However, over time it creates small deposits that solidify in the form of crystals, often in the region of the joints, as these areas of the body have lower temperatures (the joints tend to stay at 32 ºC instead of 37 ºC like the rest of the body).
These uric acid crystals cause inflammation, which results in severe pain that can last for weeks and cause seizures.
In the International Classification of Diseases ( ICD-10 ), gout can be found by the codes:
- M10 : Drop;
- M10.0 : Idiopathic gout;
- M10.1 : Drop induced by lead;
- M10.2 : Drug-induced gout;
- M10.3 : Gout due to renal dysfunction;
- M10.4 : Another secondary drop;
- M10.9 : Drop not specified.
What is the relationship between uric acid and gout?
The cause of gout is the excess of uric acid, as well as its crystallization in the joints.
Uric acid is produced by the liver, when this organ metabolizes purine. Purine, in turn, is a substance present in several foods, but it is also produced by the body itself, independent of food.
The presence of uric acid is natural for the body, but when we have too much of it in the blood, the kidneys are not able to filter it completely.
The uric acid high does not mean that one must drop, but greatly increases the chances that the substance loses solubility when its concentration is too high, which causes it to crystallize, causing pain, swelling and inflammation in the joints.
When is uric acid considered high?
To be considered high, the level of uric acid in the blood must be above 7 mg / dL in men and 6 mg / dL in women .
This number for women becomes 7 mg / dL also after menopause , since what keeps the amount of uric acid reduced in them is estrogen, which facilitates elimination.
Read more: What are the signs and symptoms of menopause? Learn how to recognize
Causes of gout
The main causes for the increased concentration of uric acid in the blood are:
When the kidneys have problems, such as in the case of kidney failure or lead poisoning, uric acid may stop being eliminated in the proper proportion.
In these cases, even with a healthy intake of purines, the concentration of the acid can rise.
The result is that the concentration of uric acid in the blood increases, it loses solubility, crystallizes in sodium urate and the gout appears. Usually, kidney problems are genetic.
High uric acid production
There may be a genetically exacerbated production of uric acid. In these cases, even with less purine intake than most people, the body still produces an excess.
Although our body has a naturally high production of purine, a large part (about 40%) of the substance reaches the body through food.
Purine is present mainly in animal products, but it can be found in vegetables as well.
If the person has a genetic predisposition to produce more of this substance or difficulties in filtering it, this can cause a considerable increase in uric acid in the blood.
Gout, in some cases, is called the “disease of kings”, as it can also affect people who consume many foods with purine, having a lifestyle with excessive nutrition, even though there is no genetic predisposition for it.
Alcohol is metabolized by the liver and also contains purine, which means that it increases the concentration of uric acid in the blood.
Although genetic causes are the main causes of gout, alcohol is responsible for most of the crises of those who have the disease.
Some people are more susceptible to gout than others. Check out some of the risk factors:
High uric acid
High uric acid is the main risk factor for gout, as this is what causes the onset of the disease. It can be elevated for several causes, not all obvious.
In such cases, it is important to take the exams to the doctor so that he or she will tell you what to do.
Men are more likely to develop gout than women, as the hormone estrogen – the female sex hormone – helps eliminate uric acid.
That is why the reference value of the concentration of the substance in the blood for men is higher than in women – 7 mg / dl for them, and 6 mg / dl for them.
This does not mean that women are immune to gout, but the chances of men developing the disease are greater.
This changes, however, after menopause, when estrogen production in women becomes reduced and the concentration of uric acid is equalized in both sexes.
People who have relatives with gout are more likely to develop the condition. This is because most of the causes of gout have a genetic cause, which is often passed on from parents to their children.
Food is one of the main risk factors for gout. Eating foods with a lot of purine causes the body to produce more uric acid, which can later be converted into sodium urate crystals in the joints, causing the characteristic inflammations of gout.
The obesity increases the chances of developing gout. In addition to people with obesity eating more food with purine, the joints of these people are under greater pressure.
Old age makes it more difficult for the kidneys to filter uric acid, which causes the levels of the substance to increase in the blood.
Alcohol is one of the foods that has more purine in its composition. That is why alcoholism often causes gout.
The high levels of purine in the diet of people with alcoholism provide an ideal environment for the body to produce uric acid.
In addition, alcohol is a diuretic, which means that it causes the person to urinate frequently.
People with alcoholism can suffer from dehydration, which facilitates the crystallization of uric acid.
Some classes of medications can contribute to the onset of gouty arthritis, such as thiazide diuretics (used to treat hypertension), aspirin and immunosuppressants (prescribed for patients who have had an organ transplant).
These substances can, in some cases, increase uric acid levels.
Renal failure is a condition that can appear as a result of several diseases – including gout – and that damages the kidneys’ filtering capacity.
In this way, uric acid can begin to accumulate in the body, increasing the chances of sodium urate crystals forming.
Frequently, kidney failure is genetic and this is one of the main factors for the development of gout.
Metabolic syndromes are conditions, usually genetic, that affect the metabolism of substances in the body.
Some of these syndromes can cause the liver to produce more uric acid and increase the body’s production of purine, both of which are substances capable of causing gout.
The classic symptoms of gout are:
Swelling and redness
When there is an infection, wound or some foreign body in some part of the body, the body sends cells from the immune system to defend the body.
This causes inflammation of the site, which can be accompanied by pain, swelling and redness.
It is precisely the inflammation that results in all the other symptoms of gout, which is nothing more than the reaction of the immune system to the presence of sodium urate in the synovial fluid of the joints.
Joint pain is the main symptom of gout, being caused by inflammation of the site.
Uric acid can crystallize in sodium urate anywhere in the body and be carried through the bloodstream to the joint, but it is common for it to crystallize directly in the region.
The sodium urate crystal is immersed in the synovial fluid, responsible for lubricating the joints.
The immune system tries to protect the body from what it believes to be an infection in the synovial fluid and the result is swelling and inflammation that can hurt a lot.
These pains usually appear at night, suddenly and can last for weeks. In addition, gout attacks can arise without warning.
The most affected area is usually the area of the toe, but it is also common for pain to reach the joints of the ankles, knees, elbows and wrists.
Gout can lead to discomfort in the joints, even at times when you are not in crisis. It is possible that the patient may be able to feel the urate crystals in the joints.
Over time and frequent seizures, the joint can become damaged, which can result in chronic pain and difficulty in movement.
Calcium pits (gypsum tops)
When someone lives with the disease without treatment for a long time, it is possible for the sodium urate crystals to absorb and accumulate calcium.
Thus, the leafy tophi are formed. These accumulations can happen under the skin, where they are more obvious to the observer.
The tophi, when small, appear as small lumps that can appear under the skin and take years to grow, but if ignored they can become large enough to prevent movement.
The lumps are also aesthetically unpleasant and cause a lot of pain.
They usually take years to form, so it is possible to avoid this complication with treatment at the beginning of the condition.
Gout types and stages
Gout has several stages, defined by the symptoms presented in each of them. It can be a silent illness before the first crisis. Know each stage of the disease:
In this first stage, there are no symptoms. What there is is a high level of uric acid in the blood and crystals of sodium urate begin to form in the joints.
It is at this stage that the gout shows its symptoms.
After uric acid crystallizes from sodium urate in the joints, the immune system causes an inflammation in the joints, which leads to pain, swelling, redness and all the other symptoms of a crisis.
Seizures often appear during the night and intensify over the next 8 or 12 hours. They disappear over the course of a few days, but their duration can be varied.
It is during the crisis that the diagnosis is usually made, since the pain causes people to see a doctor.
After a gout attack, there is a so-called break. The crystals remain in the joints, but the symptoms are not present since the acute stage of inflammation has passed.
Treatment is usually performed during this phase. Dietary changes must be made to prevent seizures from happening by reducing the level of uric acid in the patient’s blood.
Chronic gout, which can also be called chronic tophaceous gout , happens when the level of uric acid is constantly high in the patient’s blood.
Seizures become frequent and it is possible that the symptoms never leave the patient, they just decrease in intensity during the seizures.
There may be lesions in the joints, which causes several problems such as loss of mobility and the appearance of tophi.
A pseudogout is not a type of gout, but it is important to mention it. The symptoms are identical to that of gout, however the difference is found in the cause.
This condition is caused by calcium phosphate crystals instead of sodium urate.
Although the consequences are the same as the common gout, the pseudogout has a completely different treatment, aimed at reducing the amount of a different substance in the patient’s body, phosphate.
Diagnosis and exams
The diagnosis of gout is commonly made by the general practitioner or rheumatologist.
They also diagnose the pseudogout, so if symptoms do appear, these are the specialists you should be looking for.
There are some tests that can assist in the diagnosis:
Examination of synovial fluid
The most accurate test for the identification of gout is the examination of synovial fluid.
Crystals of sodium urate are deposited in this liquid that lubricates the joints and can be found in it. When crystals are identified in this liquid, the diagnosis of gout is made.
In general, there is no need for preparation before the exam, but it is important to notify the doctor if you take any medication with an anticoagulant effect, as they can affect the result.
The collection is made by injection at the joint site – sometimes anesthesia is performed – and the fluid is removed and sent for analysis in the laboratory.
Even with a gout attack, sodium urate crystals may not be found in the synovial fluid.
In these cases, separate tests are done to differentiate the situation from other diseases that cause pain in the joints.
The blood test is used to identify whether uric acid levels are high in the body.
If high uric acid is identified, the likelihood of a joint pain attack being caused by gout is more likely.
The X-ray , ultrasound and CT can be used to identify gouty tophi or crystals of sodium urate large enough to show up on imaging tests.
Identified, these crystals confirm the diagnosis of gout.
Gout has a cure?
Technically, no. Gout is usually the result of a genetic problem in the metabolism of the purine, in the production of the substance or in the filtration of uric acid.
Therefore, the problem is unlikely to be cured and it can recur even if the urate crystals are removed.
However, it is possible to eliminate the crystals and prevent new ones from forming through treatment, food control and the use of medications to reduce the production of uric acid.
As most cases have a genetic cause, curing gout is usually not feasible. The treatment, then, involves two fronts, both seeking to reduce the amount of uric acid in the blood. Check out:
Drug treatment for gout is mainly aimed at reducing pain during attacks and is usually done with anti-inflammatory drugs. However, some medications can also reduce the concentration of uric acid in the body, preventing future crises.
Removal of leafy tophi
In some cases, when the tophi become large, debridement of the tophi may be necessary. Debridement is nothing more than the simple removal of the leafy tops of a wound or an incision.
The main drugs for gout are anti-inflammatory drugs, which aim to reduce inflammation in the joints, which are the main source of pain.
Some also serve to reduce the level of uric acid in the blood, which is done to control gout. The main drugs used are:
Non-steroidal anti-inflammatory drugs
Anti-inflammatories are drugs used to treat inflammation.
Some have effects on pain receptors, inhibiting the chemicals that activate them, while others can act directly on the inflammatory process. Are they:
- Potassium diclofenac ;
- Diclofenac cholestyramine ;
- Diclofenac sodium ;
- Colchicine ;
- Ibuprofen ;
- Naproxen sodium ;
- Prednisone .
Uric acid inhibitors
Medicines that inhibit uric acid cause the production of the substance to be reduced, which allows its concentration in the blood to be lower. Are they:
- Allopurinol ;
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Homemade gout treatment
The home treatment of gout is usually done with foods that do not contain purine and are diuretics, which helps in filtering the blood.
Some foods that can reduce the effects of uric acid in the body are:
- Horsetail tea;
- Orange juice;
- Watermelon juice;
- Carrot Juice;
- Cherry juice;
- Apple juice.
You can also drink ginger tea, hibiscus tea and green tea, which also work as diuretics. It is important to note that hydration is essential when using diuretics, so drink plenty of water.
Read more: Hibiscus flower: what is it for?
In the diet indicated for the treatment of gout, it is necessary to control the intake of purine , which serves as material for the production of uric acid.
If less purine is ingested, less uric acid is produced.
The menu should contain healthy and balanced meals and, in general, processed or ultra-processed foods, which contain high rates of sugar and other harmful ingredients to the body, should be avoided.
What foods cause gout?
Animal products, especially red meat and organs (such as liver and heart), should be reduced to the maximum in the patient’s diet.
Alcoholic beverages should also be cut, as they contain large amounts of purine, especially beer and wine.
Other restrictions include:
- Shellfish, such as shrimp and lobster;
- Drinks with high sugar rates, such as soft drinks and industrialized juices;
What foods can I eat?
Although many foods contain purine, there are still several free of the substance. You can eat:
- Fruits (preferably those that contain less fructose);
- Vegetable oils, such as olive, canola and sunflower);
- Whole Foods;
- Low-fat milk and dairy products.
Foods like watermelon , apple and artichoke help with blood filtration and can also be added to the diet.
Gout, unfortunately, is not usually curable. For the patient with the disease, a change in habits becomes necessary.
Changing the way food happens is essential to prevent and prevent gout attacks and the formation of new crystals in other joints.
Gout is not capable of killing, but going to the doctor to find out how to treat the disease is essential as the quality of life can be greatly reduced by the condition.
Gout, if left untreated, can bring severe complications to the patient. They usually appear after several years without treatment, becoming more and more prominent as time goes by.
Among these complications are:
The pain, with time without treatment, becomes more intense and longer lasting, and may progress to chronic joint pain, which does not go away.
Loss of motion
Constant inflammation of the joints can cause the patient to lose or reduce their ability to move. It is also a consequence of leafy tophi or large accumulations of sodium urate.
There is a possibility that the bone in the joint region will be damaged due to sodium urate and inflammation in the region. This can be prevented with proper treatment of the condition.
Although it is not a direct consequence of gout, kidney stones can be a complication caused by the high level of uric acid.
When the concentration of uric acid in the blood is high enough, it can crystallize in organs such as the kidneys. This crystallization can lead to the formation of stones, the famous kidney stones.
Most of the causes of gout are not circumventable, so the prevention of the disease and its crises revolves around, mainly, food.
The same ways used to prevent the condition from developing can be used to prevent attacks if you already have gout.
Depending on how exacerbated the uric acid concentration is, just dietary control is not enough, but it is always necessary. In addition, it is important that you:
It is important to hydrate yourself. Hydration makes it difficult for the uric acid to crystallize in the body, in addition to helping the kidneys filter the substance. Drink 1.5 to 2 liters of water a day to prevent gout attacks.
Reduce your intake of alcoholic beverages
Alcoholic beverages, especially beer, can considerably increase the amount of uric acid in your blood, so reducing your intake helps prevent gout.
Control your intake of meat, seafood and poultry
Animal products have high amounts of purine. Controlling your intake of these foods, especially if you have had a seizure before, is important for maintaining health.
Control the weight
If you are overweight, losing weight may be a good idea to control uric acid. The most efficient way to do this is by controlling your diet and practicing physical exercises, that is, adopting a healthier lifestyle.
My uric acid is high. Should I treat gout?
Not necessarily. Elevated uric acid only denotes a risk of developing gout.
It is recommended to see a doctor to find out what is causing this elevation in order to prevent gout and other conditions that may be related to uric acid.
Will I never be able to eat meat again?
You can, but it is important that it is in moderation. Meat is a great source of purine, so overeating can cause gout attacks.
Keep your meat consumption sporadic, being careful not to overdo it during the times it happens, and never eat meat during a crisis, as adding more purine to your body increases the chances of the condition getting worse.
Does non-alcoholic beer have purines?
Yes, a lot. Although alcohol greatly increases the amount of uric acid in the blood, the other components of beer do as well. So, even without alcohol, it is good to avoid beer.
Can gout kill?
No, gout does not pose a risk of death. However, the pain and can be severe and reduce the patient’s quality of life.