• Severe joint pain − Gout generally affects the big toe, however, the pain occurs in any joint and it affects the joints including elbows, knees, wrists, fingers, and ankles.

• Redness and inflammation − The joints become red, warm, tender, and swollen. The untreated condition of gout may develop hard lumps in the joints, soft tissues, and skin that are called tophi. The tophi may permanently injure the joints.

• Persistent discomfort − The most serious joint pain and discomfort last from a few days to weeks. It becomes chronic and affects more joints.

• Limited movement − The persistent effect of gout results in incapable of moving joints.

• Other symptoms − Kidney stones, mild fever, nausea, loss of appetite.

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Diagnosis

The symptoms of gout are similar to joint infection, therefore, it is difficult to diagnose. A blood sample is collected to check the fluctuations in normal blood sugar levels and high uric acid levels. The excessive uric acid is eliminated from the blood and deposited as crystals in joints, and it indicates the normal uric acid levels when the attack of gout.

Therefore, it is necessary to collect the fluid sample from the affected joint areas. This is achieved by using a local anaesthetic and requires the insertion of a needle into the affected area to take a small quantity of fluid. The presence of uric acid crystals can be identified by testing this fluid sample in a laboratory that confirms the attack of gout. The damage in the affected joints is checked by taking X-rays, dual-energy computerized tomography, magnetic resonance imaging, and ultrasounds.

Treatments

The medical treatment is used to alleviate the pain and inflammation of intense attacks and prevent the chances of future attacks.

The non-steroidal anti-inflammatory medications like ibuprofen are used to reduce the pain. It can be taken in the initial stage of gout which reduces the extension of time and severity of the attack.

• Paracetamol with other medications may also relieve the pain.

• Colchicine helps to hinder the production of uric acid and it is highly effective when taken immediately.

• Allopurinol reduces the production of uric acid.

• Corticosteroids − such as prednisone tablets are given to reduce pain and inflammation and the injection is also effective.

• Probenecid − facilitates the kidney to remove uric acid from the body.

Gout can be treated without surgery, however, this condition leads to severe damage, tear, and infections in the skin surrounding the joints. Therefore, joint fusion surgery, tophi removal surgery, and joint replacement surgery are the common procedures to treat gout.

Diet recommendations

The diet changes are aimed to restrict or avoid purine-rich foods because the purine substances in foods produce uric acid when it is broken down by the food. The purine-rich foods to be avoided are as follows −

• Red meat such as pork, beef, and lamb

• Foods containing yeast including beer and whole grain bread

• Seafood such as shellfish including anchovies, shrimp, lobster, and mussels

• Ice cream, soda, fast food, candy, and cereals because contain high-fructose

• The best foods for a gout diet are low-purine foods that include −

• Nuts, grains, and peanut butter

• Eggs

• Fruits and vegetables

• Pasta

• Low-fat food such as skim milk and yoghurt

• Limited amount of chicken and fish

Conclusion

Gout is the most usual type of inflammatory arthritis. It is characterized by the accumulation of uric acid crystals in the joints including elbows, knees, ankles, and fingers resulting in swelling and severe pain. It is classified into four stages that are initial mild gout to chronic gout. Genetic patterns, obesity, and consumption of high purine-containing foods are also the major causes of gout. The collection of blood and fluid from affected joints is taken to check the levels of uric acid and it identifies the attack of gout. The medicines including steroids and other dietary changes are required to treat and prevent gout.

FAQs

Q1. What are the medicines used to treat gout?

Ans. Colchicine, ibuprofen, indomethacin, steroids, allopurinol, pegloticase, and several other medicines are used to treat gout.

Q2. Why do high-purine foods need to be avoided?

Ans. The purine substances in the foods are responsible for the high production of uric acid in the body, which results in gout. Therefore, high-purine foods need to be avoided.

Q3. What is hyperuricemia and how is it related to gout?

Ans. Hyperuricemia is a condition of elevated uric acid levels in the blood. Gout is characterized by the deposition of uric acid crystals in the joints. Therefore, hyperuricemia increases the risk of gout.

Q4. How is gout diagnosed?

Ans. Gout can be diagnosed by assessing the symptoms and determining the levels of uric acid in the affected areas by collecting blood and fluid samples for laboratory tests, and X-rays.

Q5. What is the initial stage of gout?

Ans. The beginning stage of gout is asymptomatic hyperuricemia, also called high uric acid level which is the building up of excessive uric acid in the blood and is developed by crystal formation that deposits in the joints.

Q6. How does gout differ from pseudogout?

Ans. Pseudogout is the accumulation of rectangular calcium pyrophosphate crystals in the joints, but gout is the accumulation of uric acid crystals that are needle-shaped in the joints.