The symptoms of gout are caused by the accumulation of crystals of uric acid in the joints.
Gout is a painful, chronic, progressive disease that especially affects the base of the big toe.
This is a hereditary disease and is characterized by a high level of uric acid in the blood (hyperuricemia).
What is gout?
Gout is a disease that results from an overload of uric acid in the body. This overload leads to the formation of small crystals of urate in the tissues of the body, especially in the joints.
When the crystals form in the joints, they cause recurrent inflammation in the joints (arthritis).
Gout is one of the most commonly recorded diseases in history.
It is often associated with hereditary abnormality in the body’s ability to metabolize uric acid.
Uric acid is a product of the degradation of purines that are part of many foods we eat.
An abnormality in the metabolism of uric acid can cause attacks of painful arthritis (gout attack), kidney stones andrenal insufficiency .
On the other hand, some people may develop high levels of uric acid (hyperuricemia) without having the symptoms of gout, such as arthritis or kidney failure.
Asymptomatic hyperuricemia occurs if there are high levels of uric acid in the blood, with no symptoms.
The level of uric acid in the blood often reduces during an acute attack of gout.
Asymptomatic hyperuricemia is considered a precursor state for the development of gout.
Arthritis attacks are extremely painful and lead to rapid inflammation of the joints.
The inflammation of the joints is due to the deposition of uric acid crystals in the synovial fluid of the joint (synovial membrane).
The intensity of inflammation of the joints is the normal reaction of the immune system which increases the amount of white blood cells to eliminate uric acid and releases the chemical mediators from inflammation that cause pain, heat and redness in the joint.
The disease progresses with more frequent and painful attacks with the involvement of other joints.
More than 8 million people in the United States suffer from gout. Gout is nine times more common in men than in women.
It predominantly affects the male gender after puberty, with a peak around the age of 75 years.
In women, gout attacks occur after menopause . Usually, among the male population in the United States, about 10% have hyperuricemia.
However, only a small proportion of people with hyperuricemia develops gout.
Causes of gout
In addition to the hereditary anomaly due to the metabolism of uric acid, other risk factors are:
- Weight gain
- Alcohol consumption
- High blood pressure
- Consumption of fructose and corn syrup in soft drinks
- Malfunction of the kidneys.
In addition, some medications, such as diuretics ( hydrochlorothiazide ), low-dose aspirin, niacin, cyclosporine, and drugs for tuberculosis can cause high levels of uric acid in the blood and lead to gout.
The very strong attacks of the disease are accelerated by:
Some diseases can cause excessive production of uric acid in the body.
Some examples are: leukemias , lymphoma .
Interestingly, one study showed a decrease in levels of thyroid hormone ( hypothyroidism ) in patients with gout.
Gout attacks triggered by recent surgery are related to changes in fluid balance in the body.
Signs and Symptoms of Gout
The big toe is the part of the body that suffers a sharp gout attack more often, it is called podagra.
Other joints that are often affected are the ankle, knee, wrist, fingers and elbow.
Acute attacks are characterized by a rapid onset of pain in the affected joint, along with heat, reddening and swelling of the skin.
Patients may also have a fever .
These painful attacks usually decrease after a day, with or without medication. In rare cases, an acute gout attack can last for weeks.
Most gout patients have a recurrence of life-threatening arthritis attacks.
Diagnosis of gout
If gout is suspected when a patient reports having arthritis pain attacks, especially at the base of the fingers.
The feet, ankles and knees are the most affected joints.
This disease usually attacks one joint at a time, while other types of arthritis (such as systemic lupus erythematosus and rheumatoid arthritis) involve multiple joints simultaneously.
The radiograph can be useful to show the crystal deposits, damage caused by chronic inflammation and control the effects of chronic gout joints.
The most useful diagnostic test is arthrocentesis, ie aspiration of fluid from the joint to see if there are crystals in the joints.
Arthrocentesis is a procedure performed under local anesthesia. Using a syringe and a sterile needle, the liquid is aspirated from the inflamed joint. The fluid is analyzed for uric acid crystals and potential infections. Uric acid crystals are seen with a microscope. The diagnosis of gout can be made by finding these urate crystals in the aspirated materials in the joint nodules and the bursa fluid (bunion).
The rheumatologist is the specialist with experience in the evaluation of gout.
Patients with history and symptoms of gout can be treated successfully without having to undergo arthrocentesis.
However, getting to the correct diagnosis is difficult since other diseases can be similar to gout, such as pseudogout, psoriatic arthritis, rheumatoid arthritis and even joint infections.