Gout (Gouty Arthritis): Symptoms, Causes, Diagnosis & Treatment

Gout, also known as Gouty Arthritis, is a disorder resulting from crystallization of uric acid in joints with a subsequent inflammatory reaction by neutrophils. It is a metabolic disorder characterized by hyperuricemia (normal plasma urate 2–6 mg/ dl). Uric acid has low water solubility, especially at a low pH. When blood levels are high, uric acid precipitates and deposits in joints, kidneys and the subcutaneous tissue (tophi).

Gout therapies either relieve acute symptoms or reduce the risk of gout attacks by lowering uric acid pool. The therapies for acute and chronic gout must not be confused with. For example, colchicine is not an appropriate therapy for the management of chronic gout. Likewise, allopurinol is an ineffective treatment for an acute Gouty Arthritis attack.

Older males are most commonly affected, and it is estimated that more than 10 million cases are reported in India annually. It has become more common in recent decades and is believed to be due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy, and changes in diet.

An attack of Gouty Arthritis can occur suddenly. A person feels intense joint pain especially in the joint of the big toe. The pain becomes adverse within 4 to 12 hours after it begins.

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How Does Gout Affect Your Body?

Gout affects the joints in the feet, legs or arms. Initial attacks often occur in a single joint in the foot. Over time, sudden outburst grows in frequency, pain and joint numbers.

Gouty Arthritis is a progressive disease. Without treatment, it can cause joints to become immobile and builds up uric crystals (tophi) in the skin and other organs, including the kidneys.

What Are The Causes of Gout?

Gout occurs when urate crystals accumulate in the joints, causing inflammation and intense pain of gout attack. Urate crystals are formed when there is a high level of uric acid in the blood, and the body produces uric acid when it breaks down purines. Purines are produced naturally in the body and are also found in certain foods such as steak, organ meats, and seafood. Other foods like alcoholic beverages, especially beer, and drinks sweetened with fruit sugar, also promote higher levels of uric acid.

Uric acid dissolves in the blood and passes through kidneys into the urine. But sometimes overproduction of uric acid or little excretion of uric acid can build up. This further leads to the formation of sharp, needle-like urate crystals in a joint or surrounding tissue that causes pain, inflammation, and swelling.

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What Are The Risk Factors of Gout?

  • Male sex – Gout occurs more often in men because women tend to have lower uric acid levels.
  • Hypertension
  • Obesity – Body produces more uric acid when a person is overweight because of which kidneys have a more difficult time eliminating uric acid.
  • Diabetes
  • Dyslipidemia
  • Hyperuricemia – The strongest risk factor is hyperuricemia, which can be caused by:
  • Underexcretion of uric acid (90% of patients) — largely idiopathic, potentiated by renal failure; can be exacerbated by certain medications (e.g., thiazide diuretics).
  • Overproduction of uric acid (10% of patients) — Lesch-Nyhan syndrome, PRPP excess, cell turnover (e.g., tumor lysis syndrome), von Gierke disease.
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What Are The Symptoms of Gout?

  • Intense joint pain – Gout usually affects the large joint of the big toe, but can also occur in any joint. The pain is severe within the first 4 to 12 hours after it begins.
  • Lingering discomfort – After the severe pain subsides, joint discomfort may last from a few days to a few weeks, which is likely to last longer and affect more joints.
  • Inflammation – The affected joints become swollen, tender, warm and red.
  • Limited range of motion – Progression of gout can make it difficult to move the joints normally.

How is Gout Diagnosed?

The tests that are conducted to help diagnose Gouty Arthritis include:

  • Joint fluid test – This is done to draw fluid from the affected joint for examining urate crystals.
  • Blood test – It is done to measure the levels of uric acid and creatinine in the blood. Sometimes, the blood test results can be misleading. Some people have high uric acid levels, but never experience gout while some have signs and symptoms of gout, but don’t have unusual levels of uric acid in their blood.
  • X-ray imaging – Joint X-rays are helpful to rule out other causes of joint inflammation.
  • Ultrasound – Musculoskeletal ultrasound can detect urate crystals present in a joint or in a tophus.
  • Differential diagnosis – Differential diagnosis is considered in those cases which show signs of infection or no improvement with treatment.
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How to Prevent And Control Gout?

  • Drink plenty of fluids to stay hydrated. However, limit sweetened beverages, especially those sweetened with high-fructose corn syrup.
  • Limit or avoid alcohol consumption. Beer is likely to increase the risk of gout symptoms, especially in men.
  • Include low-fat dairy products in the diet. It may actually have a protective effect against Gouty Arthritis.
  • Limit the intake of meat, fish, and poultry.
  • Maintain a constant body weight as losing weight may decrease uric acid levels. However, avoid fasting or weight loss, since doing so may temporarily raise uric acid levels.

Treatment of Gout – Allopathic Treatment

Chronic gout drugs (preventive):

  • Probenecid – Inhibits reabsorption of uric acid in proximal convoluted tubule (also inhibits secretion of penicillin). Can precipitate uric acid calculi.
  • Allopurinol – Limits the amount of uric acid the body makes. This may lower blood’s uric acid level and reduce the risk of Gouty Arthritis.
  • Pegloticase – Recombinants uricase catalyzing uric acid to allantoin.

Acute gout drugs:

  • NSAIDs – These are first-line therapies for acute gout attacks, particularly indomethacin. These drugs act by reducing the inflammation associated with gout.
  • Colchicine – Colchicine inhibits neutrophil mobility and activity, thereby quickly reducing the joint inflammation associated with gout attacks. Colchicine’s major limitation is its toxicity. Although highly effective in relieving acute Gouty Arthritis attacks, the drug has a narrow therapeutic index. The most common adverse effects include gastrointestinal upset and neutropenia. An overdose of colchicine can be life-threatening.
  • Intra-Articular Injection of Corticosteroids Glucocorticoids – This is nearly as effective as NSAIDs in relieving acute gouty attacks. Steroids can be injected directly into the affected joint.
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Treatment of Gout – Homeopathic Treatment

  • Colchicum – This is the primary homeopathic medicine for treating gout and is mostly used in chronic cases of gout. Patients who require this medicine should keep away from warm weather conditions also used in case of increased weakness and internal cold.
  • Ledum Pal – This medicine is used when the pain travels from the feet and gradually moves upwards, affecting the knees and the legs. Small joints are commonly affected and there is a sensation of decreased warmth in the joints and in the body. The pain improves with cold application.
  • Benzoic acid – This medicine is used for treating Gouty Arthritis when urine has a strong repulsive odor which can be detected from a distance and the color of the urine is brown. Extreme pain is experienced in the big toe and the knees swell up.
  • Antim Crudum – It is used when experiencing gastric symptoms along with joint pain and inflammation. The patient may develop an increased craving for food which causes problems due to overeating. Pain is usually experienced in the heels and fingers.
  • Sabina – This medicine is important for treating Gouty Arthritis in women, especially when the patient already suffers from another female disorder. Uterine symptoms are experienced along with the symptoms of gout. The joints swell, look red and shiny, and the pain is experienced in the toes and heels.

Gout – Lifestyle Tips

  • Limit consumption of alcohol and drinks that contain fruit sugar.
  • Drink plenty of water and stay hydrated.
  • Limit the intake of food high in purines like red meat, organ meats, and seafood.
  • Exercise regularly and maintain a healthy weight.

What Are The Recommended Exercises For a Person With Gout?

  • Walking
  • Swimming
  • Yoga

Gout And Pregnancy – Things to Know

  • Gout during pregnancy is rare. However, women are at a higher risk of developing gout while pregnant.
  • This may be associated with an increased risk of pregnancy complications and adverse outcomes.
  • Gaining weight during pregnancy may cause uric acid to accumulate in joints. However, one must not try to lose weight during pregnancy.
  • It is advised to focus on healthy eating and gaining an appropriate amount of weight during pregnancy.
  • Complete reliance on medicines while pregnant is not suggested. It is better to achieve optimal uric acid levels via lifestyle and dietary changes.

Common Complications Related to Gout

  • Some people may never experience gout symptoms while others may experience gout several times each year. If left untreated, gout can cause erosion and destruction of the joints.
  • Untreated Gouty Arthritis may cause deposits of urate crystals to form under the skin in nodules called tophi.
  • Urate crystals may collect in the urinary tract of people with gout, which further causes kidney stones.

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