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Gout

Gout

What Is Gout?


Inflammatory arthritis which starts with pain and swelling of the big toe is most likely caused due to gout. Gout is a common, yet preventable type of inflammatory arthritis that results from an excess accumulation of uric acid in the blood. While gout is chronic and progressive, there are medication options including nonsteroidal anti-inflammatory drugs and injections that can help relieve symptoms of this condition over time.

Uric acid is a by-product that occurs naturally within the body during digestion and the breakdown of certain foods (called purines) like red meat and seafood. While gout is hereditary, it affects men more frequently than women by a ratio of about 3 to 1.

Signs and Symptoms of Gout

One of the first signs that someone has gout is sudden pain in one or more joints. Gout usually affects the big toe first, but it can also cause pain in other joints, like the ankle, foot and knee. In severe cases of gout, a person may experience pain in the fingers or wrists. In addition to the pain in his joints, an individual with gout may also experience kidney stones and damage to his or her kidneys.

Gout symptoms almost always begin suddenly — often at night. The most common symptoms are:

  • Intense joint pain
  • Lingering discomfort
  • Inflammation and redness
  • Limited range of motion

What Causes Gout?

Gout occurs when urate crystals accumulate in your joints. This causes the sudden inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines, which are compounds that are naturally present in your body.

Purine-rich foods are particularly common in red meat and organ meats, such as the liver. Other foods high in purine include gravies, sardines, fish entrees such as scallops, mussels and tuna. Beer is also extremely high in purines, so it can be wise to limit your intake of alcoholic beverages if you're susceptible to gout attacks. Fruit containing drinks should also be avoided due to their high levels of fructose which can contribute to an imbalance.

Uric acid will normally dissolve in your blood and pass right through your kidneys into your urine with no problem. However, sometimes your body produces too much uric acid — or, conversely, your kidneys excrete too little uric acid. Uric acid builds up when this happens, forming sharp, needlelike urate crystals in a joint or surrounding tissue. This can cause intense, sudden pain, inflammation and swelling.

Who Is Most at Risk for Gout?

Men are 300% more likely than women to be diagnosed with gout. However, people with one or more of the following conditions are at a higher risk than average.

  • diabetes
  • kidney dysfunction
  • heart disease
  • high cholesterol
  • high triglycerides
  • obesity

In a nutshell, you're more likely to develop gout if you have high levels of uric acid in your body. The following factors can increase the uric acid level in your body — so managing these factors well can help mitigate your risk for gout.:

  • Diet. Eating a diet containing high-quality proteins and seafood rich in Omega3 fatty acids, accompanied by an adequate amount of fruit sugars may help to maintain a normal uric acid level, thus decreasing one's risk of experiencing gout. Moderate alcohol consumption will not increase the risk of developing this condition.
  • Weight. Extra weight puts a strain on your kidneys, which means your body produces more uric acid, making you more prone to gout attacks.
  • Medical conditions. Gout strikes people who are at risk more often than those without the condition. These risk factors include a family history of gout, untreated high blood pressure, chronic conditions such as diabetes and heart disease, as well as metabolic syndrome.
  • Age and sex. Gout affects predominantly men, as they are more likely to develop higher levels of uric acid in the blood than women. As such, gout is generally commoner in middle aged men but even a number of women have been affected by gout's symptoms later in life.
  • Recent surgery or trauma. Experiencing recent surgery or trauma can sometimes lead to gout problems. In some people, receiving a vaccination can trigger a gout flare.

How Is Gout Diagnosed?

Diagnosis of gout usually involves:

  • a physical exam of the joints
  • X-rays of affected joints
  • extraction synovial fluid of an affected joint to look for crystals of uric acid

At least 6 of the following 12 markers must be present to receive a definitive diagnosis of gout:

  • a tophus (urate crystal deposits in the joints or body)
  • an episode of arthritis in a single joint
  • a history of more than one such episode of arthritis
  • redness of the skin around a joint (erythema)
  • swollen or painful big toe joint (the metatarsophalangeal or MTP joint)
  • inflammation of the big toe joint on one foot only
  • inflammation of one or more midfoot joints on one foot only
  • rapid joint swelling that reaches a maximum level within a 24-hour period
  • elevated levels of uric acid in the blood
  • an X-ray showing uneven (asymmetric) swelling in a joint
  • an X-ray showing joint cysts or bone erosions without any indication of prior inflammation
  • joint inflammation where the joint fluid tests negative for infection

How Is Gout Treated?

Changes in diet and avoiding foods with high purine content reduces the inflammation and pain associated with gout. Your doctor may prescribe nonsteroidal anti-inflammatory drugs to reduce swelling, such as one of the following:

  • allopurinol
  • colchicine 
  • febuxostat 
  • lesinurad 
  • pegloticase 

Most people who suffer from gout attacks must take medication going forward.

If your doctor prescribes colchicine to prevent gout attacks and you have an attack while taking the drug, the attacks will return when you stop. If you are given allopurinol in order to reduce the blood's uric acid levels (to reduce gout attacks) or to reduce urine's uric acid levels (to reduce kidney stones), stopping treatment brings risk of attack and disease back up.

Whether you're taking medication for your gout or not, it's vital to limit your intake of foods high in purines. Studies have shown that even when medications fail to work, changing a patient's diet can significantly reduce the number of gout attacks they experience.

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