Gout also gouty arthritis is inflammatory arthritis caused by the accumulation of uric acid in the blood called hyperuricemia. Long term accumulation of uric acid in the blood leads to the formation of uric acid crystals that deposits in the joints, which cause the classical sign of gout. Gout affects 1-2% of people in the western population. It is more common in men 45 years and above and postmenopausal women.
Mayor Boss created a short guide for you to understand gout and how to treat this common type of arthritis. And on that note, let’s dive in.
Purines are naturally occurring substances found in certain foods such as seafood, meat, mushrooms, and beer. The normal breakdown of purines releases a waste product called uric acid. Uric acid is then cleaned out of the body by the kidneys and excreted with urine.
Does hyperuricemia cause gout?
Hyperuricemia (High Uric Acid) occur by two methods which can lead to gout:
- When the kidney excretes less uric acid out of the body, the unfiltered uric acid left in the blood accumulate in the blood.(Normal uric levels are 2.4-6.0mg/dL in women and 3.4-7.0mg/dL in men)
- When the body produces more uric acid as a result of eating more purines filled food or having a genetic disposition to produce more uric acid.
Risk factors that predispose a person to have gout:
- Consuming a lot of beer, seafood, meat
- Familial juvenile hyperuricemic nephropathy: is an autosomal dominant disorder characterized by chronic interstitial nephritis with marked thickening of tubular basement membrane and hyperuricemia
- kidney failure
- Certain medications such as niacin or thiazide diuretics
- Medullary cystic kidney disease (an autosomal dominant kidney disease)
- Lesch-Nyhan syndrome: is a rare genetic ailment caused by Hypoxanthine guanine phosphoribosyltransferase deficiency (HGPRT).
- Family history of gout
- Age and sex: Men of 45years and above tend to have gout more often than women in their age group. Gout usually occurs in women postmenopausal
What is the first sign of gout?
The characteristic symptom of gout is sudden recurrent painful, hot, red, tender, swelling of the big toe, also known as podagra. The joint usually affected are the metatarsal phalangeal joint. The pain usually begins suddenly at night and get worse for a few hours, after which it gets better within 24 hours to a couple of days with or without treatment. Other joints affected are ankles, wrist, fingers, elbows, and knees. This uric crystals accumulating in the joints can also accumulate in the kidneys and cause kidney failure.
The major signs and symptoms of gout are as a result of the accumulation of uric acid in joints and blood, and these symptoms tend to be recurrent once a patient stops taking their medication.
How is gout diagnosed?
Diagnosis of gout is made with:
- Synovial fluid aspiration viewed under a microscope will detect needle-like monosodium urate crystals(MSU).
- X-ray of joints affected.
- Musculoskeletal ultrasound used to detect urate crystal (tophi) in the joint.
- CT scan
- A blood test to check serum uric levels.
What is the best treatment for gout?
- Lifestyle modifications such as reduce consumption of foods with high purine levels in them and weight loss. Plant-based purine food such as beans, peas have been shown not to increase uric acid in the body or flare-up gout, therefore plant base purine foods are suitable for consumption. Here are foods that reduces uric acid levels.
- NSAIDs (Ibuprofen, indomethacin, celecoxib)
- Corticosteroids (prednisone)
- Gout specific drugs: Colchicine(reduces gout pain), Allopurinol, and Febuxostat (are xanthine oxidase inhibitors. They restrict the amount of uric acid the body creates), Uricosurics(Improves the kidney’s ability to filter uric acid from the body).
Gout is manageable with proper diet plans in place, checking serum uric levels regularly, monitoring the kidneys and liver regularly to rule out side effects of drugs, and taking medications as recommended.
Lastly, while you’re here, see our articles on ways to get rid of gout and joint pain