Gout: Symptoms , Causes and Treatment
Gout is an inflammatory disease of the joints, characterized by a sudden, acute pain syndrome in the first toe, with its redness and inability to step on the foot.
An attack of gout can occur suddenly, often in the evening. A characteristic sign of gout is inflammation of the big toe, but other joints may be affected.
Symptoms of Gout
- The attack of gout almost always occurs suddenly – more often at night or in the evening.
- Acute pain in the first toe, redness of the skin over the joint, severe swelling of it, inability to step on the foot.
- At the onset of the disease, an attack can last for several days and go away by itself. In the future, attacks can be repeated with different frequency. The more frequent seizures occur, the more their duration increases over time.
- The moments of the period without a spell are called “the light interval”. Such intervals become shorter with untreated gout.
- Also during the period of exacerbation, body temperature may rise to 38 degrees.
Causes of Gout
Gout occurs due to a long period of high levels of uric acid in the blood, which eventually accumulates in the joint in the form of urate crystals, which damage the synovial membrane and cause acute inflammation.
Uric acid is formed in our body, and also comes from outside in foods (such as meat from young animals and birds, fatty fish and seafood). Alcohol, sweet fruits and vegetables with a high content of fructose – block the excretion of uric acid, which helps to increase its level in the blood.
In the body, uric acid is dissolved and excreted by the kidneys with urine. But with various diseases, uric acid can accumulate in the body. Also, urate crystals settle in the kidneys and can lead to the development of urolithiasis, nephritis and the development of renal failure.
Gout risk factors
- Gender and age. Men are more likely to suffer from gout at the age of 30 to 50 years.
- Nutrition. The use of meat products, poultry, fatty fish and seafood, alcohol, especially beer and vodka, sweet fruits and vegetables, drinks with high fructose content.
- Diet or fasting. Can also cause a gout attack.
- Overweight. More associated with increased cholesterol.
- Taking drugs used to treat other diseases such as the diuretic, anticancer drugs, aspirin, etc.
- Chronic diseases: chronic kidney diseases, arterial hypertension, hyperlipidemia (high cholesterol in the blood without obesity).
- Hereditary predisposition: gout in blood relatives.
- Surgery or injury.
- Overheating or hypothermia. More often after a sauna.
- Increased gout attacks that are poorly controlled by non-steroidal anti-inflammatory drugs.
- Gouty status – a long attack of gout for more than 2 weeks, which is not completely stopped by non-steroidal anti-inflammatory drugs.
- Involving in the process not only the first toe but also other joints, more often the knee, ankle and small joints of the hands.
- The development of urolithiasis with the transition to renal failure.
- The development of hypertension in the background of kidney disease.
Objective examination: allows you to determine the number of affected joints, the presence of pain on palpation, swelling and redness of the skin over the inflamed joint.
Also, the doctor during the examination can reveal tophi on the ears (loss of uric acid crystals in soft tissues), less often tophi can be determined in the elbow and other joints.
Laboratory research methods
- Complete blood count: characteristic signs of inflammation.
- Biochemical analysis of blood: increasing the level of uric acid, cholesterol, and creatinine – not always.
- Urinalysis: the presence of sediment in the form of urate salts.
- Examination of the synovial fluid for the presence of uric acid crystals to confirm the diagnosis.
- Instrumental research methods
Ultrasound of the joints: to determine the presence of excess fluid in the joint, uric acid crystals in the joint.
Radiography of the joints: the early stage may not be informative, but over time there are characteristic changes in the bones that form the joint.
Computed tomography: a research method that allows the diagnosis to be confirmed in the early stages of gout.
At any stage of gout, the most effective therapeutic method is strict adherence to the anti-gout diet with the exception of meat and seafood, alcohol (especially vodka and beer, and others), sweet fruits and vegetables with high fructose content.
Drinking regimen is very important to reduce the concentration of uric acid in the blood and improve its excretion, the recommended volume of fluid to 2-2.5 liters per day in the absence of contraindications. Preferably alkaline drink (Luzhanskaya, Polyana, Borjomi, etc.) or water with lemon.
For the relief of gout attacks, nonsteroidal anti-inflammatory drugs are used for 10–14 days, with no contraindications to them. Long-term use of nonsteroidal anti-inflammatory drugs is undesirable because of the development of side effects.
You can also use colchicine, especially in the first 12 hours, then it will be ineffective. Colchicine is taken before the relief of an attack or until the development of side effects (in the form of diarrhea). For long-term treatment of gout, colchicine is not suitable because of its toxic effect on the liver.
With the ineffectiveness of nonsteroidal anti-inflammatory drugs or contraindications to them, glucocorticoids can be used for both short and long-term use.
Further, after the relief of an attack, medications are prescribed to reduce the level of uric acid in the blood, such as allopurinol
Also for the relief of gout attacks, modern treatment with immunobiological preparations in the form of subcutaneous injections is used: Claris (canakinumab), Kineret (anakinra).
Regular observation with a rheumatologist, nephrologist or urologist, cardiologist is necessary.
Help at home
With a sudden onset of gout, it is necessary to create complete peace of the inflamed joint, apply cold to the joint and in no case warm the joint!
Take anesthetic drug (paracetamol, ibuprofen) and contact a rheumatologist.
- Mainly for the prevention of the onset of gout attacks, diet, and balanced nutrition are used. The patient’s diet should contain whole grains, vegetables, cereals, dairy products with a low degree of fat. Restricting the intake of products containing fructose, oxalic acid, sugary carbonated beverages, and alcohol.
- Compliance with the drinking regime at least 2-3 liters per day of clean water, if there are no contraindications.
- Avoid fasting for weight loss. Because fasting can trigger a gout attack.
- Wearing narrow shoes to avoid traumatizing the first toes.
- Avoid hypothermia and overheating.