Gout: Causes, Symptoms And Treatment

Gout Causes

Uric acid is a degradable product of the purine amino acid, which is present in many foodstuffs. Since the increased amount of the uric acid cannot be preserved in a dissolved state of the blood, the crystals that accumulate in tissues are formed, especially in the wrist cartilage, but also in the other tissues like kidneys, heart, and brain, and often in the outer ear’s cartilage. It is important to emphasize that the increased level of the uric acid in the blood can exist without any signs of a disease and not all persons that suffer from this condition fall ill from gout. However, if the crystals of the uric acid are formed, gout can appear.

Risk factors

Besides the innate disorder of the uric acid metabolism, risk factors for the occurrence of gout include overweight, increased blood pressure, and moderate to high alcohol intake. Some medicines for urination (thiazide diuretics), aspirin, and medicines against tuberculosis, can increase the uric acid levels in the blood. In persons who are prone to the occurrence of gout, an increased temperature, dehydration, wrist injuries, high alcohol intake, or a surgical procedure, can all immediately cause the gout attack.

Frequency

Gout is relatively rare in Europe and USA (less than 1% of population), even though it is estimated that 10 % of adult males in North America have an increased uric acid levels in their blood. The disease is very rare in persons younger than 40 and its frequency increases with age. It occurs much more often in males, especially up to the age of 65, and women most often contract it in their postmenopausal years. For centuries, it has been known that gout is hereditary and that it runs in the families.

Gout Symptoms

If larger crystal sediment from the wrist cartilage gets into the wrist space, an acute wrist inflammation occurs. The wrist is swollen, red, and warm, and the patient is not capable of any movements and is bothered by the very weight of a blanket. The first attack of the gout most frequently affects the big toe’s wrist.

The attack lasts for a certain period of time and then it passes, with the patient feeling completely healthy until the same attack occurs again. Over time, the attacks become more frequent, stronger, and last longer, while the other wrists can become affected, as well as the knee, ankle joint, elbow, and the hand fingers’ wrists. In the end, wrist deformations can develop, with the causal disability.

In the case of a long-term gout, subcutaneous nodules are often created (so-called tophi), which are the deposits of the monosodium urate crystals, and they are painless, except during the acute attacks when they become very sensitive. Kidney stones can also appear due to the increased excretion of the uric acid through the kidneys.

Gout Diagnosis

Diagnosis is set in accordance with the character and the localization of the wrist inflammation, as well as according to the laboratory results that show the increased level of the uric acid in the blood.

The most reliable method in the attestation of the uric arthritis is discovering the urate crystals in the wrist area. This is done with a special needle which is introduced into the wrist (arthrocentesis) and the presence of the crystals in a liquid sample is determined microscopically. The procedure is performed with a local anesthesia. In the later stages of the disease, the changes in the appearance of the affected wrists can be discovered and followed through the X-rays of the wrists.

Gout Treatment

In the case of an acute attack, plenty of rest and medications that suppress the inflammation and pain are prescribed (non-steroid anti-inflammatory medications). The drug called Colchicine is also prescribed for relieving the pain, as well as the prevention of any future attacks. When the success in the treatment of the advanced gout is not achieved with Colchicine or non-steroid anti-inflammatory drugs, corticosteroids are then prescribed.

In the long-term treatment of the gout, drugs that prevent the creation of the uric acid (Allopurinol) or the ones that encourage the excretion of the uric acid through kidneys (Probenecid) are used.

Gout Diet

It is also important to carry out the measures for the gout attack prevention. This includes the body weight reduction, a sufficient intake of liquids, proper diet, and the reduced alcohol intake. In the diet, the foods that are rich in purine should be avoided: intestines, meat products, poultry, clamshells, sardines in oil, pulses, and mushrooms. According to some studies, vegetables rich in purine, such as spinach, asparagus, cauliflower, and Brussels sprouts, do not increase the risk of the gout attack.

With a proper treatment and prevention measures, gout can successfully be kept under control, which gives the majority of the patients the chance to lead normal lives.