What is gout?

Gout is a form of arthritis caused by excess uric acid in the bloodstream, it can cause sudden bouts of swelling, pain, tenderness and redness in the joints. Gout attacks can occur very quickly and most commonly occur in the middle of the night. The joint at the base of the big toe is a common location for gout.

The excessive amount of uric acid that is present in the body forms crystals, particularly in a number of joints throughout the body. The symptoms of gout that are caused as a result of this is the body’s natural response trying to prevent and fight against a gout attack.

Gout can be extremely painful and can also lead to lasting damage to the surrounding tissue in the inflamed area. Gout is most common in men; however women can also be affected by this particularly after they have gone through the menopause.

Individuals that suffer from gout are also increasingly at risk of developing Hypertension, cardiovascular disease and obesity

The 4 Stages of Gout

Before the Gout Attack

This is the stage before experiencing a gout attack. At this stage there are usually no symptoms, however uric acid levels are high and are starting to crystalize in the joints. The forming of the crystals is known as asymptomatic hyperuricemia.

Acute Gout

This stage is where the uric acid levels within the body have now crystalized and are moving around the joint. The gout attack may be triggered by an injury (stubbing your toe), elevated alcohol consumption, drugs or an underlying illness and infection. The attack will usually start at night and will progressively worsen over the next few hours. In some cases it can take around 10 days for the pain and discomfort to ease.

Interval Gout

This stage is what is used to describe the time in-between suffering gout attacks.

Chronic Gout

For people that have a high uric acid level for a prolonged period of time (usually 10 years or more). The gout attacks will occur more frequently.

What are the early signs and symptoms of gout?

The symptoms of gout typically arise quickly and can be commonly experienced at night. Early symptoms include; severe joint pain, usually affecting the big toe's large joint (but any joint can be affected); swelling and redness, which can see the affected joint or joints become red, swollen and tender; discomfort, which can last for days or weeks; and an inhibited range of motion in the affected joint or joints. Gout can affect the following areas of the body:

  • Big Toe
  • Fingers
  • Wrists
  • Elbows
  • Knees

You should see a GP if you experience any of the signs and symptoms above.

If spotted and treated early enough, Gout will not cause any lasting damage to your joints or surrounding tissue.

Causes and triggers of gout

The direct cause of gout is the accumulation of uric acid in the body which later develop into crystals, this then leads to severe pain and inflammation. These crystals typically form when uric acid levels in the blood are high.

There are other indirect causes and triggers, such as certain foods. That's because uric acid is produced when purines in the body are broken down. These natural purines are also found in meat and seafood, meaning that they could constitute triggers. Consumables such as beer and drinks containing fruit sugar are high in uric acid and could also bring on gout attacks in sufferers.

High uric acid levels can occur due to the kidneys not excreting enough uric acid, or the body producing too much. As a result if uric acid is not excreted from the body, this can cause needle like crystals to develop that can cause intense pain and sever inflammation of the joint and surrounding tissue.

There are several known risk factors which are understood to increase the chances of developing gout, due to high uric acid levels. These factors include;

  • Being obese, which can lead to more uric acid production and make it harder for the kidneys to excrete uric acid
  • Diet and Lifestyle - alcohol in particular can interfere with the natural functionality of the kidneys which can affect the body’s ability to remove uric acid from the body
  • Genetics and Family history of gout
  • Age and Gender - Being a man between the ages of 30 and 50 or a women after the menopause
  • Surgery and medical conditions like diabetes, kidney disease, heart disease, and high blood pressure which have not been treated.
  • Suffer from a different form of arthritis such as Rheumatoid Arthritis or Psoriatic Arthritis

How is gout diagnosed?

There are several methods of diagnosing gout. A joint fluid test can be employed to view urate crystals in fluid drawn from the affected joint, using a microscope. Blood test results can also measure uric acid levels, and imaging tests such as ultrasound, x-ray and a dual-energy CT scans are other ways to detect urate crystals and rule out other possible causes of symptoms.

How is it treated?

Medications are a primary method of treating gout. Gout attacks can be treated by; nonsteroidal anti-inflammatory drugs (NSAIDs) most commonly Ibuprofen and Naproxen 250mg and 500mg tablets, colchicine, a pain reliever; and corticosteroids like prednisone, in pills or via injection (generally used for people who can't take colchicine or NSAIDs).

Typically if the pain and discomfort does not subside over a 3-4 day period, your doctor or GP may choose to give you a steroid in the form of a tablet or injection.

There is also a range of medications which can help to prevent gout, including; uric acid blockers such as xanthine oxidase inhibitors (XOIs), like allopurinol and febuxostat; and medication which assists the removal of uric acid, called uricosurics, which include lesinurad and probenecid. Uricosurics serve to reduce uric acid levels and reduce gout risk. They can have side effects including stomach pain and rashes.

You can make changes to your lifestyle or use home remedies which can help treat gout. Try limiting the number of alcoholic drinks you consume each week, as well as steering clear of drinks which have been sweetened with fructose, substituting with water. Exercise regularly and aim to lose any excess weight. Avoid foods which are high in purines - such as red meat and seafood.

The Anti-Inflammatory Diet is known to help with other forms of arthritis and inflammation. Although this may not cure your Gout, a complete lifestyle and diet overhaul can dramatically decrease the likelihood of experiencing a gout attack.

Then there are the alternative approaches which have grown more popular in recent years. If the treatments suggested above have largely proven ineffective, you may want to try an alternative approach. These include; vitamin C supplements, as this vitamin is understood to be capable of reducing uric acid levels; coffee, which has been linked to lower uric acid levels; and cherries, which have been seen to reduce gout attacks and reduce levels of uric acid. You should discuss these alternative approaches with a doctor.

Gout prevention tips

There are several ways in which you can help to prevent gout. These include:

- Limiting alcohol intake or avoiding alcoholic drinks altogether
- Drinking a lot of fluids
- Cutting down on the amount of red meat, poultry and fish you eat - substitute with low-fat dairy products
- Maintaining a bodyweight which is close to ideal

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