Gout — Know It All!

All you need to know about Gouty Arthritis.

Know your ailment well, so you can manage it better!!

Here we come with Gout today!

What is Gout?

Gout is also known as Gouty Arthritis.

Gout is a type of inflammatory arthritis that causes pain and swelling in your joints, usually in the form of flares that last a week or two and then resolve. Gout flares frequently originate in your lower limb or big toe. Gout occurs when high serum urate levels build up in your body, which can then form needle-shaped crystals within and around the joint. That leads to joint inflammation and arthritis. When the body absorbs too much urate, or retains too little, amounts of urate build up within the body. But even people with elevated serum urate levels aren’t going to develop gout.

Areas of the body that can be affected by gout include:

• Joints.
• Bursae, cushion-like sacs between bones and other soft tissues.
• Tendon sheaths, membranes that surround tendons.
• Kidneys, because the high uric acid levels can lead to stones and sometimes kidney damage.

Gout is a disease that can move through several stages:

• Hyperuricemia, when you have elevated levels of urate in your blood and crystals are forming in the joint, but you do not have symptoms.
• Gout flares, when you have an attack of intense pain and swelling in your joints.
• Interval or intercritical gout, which is the time between gout attacks when you do not have any symptoms.
• Tophi, a late stage of gout when crystals build up in the skin or other areas of the body. Depending on their location, tophi can permanently damage your joints and other internal organs such as the kidneys. Proper treatment can prevent the development of tophi.

Gout is one of the most controllable types of arthritis, with early diagnosis , treatment, and lifestyle changes. Many people prevent gout flares and may reduce the severity of their symptoms, and may even become gout-free.

What are the symptoms of Gout :

Gout signs and symptoms almost always appear all of a sudden, most sometimes at night. Including:

• Intense Joint Pain: Gout usually affects your big toe ‘s broad joint but it can happen in any joint. The feet, knees, elbows, wrists, and fingers are most frequently affected joints. The pain will generally be most intense within the first four to twelve hours after it starts.
• Lingering Discomfort: Some joint malaise may last from a few days to a few weeks after the most intense pain subsides. Most likely later attacks would last longer and impact more joints.
• Inflammation and Redness: The affected joints get swollen, sore, warm and red.
• Limited Range of Motion: As gout progresses, the joints may not be able to function normally.

Typically such symptoms and signs involve a single joint. Usually, the pain is intense which indicates the severity of the joint inflammation. The affected joint is often very sensitive to touch to the point where some people with gout attacks experience pain from something as easy as raising the bedsheets above the inflamed joint. The impacted joint gets swollen. “Joint effusion” is the medical term for excessive fluid in a joint.

In the lower extremities Gout also includes joints. The classic position to occur in gout is the big toe (first metatarsophalangeal joint). Podagra at the base of the big toe is the medical word for inflammation. Gout can also impact your foot, knee, hip, elbow , wrist, neck, or almost any body joint. Multiple joints may be affected at the same time when gout is more severe or chronic. In several joints this induces inflammation and joint stiffness.

The presence of tophi is just another symptom of gout. A tophus is a strong nodule of uric acid depositing below the surface. Tophi can be found in different places in the body, usually on the knees, the upper ear cartilage, and other joints. When there is a tophus it means that the body is greatly overwhelmed with uric acid. Typically for years the uric acid level in the bloodstream has been high when tophi are present. Tophaceous gout indicates the presence of tophis, and prescription treatment is needed.

Untreated gout long can result in joint damage and physical deformity.

Kidney stones can be a symptom of gout, as crystals of uric acid can lodge into the kidney and cause kidney stones.

What Causes Gout?

Gout happens when your joint accumulates urate crystals, which causes the inflammation and extreme pain of a gout attack. Urate crystals can develop when the uric acid in your blood is high.

Your body releases uric acid as it breaks down purines — substances naturally present in your body.

Purines are also present in certain foods, including steaks, organ meats, and fish. Other foods also promote higher levels of uric acid, such as alcoholic drinks, especially beer, and fruit-sweetened drinks (fructose).

Uric acid usually dissolves in the blood and flows through your urine through your kidneys. But either your body produces too much uric acid, or your kidneys excrete too little uric acid, sometimes. As this occurs, uric acid may build up in a joint or surrounding tissue, forming sharp, needlelike urate crystals that cause pain , inflammation and swelling.

What are the complications of Gouty Arthritis?

People with gout can develop other severe conditions, like the following:

• Recurrent Gout. Some individuals can never again encounter signs and symptoms of gout. Others can experience gout several times a year. Medications in people with chronic gout can help prevent gout attacks. Untreated gout can cause joint erosion and damage if left untreated.
• Advanced Gout. Untreated gout can cause urate crystal deposits to form in nodules called tophi below the skin. Tophi can grow along the back of your ankles in many places, including your toes, palms, feet, elbows or Achilles tendons. Tophi normally aren’t painful but during gout attacks they can get swollen and tender.
• Kidney Stones. Urate crystals can accumulate gout in people’s urinary tract, causing stones in their kidneys. Drugs can help lower the risk of kidney stones.

What are the risk factors of Gout?

If you have elevated levels of uric acid in your body you are more likely to develop gout. Factors which increase the level of uric acid in your body include:

• Diet. Eating a diet rich in meat and fish, and consuming sweetened drinks with fruit sugar (fructose), raises uric acid levels, which increases the risk of gout. Drinking alcohol, especially from beer, also increases the risk of gout.
• Obesity. If you are overweight, your body will produce more uric acid and your kidneys will have a tougher time removing uric acid..
• Medical Conditions. Your risk of gout increases with some diseases and conditions. That include untreated hypertension and chronic disorders such as diabetes, metabolic syndrome and heart and kidney disease.
• Certain Drugs. Usage of thiazide diuretics — widely used for treating hypertension — and low-dose aspirin can also raise levels of uric acid. And the use of prescription anti-rejection medications for people who have undergone an organ transplant.
• Family history. If other family members have had gout, you will develop the disease more likely.
• Age and Sex. Gout occurs more often in men mostly because women appear to have lower levels of uric acid. However, after menopause the uric acid levels of women exceed those of men. Men are often more likely to develop gout earlier — typically between 30 and 50 years of age — while women normally show signs and symptoms following menopause.
• Recent Surgery Or Trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing a gout attack.

Who Develops this disease?

• Lots of people are developing gout. It’s more popular amongst men than among women. Gout typically occurs in medieval times. Women may not usually experience gout prior to menopause, which is why women appear to experience the disease later than men. Rarely, the disease occurs in younger people; but, if they do, the disease appears to be more severe.

How is Gout Diagnosed?

Diagnosis of gout can be complicated, since the symptoms are identical to various conditions. Your health care provider can help diagnose gout:

• Joint Fluid Test: Your health care provider may use a needle to draw fluid from your injured joint. Urate crystals can become visible when a microscope examines the fluid.
• Blood Test: Our physician can prescribe a blood test to measure uric acid and creatinine levels in your blood. But the findings of blood tests can be deceptive. Some people do have elevated levels of uric acid but never gout. And some people have gout signs and symptoms, but don’t have elevated blood levels of uric acid.
• X Ray Imaging Tests: Joint X-rays can help to rule out other sources of inflammation in the joint.
• Ultrasound: Uranium crystals can be detected by musculoskeletal ultrasound in a joint or tophus. In Europe this technique is used more commonly than in the United States.
• Dual Energy CT Scan: This form of imagery can detect the presence of urate crystals in a joint, even though it is not inflamed intensely. Because of the cost, this test is not commonly used in clinical practice, and is not widely available.

What is the Treatment of Gout?

Gout care generally includes drugs. May medicines you select with your doctor will be based on your current health and your own preferences.

Gout drugs may be used to treat acute attacks and to stop potential attacks. Medicines can also reduce the risk of gout complications, such as urate crystal deposits forming tophi.

Medications to treat gout attacks:

Drugs for treating acute attacks and for preventing potential attacks include:

NSAIDs: Over-the-counter NSAIDs include options such as ibuprofen and naproxen sodium, as well as more effective NSAIDs such as indomethacin or celecoxib.To stop an acute attack, your doctor can prescribe a higher dose, followed by a lower regular dose to avoid future attacks. NSAIDs bear the risk of pain, bleeding and ulcers in the stomach.

Colchicine: Your doctor can prescribe colchicine (Colcrys, Mitigare), a form of pain reliever that reduces gout pain in an effective way. However, the efficacy of the medication can be offset by side effects such as nausea , vomiting and diarrhea, especially when taken in large doses.Your doctor can prescribe a small daily dose of colchicine after an acute gout attack resolves to prevent future attacks.

Corticosteroids: Corticosteroid drugs, such as prednisone, can regulate inflammation and pain in the gout. Corticosteroids can be in the form of a tablet, or can be inserted into the joint.

In general, corticosteroids are only used in people with gout who can not take either NSAIDs or colchicine. Corticosteroid side effects may include mood swings, elevated blood sugar levels and increased blood pressure.

Medications to prevent gout complications:

If you experience multiple gout attacks each year, or if your gout attacks are less frequent but especially painful, your doctor can prescribe medication to reduce your risk of complications associated with gout. If you already have signs of gout damage on joint X-rays, or if you have tophi, chronic kidney disease or kidney stones, medicines might be prescribed to reduce uric acid levels in your body. Facilities include:

Medications that block uric acid production:

Drugs called xanthine oxidase inhibitors (XOIs), which include allopurinol and febuxostat , reduce the amount of uric acid that your body releases. This will reduce uric acid levels in your blood and decrease the risk of gout.

Allopurinol’s side effects include a rash, and low blood counts. The side effects of febuxostat include rash, nausea, decreased liver function and increased risk of heart disease.

Medication that improves uric acid removal: These medications include probenecid and lesinurad , which are also uricosurics. Uricosuric drugs boost the capacity of your renals to expel uric acid from your body. This may lower your levels of uric acid and lower your risk of gout but the amount of uric acid in your urine will increase. Side effects include a rash, kidney stones and stomach pain. Lesinurad can only be taken along with an XOI.

Coping with the disease:

There are many things you can do to help manage gout. You can make some lifestyle changes to help you have fewer gout flares and manage your symptoms, such as:

Losing weight. If you are overweight or obese, losing weight through a reduced-calorie diet and increased exercise helps reduce urate levels, which can help stop or lower the number of flares you have.

Making diet changes to help reduce blood urate levels and gout flares, such as:

• Drinking fewer alcoholic beverages. This includes nonalcoholic beer.
• Avoiding drinks that have high-fructose corn syrup, such as soda.
• Avoiding red meats and organ meats (liver, kidney, tongue, and sweetbreads) that are higher in purines and may increase the risk for other health conditions.
• Avoiding seafood, such as shellfish (shrimp and lobster), sardines, and anchovies.

Under the Dietary Stop Hypertension Approaches (DASH) eating strategy. This diet is particularly useful for the many gout patients who often suffer from high blood pressure. The DASH eating plan may help to alleviate high blood pressure and may help lower blood urate levels. By reducing the urate levels this technique may help avoid gout flares.

The DASH eating plan includes:

• Eating plenty of vegetables, fruits, and whole grains.
• Eating low-fat or fat-free dairy products, poultry, and oils.
• Limiting foods high in saturated fats.
• Limiting sugar-sweetened foods and drinks.

When gout is associated with regular flares or tophi, improvements in lifestyle alone are not enough to control gout, and medication to reduce levels of urate in your blood is the foundation of gout management. Taking the drugs your doctor frequently prescribes for this purpose is the secret to minimizing the incidence of gout flares and minimizing or decreasing tophi. Nevertheless, it is also important to maintain good weight and diets to help minimize the risk of cardiovascular problems, which are common among gout patients.

References:

https://www.niams.nih.gov/health-topics/gout/

https://www.medicinenet.com/gout_gouty_arthritis/article.htm

https://www.mayoclinic.org/diseases-conditions/gout/diagnosis-treatment/drc-20372903

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.