Gout: A General Overview

Overview

What is gout?

Gout is a kind of arthritis that occurs due to excess uric acid accumulation in the body. Uric acid is the body’s waste material formed due to purine (components of deoxyribonucleic acid) breakdown.¹Overview| Researched based study from Sciencedirect.com

The uric acid accumulates in the joints and causes sharp pain and recurrent swelling, and redness. Gout can occur in the forefoot, fingers, ankles, elbow, wrist, and knees. It is more common among males than females.

Prevalence

Prevalence of gout

• Gout can affect people of all ages but is more common between the age group of 30 to 60 years
• It is a persistent and progressive ailment that gets worse with time
• The majority of gout attacks start in the big toe of the feet
• Gout primarily affects women after menopause (cessation of the menstrual period).
• The prevalence of gout is more in developed countries compared to underdeveloped countries ¹Prevalence| Researched based study from Sciencedirect.com ²Prevalence| Researched based study from Journals.Iww.com.

Symptoms

Symptoms of gout

• Sudden intense pain
• Swelling and redness
• Joint stiffness
• Warm and tenderness of the affected area
• Extreme tiredness
• Persistent discomfort
• Difficulty in moving
• Appetite loss
• Mild fever ¹Symptoms| Researched based study from Sciencedirect.com

Causes

Causes of gout

Excess uric acid in the blood due in the prime cause of gout

And causes of excess uric acid in the body are

• Kidney disease in which the body is unable to excrete extra uric acid from the body
• Hyperthyroidism(thyroid gland produces excess thyroid hormone)
• Hereditary disorders (such as diabetes and obesity) ³Causes| Researched based study from Thelancet.com

Risk

Risk factors of gout

• Diet (consuming excess purine-rich foods such as red meat, liver, etc. )
• Overweight
• Dehydration
• Cardiac(Heart) problem
• Alcoholism(addiction to alcohol)
• Autoimmune disease (immune system mistakenly attacks the body’s healthy tissues)
• Diabetes
• High blood pressure (Hypertension)
• Blood cancer
• Kidney disease
• Any trauma(injury)
• Family history (gout disease running in families) ⁴Risk| Researched based study from Nlm.nih.gov

Complications

Complications of gout

Gout is associated with many health issues, including 

Advanced gout

Gouts, if untreated,

• Tophi (nodules of urate crystals) deposit below the skin in several body parts such as fingers, feet, and elbows⁵Complications| Researched based study from Nlm.nih.gov
• Tophi is tender and swollen during gout occurrence and are usually not painful

Recurrent gouts (repeated gout attacks)

Gouts, if left untreated,

• It can cause corrosion and damage the joints

Kidney stones

• The urate crystals get deposited in the kidney and the urinary tract of gout patients leading to kidney stones.
• Large urate crystals can block the ureters(tubes carrying urine to the urinary bladder from the kidneys) ⁵Complications| Researched based study from Nlm.nih.gov

Diagnosis

Diagnosis of gout

Following are the tests to determine gout

Uric acid blood test

• The test determines the amount of uric acid in the blood

Joint aspiration

The doctor uses a needle to take out fluid from the spaces between the joints. It is done

• To relieve the patient from extreme pain
• To look for the uric acid crystals to confirm gout
• To examine for any other infection

Imaging Techniques

• Ultrasound-It uses sound waves to get an image of the interior organs of the body

• X-ray-It uses electromagnetic waves to get internal images of the body

• MRI-It utilizes radio waves and magnetic fields to get three-dimensional clear images of organs inside our body.

• CT (Computed Tomography) scan-It uses computers and X-rays to get a detailed picture of the interior of our body ⁶Diagnosis| Researched based study from Nlm.nih.gov

Treatment

Treatment of Gout

The treatment of gout is based on the condition and requirements of the patient.

To relieve symptoms of gout

Corticosteroids

• It reduces swelling and redness
• It also controls any allergic reaction in the body

Colchicine

• It prevents the inflammation caused by uric acid crystals

NSAIDS (nonsteroidal anti-inflammatory drugs)

• It blocks the chemicals causing pain and swelling⁷Treatment| Researched based study from Nlm.nih.gov

Drugs to lower uric acid level

Pegloticase

• It is used to treat chronic gout
• It is given when other medicines don’t work

Allopurinol

• It prevents damage to the joints
• It prevents a recurrent gout attack⁷Treatment| Researched based study from Nlm.nih.gov

Probenecid

• It helps the kidney eliminate uric acid
• It helps prevent gout attacks

Febuxostat

• It acts on the body to produce less uric acid
• It is used to treat chronic(long-term) gout

Surgeries for gout

Arthroscopic gout removal

• In less severe cases, arthroscopic gout removal surgery is done
• It removes uric acids from the joints and relieves pain

Joint fusion surgery

• If gout has completely damaged a joint, joint fusion surgery is recommended.⁷Treatment| Researched based study from Nlm.nih.gov

• It fuses the smaller joints, relieves pain, and improves the joint’s strength

Joint replacement surgery

• It is done to reduce pain and increase the mobility of patients
• Surgeons remove the gout-damaged joint with a synthetic (artificial) joint

Tophi removal surgery

• Tophi crystals may get swollen, red, and painful
• They can break the skin and get infected so in such cases, tophi removal surgery is recommended ⁷Treatment| Researched based study from Nlm.nih.gov

Alternative treatments

Hot and cold compress

• It is done by using a hot compress for 2-3 minutes, followed by a cold compress for around half a second on the affected area of the gout attack.
• Repeating this several times helps reduce the gout swelling and pain

Acupuncture

• This technique uses fine needles that are inserted at various parts of the body.
• It relieves pain and makes one feel better

However, more research is warranted to prove the fact

Remedies

Home remedies

Balanced diet

• A well-balanced diet containing antioxidant-rich fruits and vegetables can help reduce gout symptoms.
• Moreover, the consumption of minimally processed food help decreases the gout risk.

Consuming enough water

• Drinking plenty of water can make the kidney function to excrete excess fluid, thereby reducing the symptoms of gout patients.
• However, kidney and heart patients must talk to a physician before consuming plenty of fluids ⁸Remedies| Researched based study from Nlm.nih.gov

Reducing stress

• One should include meditation (mind exercise) and yoga (breathing exercise) in daily routine to avoid stress.
• Taking enough rest during the day may also reduce stress

Elevating the affected joints

• Keeping the feet in a heightened position will allow blood to move away from the joints toward the heart and
• it reduces the swelling in gout patients ⁹Remedies | Researched based study from Arthritis.org

Drinking coffee

• Coffee reduces the serum uric acid level
• It decreases the risk of having gout

However, more research is wanted to prove the effect of coffee on gout ¹⁰Remedies | Researched based study from Wiley.com .

Drinking lemon water

• Lemon help neutralizes the uric acid level in the body.

Diet

Diet principles in gout

Food and drinks to be avoided to prevent gout attack are

• Organ meats(kidney, liver)
• Pork
• Beef
• Mussels
• Cod
• Salmon
• Processed food
• Seafood
• Sugary beverages
• Soda drinks
• Yeasts

Prevention

Prevention of gout

• Maintaining a healthy body weight
• Exercising regularly to decrease joint stress
• Complete cessation of smoking
• Avoiding alcohol consumption
• Avoid joint injuries ¹¹Prevention | Researched based study from Cdc.gov
• Limiting the consumption of purine-rich foods (viz pork, beef, shellfish)
• Keeping oneself hydrated

Takeaway

Key takeaways

• Gout is painful arthritis and can be treated and managed effectively
• Gout, if left untreated, can damage the joints permanently
• Eating a balanced diet and adopting healthy habits can help prevent gouts
• One must immediately consult a rheumatologist (doctor specializing in gout and arthritis) on experiencing repeated gout symptoms to prevent it from being chronic.