Living with gout is painful and frustrating. Gout causes sudden attacks of severe pain, swelling, redness, and tenderness in the joints. It typically attacks the joint in the big toe but can also attack the ankles, knees, fingers, wrists, and elbows.
Unlike osteoarthritis and rheumatoid arthritis, which cause chronic inflammation and pain, gout is episodic–meaning its symptoms occur in temporary, recurrent periods rather than continuously.
We've seen gout cases rise a lot recently. Makes sense since people are living longer these days, and getting older increases your chances of gout. Other health problems like kidney problems, high blood pressure, extra weight, and diabetes also make gout more likely. Drugs like diuretics or water pills that can trigger gout attacks are also more widely used nowadays
Because gout is linked to many other health problems, treating it has gotten trickier. Doctors have to consider the whole health picture when managing gout.
What are The Symptoms of Gout?
The periods between gout attacks can last for many years. During these periods, people with gout often have no symptoms at all and feel completely normal. Some common symptoms of a gout attack include:
Sudden intense joint pain, often at night. The pain is described as throbbing, crushing, or excruciating.
Swelling, warmth, and redness in the joints. The joint becomes tender, hot, and swollen.
Inflammation in the joints. The tender, swollen joint is a sign of excess uric acid crystals causing inflammation.
Limited range of motion. The swollen joint makes it difficult and painful to move the joint. Even the weight of bedsheets can be agonizing.
Fever and chills. Some people experience a fever, chills, and gout attacks due to inflammation.
Red, shiny skin. The skin over the affected joint may become red, tight, and shiny as the inflammation builds up.
Joint damage. Repeated gout attacks over long periods can lead to joint damage and deformity if left untreated.
What Are The Causes and Risk Factors of Gout?
The primary cause of gouty arthritis is elevated levels of uric acid in the blood, called hyperuricemia.
The body produces uric acid by breaking down purines, a substance in many foods and drinks. Too much uric acid in the blood can form needle-like crystals in the joints and surrounding tissue, causing inflammation and pain.
Key risk factors for developing hyperuricemia and gout include:
Diet high in purines. Foods high in purines, such as red meat, organ meats like liver, seafood like anchovies and sardines, and alcoholic beverages, especially beer, can raise uric acid levels in the blood and trigger gout attacks.
Obesity or weight gain. Excess weight puts more stress on the joints and decreases the body's ability to eliminate uric acid.
Genetics. Having family members with gout increases the likelihood of developing the condition. Inherited metabolic defects that make it difficult for the body to break down purines also increase risk.
Medical conditions. Certain conditions like high blood pressure, diabetes, metabolic syndrome and kidney disease interfere with the body's ability to remove uric acid and can lead to hyperuricemia and gout.
Certain medications. Diuretics, low-dose aspirin, cyclosporine, and levodopa may promote high uric acid levels.
Dehydration and alcohol use. Both dehydration and excessive alcohol consumption reduce the kidneys' ability to eliminate uric acid from the bloodstream.
Recent surgery or trauma. Physical stress or injury such as surgery, a broken bone, or severe illness can trigger a gout attack by causing a sudden release of uric acid from the tissues into the blood.
How is Gout Diagnosed?
Gout is often diagnosed based on symptoms, blood uric acid tests, and ruling out other causes. Joint fluid tests and imaging are mainly done in unclear cases or to diagnose other conditions that could cause similar symptoms. The key is to identify needle-shaped urate crystals confirming the gout diagnosis.
Blood Test
One method is to measure the level of uric acid in the blood. If it is higher than 360 μmol/L (6 mg/dL), the person probably has gout. If it is lower than that, but the person still has gout symptoms, the doctor may repeat the test later when the symptoms are gone.
Joint Fluid Test
Another method is to take some fluid inside the joint with a needle. The rheumatologist can look at the fluid under a microscope and see if there are uric acid crystals. If there are crystals, it means the person has gout. They may also check for microbes in the fluid to rule out infection.
Imaging Tests
A third method is to use a machine like ultrasound or x-ray to look at the joint. The doctor can see if there are signs of uric acid deposits or damage to the joint. If there are signs, it means the person has gout.
What Are The Treatments for Gout?
Anti-inflammatory medications- These provide quick relief from the pain and swelling caused by gout attacks. Examples are corticosteroids such as prednisone, and NSAIDs like ibuprofen and naproxen. They reduce inflammation and ease pain. These are usually the first line of treatment for acute gout attacks.
Colchicine - This medication relieves gout pain by reducing inflammation. It works by decreasing the production of uric acid crystals that cause joint swelling and pain. Colchicine can relieve symptoms within 12 hours for some people.
Ice packs - Applying ice to the affected joint can significantly relieve pain and inflammation. Do this for 10-15 minutes several times a day.
Rest - Giving rest to the inflamed joint also helps in relieving symptoms. Avoid any activity that aggravates your symptoms.
Drink plenty of water - Increasing water intake helps flush out excess uric acid from the body and prevents the recurrence of gout attacks. Aim for 8-16 glasses of water per day.
Uric acid lowering therapy - For chronic gout, medications like allopurinol, febuxostat, etc. are used to lower uric acid levels in the blood to prevent future attacks and joint damage. They are usually started after an acute attack subsides.
Lifestyle changes - Making certain lifestyle changes like losing weight and limiting alcohol and high-purine foods can help lower uric acid levels and reduce the frequency and severity of gout flare-ups.
In severe cases, joint aspiration to drain fluid or corticosteroid injections into the joint may be needed to reduce inflammation and pain quickly. Surgical options may also be considered to remove uric acid crystals or correct joint deformities.
What Are The Complications and Prognosis of Gout?
Gout can lead to serious health issues if left untreated. Frequent gout attacks over time can cause permanent joint damage and chronic pain. Without treatment, the uric acid buildup continues, forming large lumps called tophi. These tophi can then cause joint deformity and loss of function.
High uric acid levels can also lead to kidney stones, which cause pain, blockages, and even kidney damage. In severe cases, the kidneys themselves are damaged from excessive uric acid in a condition called uric acid nephropathy.
The outlook for gout often depends on how well it is managed. Starting treatment early, controlling other health conditions, and making necessary lifestyle changes can lower uric acid levels, reduce attacks, and improve quality of life.
Gout Treatment in Orange County
Are you suffering from the debilitating pain of a gout flare-up? Do excruciating joint aches and swelling make it hard to walk or sleep at night? Have you tried endless medications and diets with little relief?
There is hope. Effective treatments for gout are available, and relief from your symptoms is within reach. The rheumatologists at OC Rheumatology & Arthritis in Orange County are experts in gout and related conditions.
You deserve to live pain-free and feel like yourself again. Do not suffer in silence anymore. Call OC Rheumatology & Arthritis today for an appointment. Our number is 714-825-0891
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