Surprisingly, 8.3 million Americans were reported to be affected by gout between 2007 and 2008 according to the Centers for Disease and Prevention (CDC)! Well, this figure is huge right? The number must have gone higher by now.
So what exactly is gout?
This is a chronic inflammatory condition affecting mainly the joints to cause painful experiences. In worse cases when gout attacks the same joint repeatedly, it leads to gouty arthritis which is a severe form of arthritis. In most cases, gout comes and goes, with worse symptoms referred to as flares while mild or no signs referred to as remissions. No known cure has been found for gout to date. However, with effective treatment and maintenance, you can efficiently manage the condition using medication and other self-management remedies.
What are the typical symptoms of gout?
This form of arthritis starts suddenly with the flares lasting for days or even weeks. Once the symptoms disappear, it may take extended periods, like months or even years, before experiencing another flare. This condition usually attacks one joint at a time especially the big toe. Other joints that may be affected include the ankle, knee and lesser toe joints.
Flares usually come with the following symptoms;
- Intense pain around the affected joints
- Swelling of the joints
- Heat and tenderness
Sometimes gout may develop into more severe complications like kidney stones in case uric acid crystals accumulate in the urinary tract and recurrent gout with regular recurrences that cause more and more damage to the specific joints and tissues surrounding them.
What are the causes of gout?
Gout is caused by renal under-excretion of uric acid; a condition called hyperuricemia. The breakdown of purines found in the body and foods you take is what results in uric acid, and excessive accumulation of this acid in the body may build up in the joints, tissues and body fluids over time. The signs of this condition are as a result of the body’s response to uric acid crystals formed in the joints. The build-up of uric acid in the body, however, does not always cause gout and in such cases, no treatment may be needed.
There are five different stages of gout as its severity progresses. The various stages are classified as different types of gout.
This stage involves elevated levels of uric acid in the body without showing any outward symptoms. No treatment may be required at this stage but, continued accumulation of the acid may result in minor damages to specific joints. It is only advisable for people with this type of gout to avoid possible risk factors that may aggravate the condition due to the build-up of uric acid.
During this stage, accumulated uric acid crystals in the joints suddenly start causing intense pain, and inflammation. However, the flares don’t last for long as they usually diminish within three to ten days. Stress, excessive alcohol consumption, cold weather and specific drugs can trigger the flares during this stage.
Intercritical/ interval gout
This stage occurs in between two flare attacks. The next flares may take months or even years before occurring. However, if not treated and managed well, they may occur more frequently and take longer to diminish. There is more accumulation of uric acid crystals during this stage.
Chronic tophaceous gout
This is a severe type of gout probably resulting in permanent damages to the kidneys and joints. This may further result in chronic arthritis and development of big lumps, urate crystals and tophi around the colder parts of the body especially the finger joints.
Usually, it takes long periods of no treatment to get to this stage- roughly ten years. With proper treatment, it is not likely for a patient to progress to this stage
This condition exhibits same symptoms as gout but, not indeed gout. In this condition, joints get irritated by the accumulation of calcium crystals instead of uric acid. The condition thus requires a different type of treatment.
Which are the risk factors for gout?
As earlier mentioned, accumulation of uric acid does not necessarily cause gout. However, the risk factors below increase your chances of developing hyperuricemia causing gout.
- Obesity– in a research study conducted to determine the association and prevalence of gout among obese people in the US, it was concluded that overweight and obese adults (both men and women) were more prevalent to suffer from gout. The prevalence of gout among participants with normal BMI was about 2% and slightly higher by 1% among overweight participants.
- Specific health conditions like high blood pressure, diabetes, metabolic syndrome, kidney failure, cardiovascular disease and insulin resistance
- Tumor lysis syndrome– this is a rapid release of intracellular content into the bloodstream and possibility of multiple organ damages leading to renal failure, pulmonary edema and eventual death as a result of certain cancers and chemotherapy treatments. Studies have revealed a close relationship between tumor lysis syndrome and elevated uric acid levels responsible for gout development.
- Psoriasis– this is a condition that causes scales, dry and itchy patches on the skin. A study reveals that high levels of serum uric acid are often detected in psoriasis patients. This indicates that the condition is directly associated with gout.
- Food and drinks with high fructose volumes– the modern society is full of sugar-sweetened and higher fructose-quantity beverages. The effects of such additives have been studied to determine their relation with gout. Earlier studies indicated an elevated plasma uric acid and lactate levels driven by purine nucleotide or de novo purine synthesis.
- Purine-rich foods-sea food, meat, animal protein and some vegetables are known to be highly rich in purines and thus associated with gout development. In a study to evaluate the relationship between specific diets and serum uric acid levels, it was observed that serum uric acid levels increased with increase in meat and seafood intake. This is to say, more intake of meat and seafood is associated with higher serum levels of uric acid causing gout.
- Excessive alcohol consumption– for a long time, excessive alcohol consumption has been associated with gout. Research carried out back in the 1960s indicated a reduced uric acid excretion as a result of alcohol consumption. Further studies were carried out to determine the effects of ethanol on the development of gout, and accurate to the research, a comparison of consuming an alcoholic and a non-alcoholic beer indicated a rise in plasma uric acid levels at 5% and 4.4% respectively. This is a clear indication that purine load in alcoholic drinks has a significant effect on uric acid.
- Gender– a research study reveals that males under the age of 65 have a higher prevalence of gout than females. However, above this age, the ratio of male to female developing gout reduces to 3:1. This only means that regardless of the age, men still have the most burden of gout condition with younger men having four times higher prevalence than women.
- Age –this has always been associated with increased the chance of getting gout. Data analysis from the NHANES demonstrated rising prevalence of gout with age increase. This is the same case with the prevalence of other diseases associated with gout including diabetes, hypertension, and use of diuretics
- Genetics– studies have been carried out to define the role of genetics in gout and all point out explicitly that genetic polymorphisms are associated with uric acid and gout. This is based on findings indicating a significant correlation in between parents and siblings.
- Too much exposure to lead-chronic exposure to lead has been closely linked to gout cases. A cross-sectional analysis of subjects in a lead-polluted area in China indicated that blood lead level increased with increase in serum uric acid in males and females thus associated with higher prevalence of gout.
Treatment of Gout
To effectively treat gout, diagnosis by a medical doctor is necessary. The doctor will assess all the symptoms and results of physical examination, lab tests and x-rays to determine presence or absence of uric acid crystals in the joints affected. With no cure for gout, your medical doctor will recommend some strategies to help manage the flares and pain as well as prevent future occurrences of the flares. Among some of these treatment and management strategies include;
- Use of non-steroidal anti-inflammatory drugs such as steroids, colchicines, and ibuprofen
- Diet and lifestyle changes including taking less purine-rich foods, stop smoking and minimizing alcohol consumption
- Take enough water to hydrate the body
- Take low-fat dairy products
- Getting physically active at least 3 hours a week by walking, swimming, jogging or bike riding. This will also help prevent other severe health conditions like diabetes and heart disease, both of which are major risk factors of gout.
- Attend physical activity programs to help ease the pain and complications associated with gouty arthritis.
- Attend self-management education programs to learn how to manage your gout
- Using corticosteroids like prednisone to reduce inflammation and ease the pain
- Taking medicines that help reduce production of uric acid by the body, such as allopurinol
- Taking medications that help to promote excretion of uric acid, like probenecid
- Weight loss
Gout is a severe joint condition that may cause excruciating pain and discomfort. Although the condition has no cure, various treatment and maintenance options available will help a lot. Don’t get stressed up; wake up and take control of the situation and you can lead a healthy, painless life.