Background of Gout
Gout is an ancient disease. However, it is still one of the most common diseases these days and a big public concern. In ancient times, gout was considered to be associated with food overindulgence. Mostly, the disease was linked to rich people as they were the only ones who could afford such luxurious eating habits. Gout is an old disease that was first discovered about 2460 BC by the ancient Egyptians. The great Greek philosopher, Hippocrates, called it as the “unwalkable disease”.
What is gout?
Gout is a form of arthritis, which is a disease that causes joint swelling and stiffening. It is one of the severe and agonizing forms of arthritis. People with gout may feel a tremendous amount of pain and aches in the body, especially their joints.
What causes gout?
Gout is caused by the accumulation of an excessive amount of uric acid in the body. Uric acid is a chemical compound that is formed by the breakdown of purine in the body. It is a special compound found in certain types of food. Purine is present in the body tissues of human beings. It is also found in different types of foods such as liver, certain meat, fish, beans, and anchovies.
Too much consumption of foods that are rich in purine enables our body to produce an excessive amount of uric acid, which gradually builds up and changes into uric acid crystals. These crystals are deposited in the joints causing severe pain that leads to gout. Normally, uric acid dissolves in the blood and passes through the kidney and into the urine.
A high level of uric acid in the blood is called hyperuricemia. Most people who have hyperuricemia do not always develop gout. However, gout may develop if uric acid crystals are formed.
Who can get gout?
The possibility of developing gout increases if you have the following risk factors:
- A family member who has the disease
- Men are more affected by gout than women
- Drinking too much alcohol on a regular basis
- Eating foods that are rich in purine
- Had an organ transplant
- Taking certain medications such as aspirin, cyclosporine, vitamin B3 or niacin, and levodopa
- Being overweight
- Chronic environmental exposure to lead
Symptoms of Gout
A gout attack may occur suddenly without any warning. For most people, it starts from the big toe, but it can also affect the ankles, fingers, knees, elbows, or wrists. The pain usually starts suddenly, which is then followed by a severe and intense discomfort.
The most common symptoms of gout include:
- Severe pain
- Stiffening of the joints
Stages of Gout
Gout develops in four stages and every stage has its own signs and symptoms. The four stages are:
- Asymptomatic Hyperuricemia: A person can have hyperuricemia (high uric acid level) without any apparent symptoms. Treatment may not be necessary at this stage, but the patient is advised to take into account all the possible factors that result in the buildup of uric acid in the body.
- Acute Gout: Acute gout occurs when the accumulated uric acids crystals suddenly cause inflammation and severe pain. It suddenly happens and is referred to as a "flare". The pain naturally disappears in the span of 3-10 days. Factors such as excessive drinking, increased stress levels, and cold weather might be the causes of the flare.
- Interval or Intercritical Gout: This stage occurs in between the attack of acute gout. Consecutive flares do not occur for months or even for years, but if not treated over time, they may occur more regularly. The reason is that more uric acid crystals are deposited into the tissues during this period.
- Chronic Tophaceous Gout: It is the most crippling form of gout. Permanent damage may occur in the different joints of the body or kidneys. The deformities seen due to joint destruction can be easily confused with other forms of arthritis such as rheumatoid arthritis. Moreover, the presence of tophi (deposits of uric acid crystals) in the joints is the hallmark of chronic gout.
Treatment and Diagnosis
Gout is a very tricky disease to diagnose as hyperuricemia can occur in most people, but does not necessarily mean that they will experience gout flare episodes. For this reason, a majority of these people do not develop gout.
A “joint fluid test” is a test carried out by doctors for the diagnosis and treatment of gout. A sample of the joint fluid is taken from the patient with the help of a needle and then examined to check if there are uric acid crystals. Aside from this test, blood tests are also performed to measure the level of uric acid in the blood. As previously mentioned, it is not necessary for people to experience gout even though they have high uric acid levels. It is also equally possible that some people might develop gout without having an elevated uric acid level in their blood.
Most gout cases are treated with medications. Certain types of drugs are used to prevent further gout attacks and to decrease the swelling and pain in the body.
The most commonly used medications for the treatment of gout include:
- NSAIDs (Nonsteroidal anti-inflammatory drugs)
- Colchicine (used within the first 12 hours of the attack)
These medications are usually taken orally. They work best on reducing inflammation.
Following dietary guidelines for gout should be considered to avoid developing gout or gout attacks:
- Maintain a balanced and healthy diet
- Maintain a healthy weight according to your body mass index (BMI)
- Avoid drinking too much alcohol
- Exercise regularly
- Visit your doctor for a proper checkup
- Avoid foods that are high in purine (meat, fish, and organ meats such as liver and kidneys)
Foods that Contain Purine
Another important thing to do is to avoid foods that contain purines. Eating a diet that is rich in purine is one of the major causes of gout. Some examples of gout-causing foods are:
- Beef kidneys
- Anchovies, sardines, and mackerel
- Dried beans and peas
- Game meat
Knee gout causes inflammation, severe pain, and redness of the knee joints. It most commonly attacks the big toe at the base. Uric acid gets accumulated and crystals are formed around the soft joint tissues. The crystals are usually formed in cold temperatures and mostly develop around the hands and feet.
The treatment of gout is the same as described above (i.e. taking a joint fluid sample and doing blood tests). Ice is also applied to the knee to lessen the pain and intense swelling. Steroids can also be taken to reduce the pain and swelling. If you are diagnosed with the disease, you should minimize weight-bearing activities and should give rest to your joints as much as possible.
If you suspect that what you are having is gout, try to schedule an appointment with your doctor to have a medical diagnosis. In most cases, people who have an early diagnosis of gout can live normally. To alleviate joint pains caused by the buildup of uric acid crystals, try changing your diet by avoiding foods that can trigger the increase of uric acid production in your body. Lifestyle changes and proper treatment are also essential to effectively recover from this disease.