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Gout

Gout is an excruciating type of arthritis that results from the build-up of uric acid crystals within and near the joints. This condition is a common form of inflammatory arthritis, affecting men more frequently. The risk tends to increase with age.

Gout frequently develops in individuals with elevated uric acid (urate) levels in the bloodstream. Urate is a natural by-product of purine breakdown—compounds produced by the body and found in certain foods. While having some urate in the blood is normal and healthy, excessive levels can lead to gout.

Symptoms

A gout attack often comes on suddenly and can be extremely painful. The affected joint—commonly the big toe—may become red, swollen, and so sensitive that even the slightest touch, such as a bedsheet, causes discomfort. In addition, the joint may feel warm to the touch.

In some cases, gout can be accompanied by a fever, which may indicate an infection requiring instant medical attention. Individuals with gout, especially those with diabetes, are at a greater risk of complications.

Since gout is a chronic condition that can worsen over time, seeking medical care is essential. The disease can be effectively managed with proper treatment; hence, it reduces the risk of joint damage and future attacks.

Causes

Gout occurs when the body either makes excessive uric acid or fails to eliminate sufficient amounts. Too much uric acid in the blood, a condition known as hyperuricemia, can lead to the formation of uric acid crystals in the joints.

The Role of Uric Acid

Uric acid is a by-product of purine breakdown—compounds naturally present in the body and protein-rich foods. Under normal conditions, uric acid functions as a strong antioxidant and is safely removed through the kidneys and urine. Nonetheless, in some cases, high uric acid levels do not necessarily result in gout, as nearly two-thirds of people with hyperuricemia never experience symptoms.

Risk Factors for Gout

Some of the risk factors that increase the likelihood of gout include:

  • Sex and age: This disease mostly affects men, typically developing between 30 and 45 years. In women, gout usually arises after menopause, between age 55 and 70.
  • Family history: A genetic predisposition increases the likelihood of developing gout
  • Underlying health conditions: Certain medical issues are likely to contribute to higher uric acid levels in the bloodstream. These conditions include diabetes, high blood pressure, kidney disease, and certain forms of anaemia.
  • Medications: Certain drugs can raise uric acid levels, including:
    • Diuretics (water pills) taken to manage high blood pressure and heart disease
    • Aspirin. Can interfere with uric acid elimination
    • Cyclosporine. An immunosuppressant used in organ transplants
  • Lifestyle factors: The risk of developing gout increases with being overweight, consuming a high-protein diet, and excessive alcohol intake

Diagnosis of Gout

Diagnosing gout can be challenging, as its symptoms may resemble those of infections or other disorders. To confirm the diagnosis, your doctor may perform these specific tests:

Blood test

A blood test measures uric acid levels in the bloodstream. Elevated levels mostly indicate gout, though they may temporarily drop during an acute attack as uric acid moves from the blood into inflamed tissues. Doctors may also assess uric acid levels between attacks for a more accurate diagnosis. Additionally, blood markers for infection are examined since they frequently rise during a gout flare-up.

Synovial fluid analysis

If initial treatments do not provide relief, your physician may order a synovial fluid analysis, a more precise diagnostic test for gout. This involves extracting fluid from the affected joint to examine it under a microscope. If the results are positive, the fluid will contain increased white blood cells, uric acid crystals and bacteria (if an infection is also present).

Treatment and Management

Gout treatment mainly focuses on the following:

  • Alleviating pain in cases of acute attacks.
  • Preventing future flare-ups.
  • Lowering the risk of tophi formation and irreversible joint damage.

Managing Acute Gout Attacks

Acute gout attacks can be effectively managed with:

Home remedies:

  • Ice therapy: Put an ice pack (wrapped in a towel) on the affected joint for 20 minutes at a time to reduce swelling.
  • Elevation: Keep the affected limb elevated above heart level to minimise inflammation.
  • Rest: Limit movement of the painful joint to prevent further irritation.
  • Medications: Over-the-counter NSAIDs like ibuprofen and naproxen can help with mild pain, but consult your doctor before use due to potential side effects.

Prescription drugs:

Stronger medications like indomethacin may be recommended for severe pain. Colchicine is another FDA-approved medication for gout that minimises inflammation during an attack.

Corticosteroids are another remedy for acute gout attacks. These powerful anti-inflammatory drugs (available as pills, IVs, or injections) can quickly relieve severe gout symptoms.

Medications to control uric acid levels:

Lowering uric acid to below 6 mg/dL (or 5 mg/dL in severe cases) can help prevent future attacks and joint damage. Long-term drugs may be necessary for those who:

  • Experience over three gout attacks per year
  • Have severe or disabling attacks
  • Develop gout-related arthritis or tophi
  • Suffer from kidney damage or frequent kidney stones or have too much uric acid in urine

Commonly prescribed medications include:

  • Allopurinol: Lowers uric acid production.
  • Colchicine: Stops white blood cells against attacking uric acid crystals and reduces inflammation.
  • Probenecid: Helps the kidneys expel uric acid.
  • Febuxostat: Reduces uric acid levels and is an alternative for those who cannot use allopurinol or probenecid.

Lifestyle changes:

To prevent attacks and joint damage in the future, these lifestyle choices are necessary:

  • Maintaining a healthy weight through diet and exercise.
  • Drinking a lot of water or fluids to flush out uric acid.
  • Reducing calories from fat and avoiding sugary drinks.
  • Eating complex carbohydrates like brown rice, beans, nuts, starchy vegetables and oatmeal.
  • Choosing low-fat dairy over meat and seafood, as high-purine foods can increase uric acid levels.
  • Avoiding alcohol, which can trigger gout attacks.

Surgical Treatment for Gout

While acute gout attacks are typically managed with medication, surgery may be necessary in specific cases, particularly when:

  • A bacterial infection is present in the joint alongside a gout attack, requiring urgent surgical intervention.
  • Chronic gout leads to severe joint damage or the development of painful tophi.

Surgical options for chronic gout include:

  • Tophi removal: Large, painful nodules (tophi) that form around tendons, joints, or bursae may need surgical removal. Moreover, tophi that become infected, rupture, or cause persistent inflammation often require excision to relieve discomfort.
  • Joint fusion: When chronic gout results in significant joint damage, smaller joints (such as the big toe) may be fused. This procedure stabilises the joint, limits movement and alleviates chronic pain.
  • Joint replacement: Severe, end-stage arthritis caused by gout may require joint replacement surgery. The damaged joint is replaced with artificial components to restore function and reduce pain. The knee is the most commonly replaced joint due to gout-related arthritis.

Summary

Gout is a severe kind of arthritis caused by excess uric acid in the body. This accumulation forms sharp crystals in the joints, hence leading to swelling, pain, and discomfort. Fortunately, gout can be managed with the right medication and lifestyle changes.

If you’re experiencing symptoms of gout or need help managing your condition, schedule an appointment with our experts today. We will help you create personalised treatment options and dietary adjustments to help control your symptoms and prevent future flare-ups.