What is gout? Symptoms, Impacts of urate, Risk factors, Complications

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Gout is a type of arthritis which occurs when crystals of sodium urate produced by the body accumulate inside joints in different parts of the body, producing pain that lasts between 2–4 hours. Gout is simply caused by elevated levels of uric acid in the blood. The uric acid crystallizes and the crystals are deposited in joints, tendons and surrounding tissues.  

This medical condition is usually characterized by sudden recurrent attacks of acute inflammatory arthritis presenting red, tender, hot and swollen joints. The affected joint is so hot, swollen and tender that even the weight of a sheet of paper on it may seem intolerable. An acute attack of gout can wake the sufferer up in the middle of the night with the sensation that the big toe is on fire. Approximately 50% of cases most commonly affect the big toe.  

Gout has increased in frequency in recent decades, affecting about 1–2% of the Western population at some point in their lives. This complex form of arthritis can affect anyone and can be influenced by age, race and the season of the year. Often, this disorder is more in men than women, primarily because women tend to have lower uric acid levels than men. Men develop gout usually between the ages of 40 and 50 while women generally develop signs and symptoms after menopause.

WHAT IS GOUT?

Gout is a painful, chronic, progressive and potentially disabling form of arthritis associated with disorder of purine metabolism. It occurs when the final metabolite of purine – uric acid – crystallizes in the form of monosodium urate and precipitates in joints, tendons and the surrounding tissues causing intense pain, inflammation and swelling. It is an arthritic condition where the sodium urate crystals produced by the body accumulate as unwanted deposits inside joints of the big toe, heels, knees, wrists, feet, elbow and fingers, producing pain for a period of about 4 hours especially at nights.

THE IMPACTS OF THE ACCUMULATED SODIUM URATE CRYSTALS IN GOUT ATTACK

The crystals may cause two problems. Some may spill over into the soft lining of the joint (synovium), causing the pain and inflammation associated with gout.  Some of the accumulated sodium urate crystals may pack together to form hard, slowly expanding lumps (tophi) which can cause progressive damage to the joint and nearby bones. This eventually leads to irreversible joint damage which causes constant pain and stiffness in the joint.  Most people with gout will often have further attacks in the future.

RISK FACTORS OF GOUT

The increase in the attack of gout could be due to rising risk factors of:

COMPLICATIONS OF GOUT

Those with gout (nearly 75% of cases) are prone to complications that increase risk of death. The complications are:

SYMPTOMS AND SIGNS OF GOUT

Gout symptoms and signs usually occur after the ages of 30 in men and 60 in women. Symptoms and signs can develop rapidly to their worst point in 6-24 hours and usually last for 3-10 days. After this time, the joint feels normal again. The common symptoms and signs include intense joint pain, usually affecting the joints of big toe, feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first 12 to 24 hours when it begins. There is lingering discomfort after the most severe pain subsides, lasting from a few days to a few weeks. Later attacks are likely to last longer and affect more joints. Fatigue, high fever and inflammation that makes the joint or joints intensely painful, swollen, tender, hot and red with pain‐free times between attacks are other symptoms and signs of gout.

AVOIDABLES IN GOUT PREVENTION

People should avoid foods such as shellfish and red meats, sugary drinks and foods that are high in fructose.  Consumption of excessive alcohol (generally more than 66cl a day for men and more than 33cl a day for women) should be avoided. As much as possible people should avoid recurrent physical trauma or surgery, body mass index greater than or equal to 25, chronic lead exposure and lead-contaminated alcohol. Cool temperatures and use of diuretics, cyclosporine, niacin, tacrolimus and aspirin without proper medical supervision must be avoided. Other things that need to be avoided include obesity, dehydration, heavy eating, fasting or rapid weight loss and diets rich in purines such as coffee, sardines and liver.

TREATMENT OF GOUT

Fortunately, gout is treatable and there are ways to reduce the risk of gout recurrence. There are two key concepts or goals essential in the treatment of gout which are to relieve symptoms during an attack of gout and prevent future gout attacks. First, it is critical to stop acute inflammation of joints affected by gouty arthritis. Secondly, it is important to address the long-term management of the gout disease in order to prevent future gout attacks and shrink gouty tophi crystal deposits. When medication is taken as directed with some recommended lifestyle modifications such as changing diet and consuming less alcohol, many people reduce their uric acid levels sufficiently over time and dissolve the crystals that cause gout. Without treatment, an acute attack of gout usually resolves in five to seven days; however, 60% of people have a second attack within one year. Also without treatment, episodes of acute gout may develop into chronic gout causing destruction of joint surfaces, joint deformity and painless tophi. It’s therefore important to identify and report the attack of gout early for prompt medical attention that will interrupt the disease outcome.

MEASURES WHICH ALLEVIATE GOUT

People should eat beans, peas, lentils, spinach and take adequate vitamin C (1,500 mg per day). If you experience the symptoms and signs of gout, call your doctor or report promptly for medical attention to check possible worsening pain and joint damage. Drink 8 to 16 cups (about 2 to 4 liters) of fluid each day, with half at least being water and eat moderate quantity of protein preferably from tofu, eggs (2-4 weekly) and nut butters. People should limit daily intake of meat, fish and poultry to 110 to 175 grams and eat balanced diet that emphasize fruits, vegetables, whole grains, nuts and fat-free or low-fat milk products. Rest the affected joint and apply ice packs or cold compresses (cloths soaked in ice water and wrung out) to the gout spot for 20 to 30 minutes, 4-15 times a day and comply strictly with your treatment plan.

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