At a glance:
- Gout is a common type of arthritis typified by the sudden onset of inflammation and intense pain
- It is caused by the buildup of uric acid (urate) crystals in the joints leading to pain and swelling
- Uric acid is produced when the body breaks down chemical compounds known as purines that are found naturally in the body as well as in food
- A diet high in purines, products high in fructose (like soft drinks), alcohol consumption, diabetes and some medication may all increase the risk of developing gout
- Men are around three times more likely than women to develop gout
What is Gout?
Gout is a common form of arthritis that is characterised by a sudden and intense onset of pain, inflammation and tenderness of joints caused by a buildup of uric acid (urate) crystals. The joint at the base of the big toe is often the first joint to experience gout, but any joint may be affected.
An attack of gout may occur at any time, from when you’re walking around or performing day to day activities to when you are asleep. No matter when the attack occurs, the pain is intense and often described as burning. The tenderness of the affected joint is such that the weight of a bed sheet may be excruciating, let alone trying to walk around.
Any joint may be affected by gout, but it is most common in the big toe, but it may also appear in the midfoot, ankles, knees, elbows and hands. It is one of, if not the most common form of inflammatory arthritis. Men are around three times more likely to develop gout than women, with men over 40 and women post menopause being the most at risk groups. The incidence and severity of gout are increasing and starting at an earlier age.
Symptoms of Gout
One of the major differentiating factors between gout and other forms of arthritis is the speed at which it presents. Most forms of arthritis develop slowly, with people only experiencing mild symptoms in the early stages. Gout is marked by its sudden and intense onset.
In addition to sudden, intense, burning pain, gout may also cause a number of other symptoms, including:
- Lingering pain - even when the sudden, intense pain subsides, pain may linger in the joint for days or even weeks after an attack. The intensity and duration of the lingering pain may increase with each attack of gout.
- Inflammation and tenderness - the affected joint may be red and inflamed and extremely tender to the toughch. The joint may radiate heat and be so sensitive that pressure from clothing or a bed sheet may be excruciating.
- Limited motion in the affected joint - as gout progresses, someone with the condition may experience reduced motion in the affected joint, even between attacks.
- Interrupted sleep - pain from gout may easily interrupt sleep. There are a few reasons that people may experience gout attacks during sleep. During slumber, the body temperature drops slightly, helping to catalyse the formation of urate crystals in joints. During sleep, the body also absorbs some of the water that is in the synovial fluiddehydration is common, which can increase the blood concentration of uric acid, which is then deposited in joints as (a friction reducing liquid found in some joints), but leaving any built up uric acid crystals.
In addition to the pain of attacks, having gout may lead to a number of complications, such as:
- Recurring attacks - while some people may only ever experience a single attack of gout and never experience the symptoms again, others may find themselves experiencing attacks multiple times a year, or acute gout. Frequent untreated attacks may cause erosion or damage of the affected joint.
- Tophi - if left untreated, gout may lead to urate crystals being deposited under the skin, forming nodules known as tophi. These nodules typically form in areas such as the fingers, hands, achilles tendon, feet and elbows. TWhile the tophi may not cause pain or discomfort by themselves, they may become inflamed and tender during an attack of gout.
- Kidney stones - in addition to collecting in joints, urate crystals may also collect in the urinary tract leading to the development of kidney stones.
What Causes Gout?
The body produces uric acid when breaking down purines, an organic compound found naturally in the body as well as a number of foods. Typically uric acid is filtered out of the blood by the kidneys and excreted in urine or faeces.
If the kidneys don’t filter enough uric acid from the blood, or for some other reason the body processes too many purines, this leads to a condition known as hyperuricemia (high levels of uric acid in the blood). In some people, this leads to the uric acid becoming deposited in joints and forming sharp, needle-like crystals in the joints or surrounding tissue leading to inflammation and intense pain.
A number of factors may increase the risk of hyperuricemia and gout, including:
- Age - men between 30 and 50 and women over the age of menopause are more likely to develop gout.
- Alcohol consumption - heavy alcohol consumption, especially beer, increases your chance of developing gout.
- Diet - eating a diet high in red meat, seafood or products high in fructose (fruit sugars) may increase levels of uric acid in the blood and risk of developing gout.
- Medical Conditions - diabetes, heart disease, Sleep apnea, liver disease and high blood pressure may all increase your chances of developing gout.
- Medications - some medications taken for hypertension (thiazide diuretics), frequent, low level aspirin usage and antirejection drugs used for people with organ transplants may all increase the amount of uric acid in the body.
- Obesity - being obese causes the body to produce extra uric acid as well as decreases the efficiency with which your kidneys filter uric acid.
- Recent surgery or trauma - recent surgery or trauma may be linked to increased instances of gout attacks.
- Sex - men are around three times more likely to develop gout than women.
If you’ve experienced sudden, intense, burning pain in your big toe, don’t ignore it - book an appointment with a podiatrist .
Treatment for Gout
Gout may be prevented or attacks limited by adopting a gout friendly healthy diet. Before entering into any diet they should be discussed with a doctor or dietician, but a gout prevention, low purine diet typically includes dietary changes such as:
Limit alcohol intake but drink plenty of other fluids (especially water)
Alcohol may increase production of uric acid but staying well hydrated may help flush uric acid from the blood.
Limit red meat, fish and poultry consumption
Meat, poultry and seafood contain high levels of purines, so limiting consumption may help limit uric acid production. Low fat dairy products may offer a good alternative, low purine protein source.
Maintain a healthy weight
A gout diet may also involve weight loss.
A number of medications are used to treat gout, both during attacks and to prevent attacks or complications. Commonly used medications include:
Non-steroidal Anti Inflammatory Drugs (NSAIDS)
Both over the counter NSAIDS (such as ibuprofen) as well as stronger prescription drugs may be used to ease pain during an attack.
Colchicine
A pain reliever proven to effectively control gout pain. Colchicine may also be used in small doses to reduce the chances of recurring attacks. Unfortunately the drug has a number of possible side effects including nausea, vomiting and diarrhea.
Corticosteroids
Typically only used on people who may not be able to take NSAIDS or Colchicine , corticosteroids may be administered either in pill form or as an infection. Prednisone and other corticosteroids may effectively treat inflammation and pain in joints but may also lead to high blood sugar levels and high blood pressure.
Uricosurics
These drugs improve the kidney's ability to remove uric acid from the body, reducing the risk of gout or repeated attacks.
XOIs
Xanthine oxidase inhibitors limit the body’s ability to produce uric acid, reducing the risk of gout or repeated attacks. XOIs may have a number of side effects including nausea, reduced liver function and increased risk of heart related death.
Although gout may not be surgically treated, surgery may be necessary to repair or limit joint erosion caused by untreated gout, or to treat complications like tophi or kidney stones.
If you are experiencing sudden, intense pain in other joints, like your hands or elbows, schedule a consultation with a doctor . The fastest and easiest way to get the medical help you need, when you need it is to search and book online with MyHealth1st.