Gout is a very painful recurrent form of arthritis caused by the build-up of urate crystals in the joint, causing inflammation in the areas around the joint. It is more commonly found in men but can affect women after menopause.

It can affect one or more joints at a time like the ankles, knees, elbows, hands, wrists, and fingers, but is often found in the big toe. Symptoms usually occur suddenly, usually at night, and may last for 1 to 2 weeks followed by a period of no symptoms. These symptom-free periods can last months or years.

If untreated gout attacks can reoccur and these reoccurrences are known as flares.

What are urate crystals?

Urate crystals are formed when there are high levels of uric acid in the blood. Uric acid is produced from the metabolism of purines which are found naturally in the body and in some foods we eat like tuna, sardines, and red meat to name a few.

Normally uric acid leaves the body through the kidneys in urine but if the body makes too much uric acid, or the kidney excretes too little, or a combination of these two reasons, a build-up of uric acid can occur forming needle-like crystals that clump together in the joints and surrounding areas causing inflammation and pain.

Not everyone with high levels of uric acid in the blood will get gout, but everyone who gets gout has high levels of uric acid in their blood.

Symptoms

Some symptoms are swelling, intense pain, tenderness, and redness. The affected joint may feel hot and stiff. In some cases, there may be a feeling of tiredness with fever and chills.

The first attack may last a few days to 2 weeks while future attacks could last a few weeks.

Factors that increase the risk of getting gout

People are more likely to get gout if the levels of uric acid in their blood is high. Some factors that increase the uric acid levels in the blood are:

• Family history of gout
• A diet that includes a lot of red meat, organ meat (eg. liver, tripe, brain), scallops, shellfish, tuna, turkey, gravies, high sugar drinks, and processed foods with lots of high fructose corn syrup.
• Being overweight
• Use of certain medication: Aspirin, diuretics (like spironolactone), levodopa, immunosuppressants (like cyclosporine), blood pressure medication like beta blockers
• Certain medical conditions: Kidney disease, psoriasis, high blood pressure, diabetes, high cholesterol, some types of anemias
• Alcohol especially beer

Complications of untreated gout

If gout is left untreated, the formation of tophi which are urate crystal deposits can occur in the joints, in the kidney, and under the skin. This is called advanced gout. These tophi can lead to joint deformity and cause permanent damage in the affected areas. Kidney Stones may form due to urate crystals being deposited in the kidney.

The tophi themselves are not painful, but they can cause inflammation which can be very painful.

Other conditions that could occur as a result of untreated gout are heart disease, congestive heart failure, hypertension, and heart attack.

Treatment

Gout should be diagnosed and treated by your doctor. Treatment is usually a combination of managing the symptoms of acute gout and prevention of reoccurrence by altering your diet, other lifestyle modifications like following a weight loss plan if overweight, and medication.

Management of acute gout:

During the attack, you need to stay hydrated with plenty of water, ice the joints with a cold compress, avoid alcohol, avoid sweet foods and drinks, and keep the affected joint elevated above heart level. Resting the affected joint as much as possible with limited movement is also important.

Colchicine is used to treat and prevent gout attacks. When taken within 24 hours of a gout attack it helps to reduce pain and inflammation. It is known to cause nausea, vomiting, diarrhea, and stomach cramps. It should be avoided in patients with stomach ulcers and other gastrointestinal conditions. Side effects are less at lower doses.

NSAIDs (Non-steroidal anti-inflammatory drugs) like indomethacin, ibuprofen, or naproxen may be used to reduce pain and inflammation. NSAIDs should not be taken if you have heart disease, kidney disease, or stomach ulcers unless directed by your doctor. They should always be taken with or just after food.

Corticosteroids reduce inflammation and can be given orally or by injection depending on the situation and the patient.

Prevention of future attacks

• Following a low-purine diet by limiting the foods that produce high levels of uric acid in the blood can help. Also, exercise regularly, stay hydrated, lose weight if overweight, and limit alcohol.
• Taking medication that lowers the blood uric acid levels. Some examples are allopurinol, febuxostat, and probenecid. These should NOT be taken during the gout attack, they can be started 1 to 2 weeks after the attack has been resolved.
  • Allopurinol and febuxostat reduce the amount of uric acid produced by the body while probenecid works by removing excess uric acid from the body.

Disclaimer: This is not an exhaustive list and is for information only. This is not medical advice. Please consult your doctor or pharmacist if you need personal treatment options or have any questions that affect you directly.