Gout is a chronic inflammatory disease characterized by attacks of acute pain and inflammation in the joints , usually in the big toe joint. It is a form of crystalline arthritis caused by the accumulation of uric acid crystals in and around the joints .
Gout , also known as the “Disease of the Rich” or “Royal Disease” due to its association with excess food and alcohol, is a typical metabolic disease that can lead to extremely painful symptoms. Also known as patrician arthritis .
Causes of gout
1. Increased uric acid levels:
Gout is closely related to significantly elevated levels of uric acid in the blood . Uric acid is a product of the breakdown of purines found in food. When uric acid levels become too high, they can form crystals that deposit in the joints and cause inflammation .
2. Genetic factors:
There is a genetic predisposition to gout . If you have a close relative suffering from this disease, the risks of developing gout may increase . Genetics can play a role in how the body processes and disposes of uric acid.
3. Improper diet:
Diet is an essential factor in the development of gout. Foods rich in purines, such as red meat, organic meats, seafood and alcohol, can stimulate the production of uric acid. Consumption of these products can immeasurably promote the formation of crystals in the joints.
4. High blood pressure and diabetes:
People with high blood pressure or diabetes have an increased risk of gout . These conditions can affect the way the body processes uric acid and can promote the formation of crystals .
Weight gain often affects men and women after menopause . The increase in uric acid levels in men usually begins after puberty, while in women it occurs after menopause . Body mass affects the production and elimination of uric acid.
1. Joint Pain:
- Localized Pain: The most common symptom of gout is a sharp and intense pain in the joint of the big toe.
- The pain can feel like a throbbing pain and often starts suddenly , often at night.
- Increasing Pain: As the hours tick by, the pain usually increases, reaching a peak , then gradually diminishes. This cycle of pain can last from a few days to weeks.
2. Inflammation and Edema:
- Red and Swollen Joints: Affected joints become red and swollen during gout attacks. The swelling can be significant and interfere with normal joint mobility.
- Heat in the Affected Area: Inflammation usually leads to increased temperature in the area of the joint.
3. Sensitivity to Touch:
- Affected joints are usually tender to the touch. Even a light touch can cause additional pain .
4. Limited Mobility:
- During attacks, patients often experience difficulty moving the affected joint. A slight limp may occur.
5. Skin Changes:
- Tophi: Tophi are hard, crystalline growths that form under the skin around affected joints. They are one of the characteristic conditions of gout and can be felt to the touch.
6. General Symptoms:
- Fever: In some patients, gout attacks may be accompanied by fever.
- Weakness and Fatigue: Long-term episodes of gout and chronic pain can lead to weakness and fatigue.
How is gout diagnosed?
1. Medical History and Symptoms:
- The doctor will conduct a detailed conversation with the patient, which includes questions about the presence of joint pain, the length and nature of the attacks, as well as about other symptoms that may be related to gout .
2. Physical Examination:
- The doctor will perform a physical examination focusing on the affected joints . Usually the big toe joint is the main affected area. The doctor will check for signs of inflammation , such as red and swollen joints, and assess the tenderness and mobility of the joint.
3. Laboratory Studies:
- Uric acid level testing : Blood tests can measure uric acid levels in the blood. Elevated levels are common in gout, but it’s not the only indicator.
- Synovial fluid analysis: If necessary, the doctor may remove a small amount of synovial fluid from the affected joint through a procedure called arthrocentesis. The sample is sent for analysis, which can confirm the presence of uric acid crystals.
- General blood tests: Blood tests can help rule out other conditions or assess a patient’s general health.
4. Examination of X-rays or Ultrasound:
- The doctor may order x-rays or an ultrasound of the affected joints. These tests are used to look for stones (tophis) or other changes in the joints.
Once the doctor gathers enough information from these sources, he can make a diagnosis of gout . It is important to note that gout can mimic other conditions and therefore it is important to rule out other possible causes of the patient’s symptoms . Early diagnosis and initiation of treatment are essential for managing gout and preventing complications .
Treatment and Management of Gout
Gout , a disease characterized by joint pain and the formation of uric acid crystals , can be managed and controlled through a combined approach that includes medications , lifestyle changes, and diet .
1. Medications for Symptom Management:
- NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): These drugs, such as ibuprofen and naproxen, can help manage pain and inflammation during flare-ups.
- Colchicine: A drug that can be used to prevent and treat gout attacks.
- Uric acid-regulating drugs: When uric acid levels are high, drugs such as allopurinol and febuxostat may be prescribed to reduce their concentration in the body.
2. Changes in lifestyle and physical activity:
- Regular Exercise: Physical activity is essential for managing gout. Regular exercise helps maintain a healthy weight, which is important because excess weight increases the risk of seizures. Moderate exercise such as walking, swimming or cardio is recommended.
- Avoiding Weight Loss with Crash Diets: Long-term and healthy weight loss using a balanced diet and physical activity is preferable to crash and radical diets that can trigger gout flare-ups.
3. Diet for Gout:
- Limiting Purines: Foods rich in purines, such as red meat, offal, and seafood, can promote uric acid formation. Limiting their consumption can help control uric acid levels.
- Increase Water Consumption: Drinking enough water helps dissolve uric acid and flush it out of the body efficiently.
- Include Healthy Foods: Adding vegetables, citrus fruits, whole grains, and low-fat dairy products to the diet can help maintain a healthy weight and prevent flare-ups.
- Avoiding Alcohol and Carbonated Beverages: Alcoholic beverages, especially beer, and carbonated beverages are associated with an increased risk of gout and may be avoided or consumed in moderation.
Effective treatment and management of gout requires a combination of lifestyle changes . A healthy diet , physical activity and avoiding factors that can trigger attacks are key to maintaining control of this chronic disease and improving quality of life . It is very important for people with gout to work with a healthcare professional to create an individualized management plan that meets their individual needs and conditions.
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Gergana Ivanova from the team of