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Gout – Occurrence, Stages of Development, and Treatment

News

16.02.2022

Although gout has been called the “disease of kings” in the past, anyone can be affected by it. It is a common rheumatic disease, a complex form of arthritis. It is characterized by sharp pain, swollen and reddened joints, and this most often affects the joint of the big toe. There may also be pain in the knees, ankles, and arms.

How does gout occur?

The cause of gout is increased levels of uric acid in the bloodstream (hyperuricemia). Acid crystals build up in the body either due to an excess of purines that form uric acid or due to insufficient excretion.

Purines are found in many foods that are high in protein, such as red meat, offal, and seafood. Purine levels are also increased by alcohol, mainly beer, as well as sweetened soft drinks.

Normally, uric acid passes through the kidneys and leaves the body in urine after it is dissolved in the blood. But if the body produces more uric acid or the amount excreted by the kidneys is too small, its level increases. Needle-like urate crystals form in certain joints or the tissues around them. There is pain, swelling, and edema.

Gout often occurs alongside conditions such as psoriasis, kidney failure, or is accompanied by metabolic problems such as weight gain, diabetes, high blood pressure, and cholesterol. It is more common in men, increasing with age.

What are the stages and signs of gout?

Although the disease is often inherited, it can be triggered by many risk factors such as excessive consumption of protein-rich foods or alcohol, limited fluid intake, lack of exercise, prolonged use of certain medications, kidney failure, and more.

The development and symptoms of gout are characterized by several stages:

●       Asymptomatic hyperuricemia

The serum urate concentration is elevated, but there are no symptoms. About 15% of people go to the next stages and develop gout, and at this stage, they begin to accumulate uric acid.

●       Acute flares of gout

In this first manifestation of the disease, the pain is very strong, usually at night, and is felt in the big toe. Only 2-3 hours after the flare onset, redness around the joint appears, and there is swelling and severe tenderness, as well as chills.

The acute attack, accompanied by excruciating pain, can also affect the joints of the ankle, foot, small joints of the hands, and others. Trauma, alcohol, fever, medications, and more can trigger an attack.

●       Intercritical gout

Asymptomatic periods between attacks sometimes last months or years, depending on the patient’s diet and treatment. At first, the attacks last about 3-10 days, but if the treatment is incorrect, they affect more and more joints and become more frequent and prolonged.

●       Chronic gout

As the disease progresses, the uric acid deposits can form nodules called tophi under the skin, in the earlobes, in the joints or around them, and elsewhere.

The tophi begin to destroy the articular cartilage and the bone beneath them. Rheumatoid arthritis-like deformity of the joints occurs. Bone growths appear in the areas of damage – osteophytes or “bone spurs.”

Deposition of uric acid can also occur in the kidneys and lead to urate nephropathy, resulting in the formation of “stones” in the kidneys. Gout patients often have kidney problems caused by urate.

What is the treatment for gout?

For most specialists, a physical examination and some concomitant questions are sufficient to diagnose gout. If necessary, a synovial fluid test or blood test, X-ray, ultrasound, or CT scan is ordered.

Depending on the stage of the disease, medications or a change in diet may be prescribed, as well as a recommendation to adopt useful habits.

Medicines are usually aimed at reducing the risk of complications and block the production of uric acid or improve its excretion.

A number of alternative methods such as consuming coffee, cherries, goldenrod tea, vitamin C intake, and techniques for relaxation and deep breathing can also yield promising results.

Positive results are often observed following diet improvement, proper hydration, avoiding alcohol and protein foods from fried meat and lunch meats, maintaining a healthy weight and exercising.

Changing the lifestyle and diet and doing more exercise help significantly reduce or completely prevent the risk of painful gout that restricts movement and triggers cardiovascular disease.

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