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Gout (gouty arthritis) : Symptoms, Causes, Diagnosis and Treatment

What is Gout?

Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in a joint. It usually affects the joint in the big toe.

Gout attacks can come on quickly and keep returning over time, slowly harming tissues in the region of the inflammation, and can be extremely painful. Hypertension, cardiovascular, and obesity are risk factors for gout.

It is the most common form of inflammatory arthritis in men, and although it is more likely to affect men, women become more susceptible to it after the menopause.

The Centers for Disease Control and Prevention (CDC) report that 8.3 million Americans were affected by gout between 2007 to 2008.

Gout is a type of arthritis. Arthritis is a common condition that causes swelling and pain in your joints. Gout is considered a chronic disease, meaning it does not have a cure and will usually last your whole life.

Gout comes in sudden, and sometimes severe attacks, also called flares, or flare-ups. During a gout attack you may have pain, swelling, and/or redness in your joints. Gout attacks often happen in the big toe, but can affect any of your body?s joints like your elbows, knees, hands, or ankles. Gout is extremely painful and sometimes hard to control. Gout can be either acute or chronic.

Kidney disease can lead to gout, and gout may lead to kidney disease. If you have either condition, talk to your doctor about preventing the other.

Types

There are various stages through which gout progresses, and these are sometimes referred to as different types of gout.

Asymptomatic hyperuricemia

It is possible for a person to have elevated uric acid levels without any outward symptoms. At this stage, treatment is not required, though urate crystals may deposit in tissue and cause slight damage.

People with asymptomatic hyperuricemia may be advised to take steps to address any possible factors contributing to uric acid build-up.

Acute gout

This stage occurs when the urate crystals that have been deposited suddenly cause acute inflammation and intense pain. This sudden attack is referred to as a ?flare? and will normally subside within 3 to 10 days. Flares can sometimes be triggered by stressful events, alcohol and drugs, as well as cold weather.

Interval or intercritical gout

This stage is the period in between attacks of acute gout. Subsequent flares may not occur for months or years, though if not treated, over time, they can last longer and occur more frequently. During this interval, further urate crystals are being deposited in tissue.

Chronic tophaceous gout

Chronic tophaceous gout is the most debilitating type of gout. Permanent damage may have occurred in the joints and the kidneys. The patient can suffer from chronic arthritis and develop tophi, big lumps of urate crystals, in cooler areas of the body such as the joints of the fingers.

It takes a long time without treatment to reach the stage of chronic tophaceous gout ? around 10 years. It is very unlikely that a patient receiving proper treatment would progress to this stage.

Pseudogout

One condition that is easily confused with gout is pseudogout. The symptoms of pseudogout are very similar to those of gout, although thr flare-ups are usually less severe.

The major difference between gout and pseudogout is that the joints are irritated by calcium pyrophosphate crystals rather than urate crystals. Pseudogout requires different treatment to gout.

Gout is also known as gouty arthritis. Gout belongs under the category of Arthritis disease. Asymptomatic hyperuricemia, Acute gout, Interval or intercritical gout, Chronic tophaceous gout, Pseudogout are some common types of Gout. Generally Male, Female, Child are the victim of the Gout. Seriousness of this disease is Low.

Symptoms of Gout are :

  • Lingering discomfort
  • Stiffness
  • redness of skin
  • itchy skin
  • Itchy skin, also known as pruritus, is an irritating and uncontrollable sensation that makes you want to scratch to relieve the feeling. The possible causes for itchiness include internal illnesses and skin conditions.

  • Swelling
  • Severe joint and muscle pain
  • Joints are the parts of your body where your bones meet. Joints allow the bones of your skeleton to move. Joints include:

    • shoulders
    • hips
    • elbows
    • knees

    Joint pain refers to discomfort, aches, and soreness in any of the body?s joints. Joint pain is a common complaint. It doesn?t typically require a hospital visit.

    Sometimes, joint pain is the result of an illness or injury. Arthritis is also a common cause of joint pain. However, it can also be due to other conditions or factors.

    Causes

    Gout can be caused due to:

    Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

    Your body produces uric acid when it breaks down purines ? substances that are found naturally in your body.

    Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

    Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

    What kind of precaution should be taken in Gout?

    During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

    • Drink plenty of fluids. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high-fructose corn syrup.
    • Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
    • Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
    • Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types ? and how much ? seem to cause problems for you.
    • Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.

    Treatment for the Gout

    Diagnosis:

    Tests to help diagnose gout may include:

    • Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope.
    • Blood test. Your doctor may recommend a blood test to measure the levels of uric acid and creatinine in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.
    • X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation.
    • Ultrasound. Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus. This technique is more widely used in Europe than in the United States.
    • Dual energy CT scan. This type of imaging can detect the presence of urate crystals in a joint, even when it is not acutely inflamed. This test is not used routinely in clinical practice due to the expense and is not widely available.

    Treatment

    Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences.

    Gout medications can be used to treat acute attacks and prevent future attacks. Medications can also reduce your risk of complications from gout, such as the development of tophi from urate crystal deposits. The majority of gout cases are treated with medication. Medication can be used to treat the symptoms of gout attacks, prevent future flares, and reduce the risk of gout complications such as kidney stones and the development of tophi.

    Commonly used medications include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids. These reduce inflammation and pain in the areas affected by gout and are usually taken orally.

    Medications can also be used to either reduce the production of uric acid (xanthine oxidase inhibitors such as allopurinol) or improve the kidney?s ability to remove uric acid from the body (probenecid).

    Without treatment, an acute gout attack will be at its worst between 12 and 24 hours after it began. A person can expect to recover within 1 to 2 weeks without treatment, but there may be significant pain during this period.

    Possible complication with Gout

    People with gout can develop more-severe conditions, such as:

    • Recurrent gout. Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
    • Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren't painful, but they can become swollen and tender during gout attacks.
    • Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

    References:

    1 https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897 2 https://www.medicalnewstoday.com/articles/144827 3 https://www.medicinenet.com/gout_gouty_arthritis/article.htm#how_do_health_care_providers_diagnose_gout 4 https://www.healthline.com/health/gout#diagnosis 5 https://www.cdc.gov/arthritis/basics/gout.html 6 https://www.niams.nih.gov/health-topics/gout 7 https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/complications/gout/#causes-of-gout 8 https://www.arthritis-health.com/types/gout/all-about-gout-symptoms-diagnosis-treatment 9 https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout

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