The symptoms of gout are triggered by accumulations of uric acid crystals in the joints, especially on the big toe joint.
This condition is characterized by increased uric acid in the blood (hyperuricemia) and is painful, chronic and progressive.
Gout is hereditary and non-contagious.
This disease mainly affects adults and the elderly, rather rarely it is also diagnosed in children.
The uric acid crystals can be stored in small fluid-filled sacs (bursa) around the joints.
These crystals increase the inflammation that causes pain and swelling around the joints (bursitis). In rare cases, gout develops into a chronic type of inflammation, similar to rheumatoid arthritis.
In chronic gout, uric acid crystals are deposited in different areas of soft tissue in the body; in the finger joints, on the elbow, on the ears and around the big toes. These nodules can occur anywhere in the body. In fact, they have also been found in unusual areas such as the vocal cords or around the spinal cord.
What is gout?
Gout is a condition caused by too much uric acid in the body. This overload leads to the formation of small uric acid crystals, which are stored in the tissues of the body, especially in the joints.
When these crystals accumulate in the joints, they lead to recurring joint inflammation (arthritis).
Often, gout is caused by an inherited disorder in the body’s ability to metabolize uric acid.
Uric acid is a breakdown product of purines (substances found in proteins and DNA) found in many foods we eat.
An excess of uric acid can lead to attacks of painful arthritis (gout attack), but can also affect the intestines, especially the kidneys.
The consequences can be kidney stones and renal insufficiency.
Caution, some people may have elevated levels of uric acid in their blood (hyperuricemia) without symptoms of gout such as arthritis or kidney failure.
Asymptomatic hyperuricemia occurs when there are elevated levels of uric acid in the blood without symptoms.
The level of uric acid in the blood often drops during an acute attack of gout.
Asymptomatic hyperuricemia is considered a precursor from which gout develops.
Arthritis attacks are extremely painful and lead to rapid inflammation of the joints.
Inflammation of the joints arises due to the deposits of uric acid crystals in the synovial fluid and lining of the joint (membrana synovialis).
Joint inflammation is the normal response of the immune system, which sends out the white blood cells to eliminate uric acid and releases chemical inflammatory mediators that cause pain, overheating, and redness around the joint.
This condition develops with more frequent painful attacks and extends to other joints as well.
Who suffers from gout?
Over 8 million people in the United States suffer from gout.
Gout occurs nine times more often in men than in women.
Predominantly men are affected after puberty, with a peak value around the age of 75.
In women, gout attacks usually occur only after menopause.
Among the male population of the United States, about 10% have hyperuricemia.
Despite this, only a small proportion of those with hyperuricemia develop gout.
Causes of gout
In addition to the hereditary anomaly related to uric acid, there are other risk factors: obesity, increase in body weight, alcohol consumption, high blood pressure, intake of fructose and corn syrup in soft drinks, and kidney problems.
Some medications, such as thiazide diuretics (hydrochlorothiazide), low doses of aspirin, cyclosporine, and anti-tuberculosis medications, can lead to increased uric acid levels in the blood and thus gout.
Very severe attacks of the disease are favored by dehydration, fever, alcohol consumption, previous trauma or surgical operations.
Some diseases can also increase uric acid production in the body. Some examples are: leukemia and lymphoma.
A study has shown the reduction of thyroid hormones (hypothyroidism) in gout patients.
Gout attacks may be caused by a previous operation due to increased blood loss.
How does gout manifest itself? Signs and symptoms
The big toe is the part of the body that most often experiences an acute attack of gout. This is called Podagra.
The most commonly affected joints are:
Acute attacks are characterized by sudden pain in the affected joints along with swelling, overheating and redness of the skin.
Gout can also occur polyarticularly, that is, simultaneously affect different joints.
Patients may also have a fever.
These painful attacks usually pass after a few days with or without medication. In rare cases, an acute attack of gout can last for a few weeks.
Most gout patients have suffered a recurrence of acute arthritis in their lifetime.
Diagnosis of gout
Gout is suspected when a patient suffers from attacks of arthritis, especially if they occur on the metatarsophalangeal joints.
The ankles and knees are most involved among the joints.
In most cases, this disease manifests itself in only one joint at a time, while other types of arthritis, such as systemic lupus and rheumatoid arthritis, involve several joints at the same time.
The X-ray helps to reveal crystal deposits and possible damage as a result of chronic inflammation and to assess the effects of chronic gout on the joints.
The most important diagnostic examination is arthrocentesis, namely the aspiration of synovial fluid to determine whether crystals are present in the joints.
Arthrocentesis is performed under local anesthesia.
With the help of a syringe with a sterile cannula, the fluid is aspirated from the inflamed joint. The liquid is analyzed to find uric acid crystals and potential infections.
Uric acid crystals are visualized under the microscope.
The diagnosis of gout can be made by finding urate crystals in the aspiration material from the articular nodes and bursa fluid.
The rheumatologists are the specialists for this assessment.
Patients with a classical history and the symptoms of gout can be treated accordingly even without arthrocentesis.
Nevertheless, it is difficult to make a correct diagnosis because other diseases can resemble gout, such as pseudogout, psoriatic arthritis, rheumatoid arthritis and infections of the joints.