The Facts Behind Gout
By Orthopaedic and Neurology Clinic
Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in a joint. It usually affects the joint in the big toe.
As a result, gout attacks can come on quickly and keep returning over time, slowly harming tissues in the region of the inflammation and can be extremely painful. Hypertension, cardiovascular, and obesity are risk factors for gout.
What causes Gout?
Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can be form when you have high levels of uric acid in your blood.
Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.
Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
What are some symptoms of Gout?
Common gout symptoms include:
- Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
- Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
- Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
- Limited range of motion. As gout progresses, you may not be able to move your joints normally.
If you’ve been experiencing sudden, intense pain in a joint, see our specialist.
“Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, diabetes, and abnormal kidney function are among the risk factors for developing gout.”
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What types of diagnosis?Our doctor will based on the following tests to make an assessment:
- Blood tests. Blood tests to measure your urate levels can be helpful to support a diagnosis of gout, but aren’t enough on their own to confirm it.High urate levels in blood tests can suggest that you have gout, but this will need to be considered alongside your symptoms. It’s possible to have high levels of urate, but not have any other symptoms of the condition.
- Imaging tests. Ultrasound and CT scans can be good at spotting joint damage, crystals in the joints and early signs of gout. X-rays are generally used to pick up the bone and joint damage caused by having gout for a long time.
- Synovial fluid examinations. These are a good way to rule out other crystal conditions and make a diagnosis. They’re done by taking a sample of your synovial fluid through a needle inserted into one of your joints. The fluid is then examined under a microscope for urate crystals. If you have tophi, doctors can take a sample from one of those instead.
Possible treatment methods?
There are medicines available that can lower urate levels, prevent new crystals from forming and dissolve away the crystals in your joints. They are called urate lowering therapies or ULTs for short.
Treatment with ULTs is generally started after an attack of gout has completely gone.
There’s no single fixed dose of a ULT, and different people need different doses to get to the right blood urate level.
It can take a few months or years for the drugs to completely clear your body of urate crystals. But once they’re gone, you will no longer have attacks of gout, tophi or risk of joint damage due to gout.
Therefore it’s important to remember that ULTs won’t stop attacks of gout straight away. You could actually have more attacks within the first six months of starting them.
Don’t stop taking your ULTs if this happens to you, as this is actually a sign that the drugs are working. As the drugs start dissolving the crystals, they become smaller and are more likely to get into the joint cavity, triggering an attack.
Our specialist might suggest taking a low dose of medicine as a precaution against attacks during the first six months of starting ULTs.
ULTs are usually life-long treatments and require yearly check-ups to monitor your urate levels. If your symptoms aren’t getting under control, talk to our Specialist about your urate level, as you might need to be on a higher dose.
Try not to miss or skip any of your doses, especially in the first year or two of starting treatment. This could cause your urate levels to go up and down, which could trigger an attack.