Gout symptoms include swelling, redness and warmth of the affected joint. Gout is an acute and painful inflammation in a joint, often in the big toe or foot, but gout can also occur in other joints such as the foot, ankle, knee, wrist and elbow. The inflammation heals within one to three weeks. After a while, a new attack may occur. More than three gout attacks per year are considered chronic gout. You may also experience gout nodules in this phase. Gout is a rheumatic disease. Gout mainly affects men, most of whom have their first attack between the ages of 40 and 50. Women often suffer from it after menopause. Gout can be treated with medication. Lifestyle and diet changes can also help with gout.
- Gout: acute inflammation of joints
- Cause of gout
- Risk factors
- Nutrition and diet
- Overweight or obesity
- Medical conditions
- Use of certain medications
- Family history of gout
- Age and gender
- Recent surgery or trauma
- Exposure to heavy metals
- Symptoms of gout
- Stages of gout
- Complications
- Recurrent gout
- Gout nodules (tophi)
- Kidney stones
- Diagnosis and research
- Gout treatment
- Preventing gout attacks
- Nutrition and gout
- Celery
- Vitamin C
- Cherries
- Other
- Antigout drug associated with lower heart attack risk
- Link between gout and type 2 diabetes
Gout in foot (big toe) / Source: Manu5, Wikimedia Commons (CC BY-SA-4.0)
Gout: acute inflammation of joints
Gout (arthritis urica) is an acute inflammation of the joints (weight inflammation), usually the base joint of the big toe. The inflammation heals within one to three weeks. After a while, a new attack may occur. More than three gout attacks per year are considered chronic gout.
What is gout?
Gout is a rheumatic disease in which uric acid crystals deposit in the joints. This is because the metabolism in the body does not run properly, causing uric acid to accumulate.
Cause of gout
Gout is a condition caused by uric acid crystals from the blood depositing in joints. This causes an inflammatory response in the joint. Uric acid is a product of metabolism, a breakdown product of DNA and proteins, and is normally excreted in the urine. People with gout either produce too much uric acid or, more commonly, their bodies have a problem removing it. There are a number of possible consequences of this accumulation of uric acid in the body: the disease manifests itself in joints (gout-arthritis) or skin and kidneys (urate stones). Gout can occur alone (primary gout) or can be associated with other medical conditions or medications (secondary gout).
Excessive alcohol consumption can trigger gout / Source: Istock.com/Csaba Deli
Risk factors
However, the precise cause of gout is unknown. There are a number of factors that increase the risk of gout. You are more likely to develop gout if you have high levels of uric acid in your body. Factors that increase uric acid levels in your body include:
Nutrition and diet
Eating foods high in purines, such as meat and fish, can cause or worsen gout in some people. A diet containing a lot of organ meat or red meat (proteins) is a risk factor in particular. Drinking drinks sweetened with fruit sugar (fructose) also promotes higher levels of uric acid, which increases the risk of gout. Alcohol consumption, especially beer, also increases the risk of gout.
Overweight or obesity
If you are overweight and overweight, your body produces more uric acid and your kidneys have a hard time breaking down uric acid, increasing the risk of gout.
Gout / Source: ThamKC/Shutterstock.com
Medical conditions
Certain diseases and conditions make it more likely that you will develop gout. This mainly concerns untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, heart disease and kidney disease.
Use of certain medications
Gout can also be a side effect of certain medications, such as water tablets.
Family history of gout
Hereditary factors may play a role in the risk of gout. If other members of your family have had gout, you are more likely to develop the disease.
Age and gender
Gout is more common in men, mainly because women often have lower uric acid levels. However, after menopause, women often have the same levels as men. Men are more likely to develop gout earlier, often between the ages of 30 and 50, while women often experience it after menopause.
Recent surgery or trauma
A recent surgical procedure or trauma is associated with an increased risk of developing gout.
Exposure to heavy metals
Exposure to lead and other heavy metals, such as cadmium, are a risk factor.
Symptoms of gout in the foot / Source: Cnick, Pixabay
Symptoms of gout
The first symptom of gout is the sudden onset of a warm, red, swollen and painful joint (arthralgia). The most common place where gout manifests itself is the big toe, but some patients also suffer from other joints such as the foot, ankle, knee, wrist and elbow. In some people, the acute pain is so intense that the slightest touch causes severe pain.
Course
While the pain and swelling go away completely, gout almost always returns in the same joint or in a different joint. Gout may become more common and last longer over time. While the first attacks usually involve only one or two joints, over the years several joints can become inflamed at the same time. Regular attacks of gout can lead to joint damage, but also to kidney damage as uric acid crystals can deposit in the kidneys and urinary tract in the form of kidney stones. Therefore, early detection and treatment with medications is necessary.
Stages of gout
Gout is often divided into four stages or phases:
| Phase | Description |
| Stage 1: Asymptomatic hyperuricemia | Asymptomatic means ‘without symptoms’. At this stage, a person has elevated levels of uric acid in the blood (hyperuricemia), but no other symptoms. Treatment is usually not required. It is advisable to make sure that you keep a close eye on the amount of purine in food. |
| Phase 2: Acute Arthritis Gout | At this stage, uric acid crystals are formed in the joints. The immune system responds by releasing white blood cells that burst due to the pointed shape of the crystals, causing proteins to leak from these cells, causing inflammation with severe pain and swelling of the joints, which are also warm and very sensitive . An acute attack often occurs at night and can be caused by stressful events, alcohol or drug use, or the presence of another illness. The attacks usually disappear within 3 to 10 days even without treatment and the next attack may occur months or even years later. Over time, attacks may last longer and become more frequent. |
| Stage 3: Recurrent/interval gout | This is the period between acute attacks. At this stage you have no symptoms. It can take a long time before another gout attack occurs, months to years. |
| Stage 4: Chronic Gout Nodules or Joint Nodules (tophi) | This is the most disabling stage of gout. It usually develops over a longer period of time, such as ten years. At this stage, the disease can cause permanent damage to the affected joints. The gout often spreads to several joints and white lumps may develop under the skin (tophi). There is also an increased risk of developing kidney stones and kidney disease. With proper treatment, most people with gout do not progress to this chronic stage. |
Complications
People with gout can develop more serious conditions, such as:
Gout / Source: James Heilman, MD, Wikimedia Commons (CC BY-SA-4.0)
Recurrent gout
Some people never suffer from a gout attack again, while others may be attacked by a gout attack several times a year. Medications can help prevent gout attacks from occurring in people with recurring gout. Untreated gout can lead to erosion and destruction of a joint.
Gout nodules (tophi)
Untreated gout can cause deposits and accumulations of urate crystals under the skin, causing lumps known as ‘tophi’. Tophi can develop in various areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi are usually not painful, but they can be swollen and tender during gout attacks.
Kidney stones
Urate crystals can collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones, as can dietary changes.
CT scan / Source: IStock.com/Pavel Losevsky
Diagnosis and research
The doctor can perform various tests to make the diagnosis:
- A joint puncture, in which some joint fluid is aspirated through a needle. (Reduction of fluid from an inflamed joint, for example fluid in the knee.) This is examined under the microscope for uric acid crystals;
- Blood tests: with gout the uric acid may be increased, although during an attack the uric acid is often decreased. Blood tests in themselves are therefore not sufficient to make the diagnosis;
- X-ray examination may be useful to rule out other causes of joint inflammation and to see whether the gout has also caused damage to the joints;
- Ultrasound can sometimes help make the diagnosis; and
- A special CT scan (DECT scan) is sometimes necessary to make the diagnosis.
Differential diagnosis
The following conditions may be very similar in appearance to gout:
- cellulite;
- nephrolithiasis (the formation of stones in the kidneys);
- pseudogout;
- rheumatoid arthritis; and
- septic arthritis.
Treating gout with medications / Source: Stevepb, Pixabay
Gout treatment
Fortunately, there are effective medications to treat gout. In case of a gout attack, anti-inflammatory drugs such as diclofenac, naproxen or ibuprofen can be used. If this offers little relief, colchicine can reduce pain and inhibit inflammation if necessary. As a ‘ultimum remedy’, corticosteroids can be injected into the joint to inhibit inflammation.
Chronic gout
: Three or more attacks per year are referred to as chronic gout and it may be advisable to take daily and long-term medications that lower the uric acid level in the blood, such as allopurinol or probenicide.
Preventing gout attacks
The patient can prevent a new attack of gout by observing the following rules of life:
- combating obesity;
- avoiding alcohol;
- a healthy, low-fat diet high in carbohydrates and low in protein to reduce uric acid production;
- drink at least two liters of water daily, which promotes the removal of uric acid from the body;
- sufficient exercise daily;
- If necessary, replace medications that can trigger attacks in consultation with your GP.
Celery good against inflammation / Source: Istock.com/Lecic
Nutrition and gout
Celery
The components in celery work very well against inflammation. The substances polyacetylene and luteolin found in celery are powerful anti-inflammatory agents. If you suffer from gout, eating celery or drinking celery juice can provide relief from the symptoms.
Vitamin C
Vitamin C supplements can lower the levels of uric acid in your blood. However, research does not indicate that vitamin C affects the frequency or severity of gout attacks. You can also increase your vitamin C intake by eating more fruits and vegetables, especially oranges.
Cherries
Cherries are associated with lower levels of uric acid, as well as a reduced number of gout attacks. Eating more cherries and drinking cherry extract is a good addition to regular gout treatment, but discuss it with your doctor first.
Other
Antigout drug associated with lower heart attack risk
allopurinol , which inhibits the conversion of purine to uric acid, to treat the symptoms of gout , have a relatively slightly reduced risk of a heart attack compared to control patients who do not take the drug. French researchers state this in Annals of the Rheumatic Diseases based on a large case-control study (2015;74:836-42).
Link between gout and type 2 diabetes
Gout patients also often suffer from type 2 diabetes, according to a new study published in the British Medical Journal. The risk of diabetes is especially high in female gout patients. They are twice as likely to develop this as women without this joint inflammation. Gout does not cause diabetes. The clear connection can possibly be explained by the common risk factors or the continuous presence of inflammation in the body that is associated with gout. (Source: NU.nl, October 8, 2014)
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