July 22 2021
Gout is defined as a type of arthritis that has a sudden onset, occurring especially in the joints. Deposits of uric acid, which are needle-like crystals, in a joint is known as gouty arthritis. Usually, gout causes inflammation in a single joint. When many joints are affected at a time, this form of severe gout is called polyarticular gout.
Symptoms of gout
- Joint tenderness
- Swollen joints
- Joints red and warm
- Joint pain
The most characteristic feature of gout is the presence of nodules under the skin called tophi. If left undiagnosed and untreated, gout can lead to irreversible kidney damage and joint degeneration. The surest shot method to diagnose gout is to have the extracted fluid from an inflamed joint examined for the presence of urate crystals.
The affected joint is extremely sensitive to touch such that even simple daily household chores can lead to severe pain attacks at the inflamed joint leading to a swollen joint. The presence of excessive fluid in a joint is called a joint effusion. Gout most commonly occurs in the joints of the lower limbs. Gout can also occur at the feet, knee, ankle, elbow, wrist and hands. When gout affects multiple joints at the same time, it causes pain and stiffness in all those joints.
The presence of tophi is the indicator of gout. A hard nodule of uric acid which gets deposited under the skin is called a tophus. Tophi can be predominantly found on the elbows, upper ear cartilage and in the surface of other joints. A tophus is formed when the body is overloaded with uric acid. Untreated chronic gout can lead to physical deformity and permanent joint damage. The accumulation of uric acid crystals can also lead to the formation of kidney stones which may also be a sign of gout.
Causes of gout
The presence of excessive uric acid in the bloodstream and the accumulation of unusually large amounts of uric acid crystals in the body tissues causes gout. The symptoms of inflammation- pain, redness, heat and swelling occur due to the deposition of uric acid crystals in the joints. Uric acid is the byproduct of the breakdown of proteins called purines. Elevated blood uric acid levels, called hyperuricemia, often occur as a result of factors such as genetics, obesity, chronic kidney disease and due to the side effects of medications like diuretics.
Risk factors for gout
Hypertension is one of the risk factors for gout. It is found that gout is more common after surgery, trauma and dehydration. Medications which are used to treat blood pressure and diuretics which are responsible for increasing the uric acid levels in the bloodstream are risk factors for gout as they lead to the deposition of uric acid crystals in a joint. Cancer therapy may also release high levels of uric acid when the cancer cells are destroyed which also acts as a trigger factor for gout. Degenerative arthritis also makes the already weakened joints more prone to gout.
Diagnosis of gout
Gout is diagnosed by removing joint fluid from an inflamed joint ( called arthrocentesis) and microscopically examining it for the presence of uric acid crystals. This test can also rule out other bacterial infections.
When frequent disabling gouty attacks occur, it becomes imperative to seek medical intervention. Treatment modules differ from patient to patient. Diet and lifestyle changes are sufficient to treat mild and infrequent attacks of gout. This type of protocol is not found to be effective in cases of severe gout, thereby requiring medications. Frequent attacks of gout indicate the presence of kidney stones, the formation of tophi and evidence of joint damage where medications help to reduce the uric acid levels in the blood.
Medications used in the treatment of gout are broadly classified into three categories -
- Medicines to lower the uric acid levels - these medications are the primary line of treatment in gout. They reduce the amount of uric acid in the body and also decrease the size of the tophi. Some examples include allopurinol, febuxostat, probenecid and pegloticase
- Prophylactic medications which are used in combination with uric acid lowering medicines - these are preferable in the first six months of the treatment of gout to prevent gout flares rescue medications used to provide immediate relief from joint pain due to gout - these are used to lower the elevated uric acid levels in the body and also to reduce the intensity and frequency of flares. Colchicine and NSAIDs (nonsteroidal anti-inflammatory drugs) such as indomethacin, diclofenac, ibuprofen and naproxen sodium are frequently used as prophylactic medications to prevent gout flares during uric-acid lowering. These are used to reduce pain and inflammation during acute gout attacks along with corticosteroids such as prednisone, methylprednisolone and prednisolone.
Foods to be avoided in gout patients
Dietary modifications in gout include eliminating purine-rich foods. A marked weight loss regimen should be put into place to prevent obesity-associated with gout. A diet high in protein and low in saturated fat helps in lowering the serum uric acid levels. Seafood and red meat should be completely avoided. Drinking alcohol and sugar-coated beverages increases the risk of gout.
Home remedies for gout attacks
One of the ways to alleviate the painful symptoms during an acute gout attack is to drink plenty of water. Other home remedies can also be used for the management of gout which includes:
- Application of ice to the affected joints can reduce gout related inflammation.
- Exercising and meditation can be taken up to relieve stress which can, in turn, lead to relief from gout symptoms.
- Elevating the affected joints can reduce swelling caused by gout.
- Fish contains anti-inflammatory compounds which can reduce uric acid levels. Thus increasing the fish consumption can help in people with gout.
- Eating more cherries can decrease the risk of gout attacks.
- Drinking lemon water helps to neutralise uric acid levels in the body.
- Meats rich in purine such as bacon, turkey, anchovies, sardines and scallops should be avoided to reduce gout symptoms.
- Supplements like Alvizia milk thistle help in lowering the uric acid levels thereby causing relief from the symptoms of gout.