Gout is a relatively common and complex form of arthritis that can affect anyone. It is characterized by sudden, severe and excruciating pain, swelling, redness and tenderness in the affected joint. Gout (from Greek – leg trap) can also develop in several joints, but most often – in the joint of the big toe.
“A gout attack can come on suddenly, often waking up in the middle of the night with a burning sensation in the big toe. The affected joint is hot, swollen and so sensitive that even the weight of the sheet on it can seem unbearable,” says Inga Orleāne, an internist at the Association of Health Centers, head of the VCA “Aura” day hospital. The doctor emphasizes that gout symptoms can come and go, but there are ways to control symptoms and prevent flare-ups.
Symptoms appear suddenly
The signs and symptoms of gout almost always appear suddenly and mostly at night.
• Severe joint pain. Gout usually affects the big toe, but it can affect any joint. Other commonly affected joints are the ankles, knees, elbows, wrists, and fingers. The pain will usually be most pronounced in the first 4 to 12 hours after it starts.
• Prolonged discomfort. After the first severe pain subsides, the joint remains in discomfort lasting from a few days to several weeks. Later, symptoms may return and are likely to last longer and affect multiple joints.
• Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
• Limited range of motion. As gout progresses, it may be difficult to move the joints normally.
When should you see a doctor?
If you experience sudden, intense joint pain, contact your doctor. Inga Orleāne warns that untreated gout can lead to worsening pain and, what’s worse, permanent joint damage. Seek immediate medical attention if the pain is accompanied by a fever and the joint is hot, with signs of inflammation – this may indicate an infection.
Causes of gout
Gout develops when urate crystals build up in the joint, causing inflammation and intense pain, or a gout attack. Urate crystals can form when there is a high level of uric acid in the blood. Uric acid is actually nothing new to our body – it produces uric acid in the process of breaking down purines. However, when something goes wrong in these processes, gout develops.
“Purines are also found in some foods, including red meat and animal internal organs such as liver. Seafood rich in purines include anchovies, sardines, mussels, scallops, trout, and tuna. Alcoholic drinks, especially beer, and drinks sweetened with fruit sugar (fructose) increase the level of uric acid,” says Anita Baumane, a nutritionist at the Association of Health Centers. The doctor adds to what she said, explaining that normally uric acid dissolves in the blood and passes through the kidneys into the urine, but sometimes either the body produces too much uric acid, or the kidneys produce too little uric acid, and then the problems begin. When this happens, uric acid can build up to form sharp, needle-like urate crystals in the joint or surrounding tissue, causing pain, inflammation, and swelling.
Risk factors
Those with high levels of uric acid in their bodies are more likely to get gout. Let’s list the factors that increase the level of uric acid in the body!
diet
“Consuming a lot of red meat and shellfish on a daily basis, as well as drinking drinks sweetened with fruit sugar (fructose), increases the level of uric acid, which accordingly increases the risk of developing gout,” emphasizes Anita Baumane, emphasizing the importance of a healthy lifestyle. The specialist adds that the use of alcohol, especially beer, also increases the risk of gout. With the start of more summery weather, grilling season and midsummer celebrations, it’s worth considering.
Excess body weight
The nutritionist points out that the body produces more uric acid in people who are overweight, so the kidneys have a greater load when excreting it. “It is important to eat regularly, because not only skipping meals and fasting raise uric acid levels. Every day, it is necessary to supplement the menu with spices, fibers, such as rye bread, brown pasta, nuts, seeds, dairy products and eggs, but add a healthy dose of physical activity, for example, even half an hour long energetic walk at a fast pace,” says Anita Baumane.
Comorbidities
“Some diseases increase the risk of getting gout,” says VCA internist Inga Orleāne. “Risk factors include untreated high blood pressure and various chronic diseases such as diabetes, obesity, metabolic syndrome, heart and kidney disease.”
Family history of gout
If someone in the family has had gout, other family members are more likely to develop the disease. Therefore, special attention should be paid to the daily menu and weight changes should be monitored.
Age and gender
The doctor knows how to tell that gout affects men more often, mainly because women usually have lower levels of uric acid in the body. However, uric acid levels rise in women after menopause. Men are also more likely to develop gout earlier, usually in their 30s to 50s, while women are more likely to develop it after menopause.
Recent surgery or injury
Recent surgery or trauma can sometimes trigger a gout attack. Vaccination can also cause a gout flare-up in some people.
Some medications
Linda Fevraleva, a pharmacist at Mēnes Aptiekas, adds to what the doctor and nutritionist said, explaining the effect of medications on the possible development of the disease: “Aspirin in small doses and some other medications used to control hypertension, including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers, immunosuppressants ciclosporin or tacrolimus, drugs for the treatment of Parkinson’s disease with the active ingredient levodopa can also increase uric acid levels. If, in addition, there are close relatives suffering from gout in the family history or there have already been gout attacks, you should definitely consult a doctor or pharmacist about the use of other medicines.” On the other hand, medications that reduce the level of uric acid in the blood, as well as medications that relieve inflammatory processes, are mainly used for treatment.
Possible complications
People who suffer from gout can also develop more severe conditions, warns Inga Orleāne.
Recurrent gout
Some people may never have gout symptoms again. However, others may experience gout several times a year. Medications can help prevent gout attacks in people with recurrent gout. If left untreated, gout can lead to joint erosion and complete collapse.
Progressive gout
Untreated gout can cause urate crystal deposits to form under the skin in nodules called tophi urici. They can develop in a number of places, such as the fingers, hands, feet, elbows or Achilles tendons along the back of the ankles, as joints become swollen and tender during a gout attack.
Kidney stones
Urate crystals can build up in the urinary tract, causing kidney stones. A proper diet and medication can help reduce the risk of kidney stones.
