Gout: Symptoms, Causes, Diagnoses and Treatment

by | Jun 3, 2019 |

Gout is a type of arthritis which develops when a high level of uric acid deposits in the body and forms needle-like crystals in the joints and therefore, causes swelling and severe pain in the joints, often the joint at the base of the big toe. Gout occurs mostly in men between the ages of 30 to 50 years, in women after the menopause, and in patients with kidney disease. It can be asymptomatic (in which uric acid increases but no symptoms occur), acute (in which symptoms develop and resolved within 1-2 weeks), and chronic (which involves long-term complications).

Symptoms

Attacks usually occur at night and affect joints especially the big toe. Other common sites include the elbow, wrist, ankles, knees, and fingers. Major signs and symptoms include:

  • Sudden and intense joint pain
  • Acute inflammation and redness in joints leading to joints red, warm, and tender
  • Stiffness and pain in joints during movement
  • Mild fever
  • Fatigue
  • Bone erosion
  • Kidney failure

Causes

Gout is caused by the presence of high levels of uric acid in the body. When the uric acid level is normal in the body, it is easily dissolved in the blood and excreted out from the body in the form of urine but, high level of uric acid is difficult to excrete out by the kidney and it forms needle-like crystals around the affected joint that cause intense swelling and pain.

The different factors that increase the amount of uric acid in the body are:

  • Diet: Drinking alcohol and sweetened beverages. Eating seafood and meat-rich diet.
  • Obesity: Being overweight also makes the body difficult to excrete out uric acid.
  • Medical conditions: Diabetes, heart, and kidney disease
  • Age: Between 30 to 50 years
  • Medications: Drugs like diuretics and aspirin with salicylates.
  • Genes: Hereditary gout also leads to its development in the next generations.

Diagnoses

An accurate gout diagnosis is required as gout has some same signs/symptoms as other forms of arthritis. The various methods to diagnose gout are:

  • Medical history: To assess hereditary chances of gout.
  • Blood tests: To measure the levels of uric acid and creatinine in the blood.
  • Ultrasound: To detect urate crystals around the affected joint.
  • Joint fluid test: To detect urate crystals by examining fluid taken from the affected joint.
  • Dual-energy CT scans: To detect the presence of urate crystals around the affected joint.
  • X-ray imaging: To find other cause of the joint problem.

Treatment & Prevention

Gout can be treated either by treating its symptoms, ie, pain, swelling, etc or by blocking the production of uric acid or by speeding the removal of uric acid. Its complications can also be prevented by adopting a healthy diet.

Drugs which are used to relieve pain and swelling

  • Nonsteroidal anti-inflammatory drugs (NSAIDS) – Drugs like ibuprofen, indomethacin and naproxen sodium
  • Corticosteroids
  • Colchicine

Drugs which are used to block uric acid production

  • Allopurinol
  • Febuxostat
  • Pegloticase – It is used when other standard medications are unable to lower the level of uric acid. This drug is administered by intravenous (IV) infusion route every two weeks.

Drugs that improve uric acid removal

  • Probenecid
  • Lesinurad

Diet plan

As already mentioned that diet plays a major role in increasing uric acid levels and its complications, so, it is important to adopt a healthy lifestyle when detected with gout.

Foods to eat

  • Skim milk and low-fat dairy products
  • Whole grains
  • Plant oils including olive, canola, sunflower oils
  • Vegetables
  • Fruits those are less sweet
  • Vitamin C supplements
  • Coffee
  • Water

Foods to avoid

  • Refined carbohydrates and processed foods
  • Red meat
  • Shellfish
  • Sugary beverages
  • Excessive alcohol
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