The Painful Facts About Gout
How is your day-to-day diet? Do you dine and wine like a king? Then you are at a high risk of getting gout, an arthritis type of disease.
Many years ago, King Henry VIII, who was obese from his incredible appetite for sumptuous meals and alcohol, suffered from the "disease of kings," or the "king of arthritis" called gout.
Another great man of old with a history of gout is Benjamin Franklin. He did have not only gout but also a large bladder stone. Both conditions caused him intense pain, affected his mobility, and eventually led to his death.
That does not mean gout is a discriminator of the rich. The disease can occur to anyone despite the economic background. What would matter is indulging in the wrong type of foods that would place you at risk of the disease.
What is Gout?
Gout is an arthritis disease associated with intense pain more than any other type of arthritis. It also causes joint stiffness, inflammation, and swelling. The most affected areas are the joints, and especially the big toe, which is most susceptible. The disease has the characteristics of sudden attacks, which frequently may occur during the night.
The gout precursor is high uric acid in the body deposited in the joints to cause inflammation and pain. In most cases, the first gout attack happens in the big toe and can progress to other joints.
Facts About Gout
Gout is not only for the rich but also for any economically average person whose usual diet includes meat and alcohol. Gout is prevalent with men by 6.1 in 1,000 cases than women who have 1 in 1,000 patients.
In 2017, the prevalence of gout cases globally was about 34.5 million. The overall estimated mortality cases in the world were 7.44 million.
In the U.S., there are about 8.3 million gout cases, of which about 6.1 million are men and 2.2 million are women.
Women have few cases because of the estrogen hormone, one of the two sex hormones they have. The hormone helps the kidneys process and flush out uric acid through the urine.
But at menopause and beyond, a woman's body stops making estrogen and therefore becomes exposed to gout.
In the early years, when gout was a disease associated with the kings, famous people, and the rich, it instantly raised social status for anyone with the disease.
People knew that to get the disease, one must have a rich diet containing seafood, meat, and alcohol, which have a high chemical compound called purine. The human body produces uric acid when breaking down purine.
How Does Gout Occur?
It is good to note that not everyone with hyperuricemia or high uric acid levels develops clinical gout.
When gout first attacks, it commonly would involve the joint of the big toe, which becomes swollen, tender, hot, and red skin on the affected joint. The disease can also attack other joints such as the knees, ankles, insteps, wrist, and fingers.
Primarily, gout begins from frequently eating red meat, seafood, sweetened beverages. Indulging in such a diet would increase uric acid to break down the purine chemical found in such a diet.
The urate crystals collect in your joints over the years without your knowledge. When the crystals build up in the joints, you can know about your condition from the symptoms.
The sharp needle-like urate crystals can rub against the synovium to cause gnawing pain and inflammation.
If you are a man or a menopausal woman, your kidneys might fail to flush out the high uric acid in the blood, which may form urate crystals. The blood then deposits the crystals in the joints.
One description written by Dr. Thomas Sydenham in 1683 accurately noted that a gout attack is a violent stretch and tear of the ligament that causes gnawing pain. The pain is so bad that you cannot even withstand the weight of bedclothes.
In normal and healthy purine chemical breakdown, the blood deposits the uric acid in your kidneys to flush it out through urination.
But when your kidneys become overburdened by the uric acid or, for some health reasons, fail to eliminate the uric acid, it builds up in the blood.
The blood deposits the sharp-like needle crystals in the joints, which is the reason for joint inflammation, swelling, and intense pain. Such symptoms may occur suddenly without warning and especially during the night.
After days of such agony episodes of gout flares, the symptoms may subside either from treatment or on their own. As you continue eating a diet containing purine chemicals, you continue experiencing bouts of gout off and on.
However, if you have repeated gout attacks, you can progress in phases to gouty arthritis or chronic gout, a worse type of arthritis.
Four Phases of Gout Progression
Gout is a progressive disease that develops in four stages:
Asymptomatic Hyperuricemia. As the name suggests, asymptomatic hyperuricemia is high uric acid in the blood that has yet to develop symptoms. At this phase, the levels of serum urate have increased above 6.8mg/dL. The normal serum urate levels are 2.4 to 6.0 mg/dL in females and in male 3.4 to 7.0 mg/dL.
If you are at asymptomatic hyperuricemia level, you are safe from gout. However, if you exceed your gender level, you will likely get to the next clinical gout level, which is acute gouty arthritis.
Acute Gouty Arthritis. At this level, you experience gout symptoms. The blood deposits the needle-shaped urate crystals in any susceptible joints, such as the big toe joint. The sharp urate crystals rub against the synovium to cause acute and intense pain, skin redness, inflammation, and swelling. Due to the intense pain, you may have limited movement of the affected joint.
Intercritical Gout Phase. The intercritical gout phase is the remission stage between bouts of gouts. It is your resting period between your next gout attack.
Although you can easily forget about the gout issue at this gout recess phase, you should continue with your treatment if you have already started. If you have not, you may seek treatment besides the flare remission.
It is essential to lower the uric acid level to prevent more future flares or get to the next level, chronic tophaceous gout.
Chronic Tophaceous Gout. As the name of this phase suggests, it is the height of your gout condition, which has become chronic. You may cease to experience the intercritical periods of asymptomatic gout at this phase and begin to experience agonizing chronic pain and other symptoms.
The chronic tophaceous gout occurs when the urate crystals form chalky deposits in the joints known as tophi. Tophi are nodular masses containing crystals of uric acid. If you are at this chronic phase, you may have tophi on your fingers, big toe, and at the elbow knuckle.
As the disease progresses further for a length of time without treatment, you begin to experience multiple hard nodules on other parts of the body, even at the helix of your ear.
The uric acid tophi deposits on the joints can damage the bone and the cartilage to cause swelling and deformity. One can easily confuse the deformity with rheumatoid arthritis.
What Are the Symptoms of Gout?
Gout usually occurs suddenly without any warning and mostly during the night when you might be sleeping. The initial gout symptoms are:
- Excruciating joint pain
- Persistent discomfort
- Skin redness on the affected area
- Limited range of movement
If you fail to get treatment after your early signs, your gout can progress to become chronic. The following are signs of chronic gout:
- Swollen masses of hard nodules on the affected joint
- Severe joint pain
- Joint deformity
- High temperature above 38C or 100.4F
What Causes Gout?
Gout is a metabolic disease caused by uric acid buildup in the blood. It is a disorder of purine breakdown, which leads to an increase in uric acid. Therefore, the base of gout disease is hyperuricemia, which is an increase of body uric acid.
A kidney condition can affect the flushing of uric acid from the body through the urine.
Thyroid hormone deficiency can cause serum uric acid buildup, which can lead to gout.
Gout Risk Factors
You are at a high risk of gout if you have the following:
Genetic: There is a likelihood that gout can move in the family. If your close relation had gout, then you are likely to have the same.
Gender and age: Men are at a high risk of uric acid buildup because they lack estrogen, a sex hormone in women that flushes out uric acid from the body. Women at the age of menopause and beyond are also at high risk of gout from estrogen hormone deficiency.
Diet and Lifestyle: Regular eating a diet containing high-purine foods can increase the chance of getting gout through a uric acid buildup in the body. Alcohol can also contribute to gout by interfering with flushing out of uric acid from the body.
Medications: Some medicines can increase uric acid in the body, such as those containing salicylate. These drugs are diuretics, diclofenac, ibuprofen, and acetaminophen.
Lead exposure: Lead exposure leads to renal impairment, which affects flushing out of uric acid and therefore causing gout.
Other disorders: Diseases such as kidney disease, diabetes, thyroid disease, and high blood pressure can put you at risk of gout.
Weight: You are at risk of gout if you are overweight. Your body might produce too much uric acid for your kidneys to excrete. Also, the more the mass body tissue, the more the purines breakdown from the body tissues.
Trauma or Surgery: If you recently had a joint injury or surgery, you are at risk of a gout attack.
Pseudogout vs. Gout
Pseudo is a prefix that means false, copy, or similar. Therefore, pseudogout is not a common gout but a disease that imitates gout.
Pseudogout is a type of arthritis that has almost the same symptoms as gout. It causes sudden joint pain, although not as intense as the real gout attacks. It also causes swelling.
The difference between the two conditions is that gout is a result of acid crystals buildup. On the other hand, pseudogout is the deposition of calcium pyrophosphate dihydrate crystals (CPPD) in the joints.
Unlike gout that can affect multiple joints, pseudogout attacks one joint at a time. The common joints that CPPD affects are the wrist and the knee. However, it can affect others such as the shoulder, elbows, hips, and fingers knuckle, although rarely.
Pseudogout can occur alongside gout, even on one joint but also rarely. You can also have pseudogout alongside other conditions such as joint infection or osteoarthritis.
Diagnosing of the two conditions is almost the same. Although an X-ray might not reveal whether you have gout or pseudogout, a lab test can differentiate the two. Synovial fluid testing can tell what type of crystal deposits you have.
Gout Diagnosis Family and Health History. Your doctor may begin the diagnosis process by asking you a few questions about your health, diet, and lifestyle. Another question would be whether you have anyone in your family with gout. After getting that information, your doctor would proceed to other diagnoses.
Physical Examination. After you specify where and how you feel pain, your doctor will examine your affected joint to note the visible signs such as redness, swelling, or tophi if your case is advanced.
X-ray Imaging Test. An X-ray on the affected joint is essential to help rule out other joint inflammation diseases. The X-ray can reveal images of uric acid crystals deposition. However, an X-ray can miss the joint changes, which would appear normal despite the gout presence and hence the need for joint fluid analysis.
Joint Fluid Analysis. Your doctor may choose to have your joint synovial fluid tested for uric acid. As you may know, pseudogout has the same symptoms as gout. This synovial test would distinguish whether the disease is pseudogout or gout.
Blood Test. Your doctor may require you to undertake a blood test to measure uric acid levels in the blood. The blood test would also reveal your kidneys' condition and how they are functioning when flushing out the uric acid from your blood.
Besides these tests, a thorough examination would be necessary because the level of uric acid in the blood might not determine whether you have gout or not. Some people have low levels of uric acid in the blood and yet have gout. Others have high levels of uric acid in the blood and yet have no signs of gout.
Other Tests. Other tests may include ultrasound and CT scan if the former test results are not specific. However, some tests would not be readily available in all health centers limiting the diagnosis to X-ray, joint fluid analysis, and blood test.
Gout treatment may vary with each case due to other involvements such as the causes. Your doctor would base your medication on what is right for you, your gout's severity, and your current health condition.
Some of the treatments your doctor may consider for your case are:
Medications for Pain and Inflammation. The drugs your physician might prescribe to ease your pain and inflammation are NSAIDs (nonsteroidal anti-inflammatory drugs). Ibuprofen and naproxen sodium would be the drug choice for pain and inflammation. Be aware of NSAIDs' side effects; ulcers, stomach pain, and bleeding.
Others are colchicine for pain relief and later a low dose for preventing flare-ups. Corticosteroid is a choice for pain and inflammation if you can't use NSAIDs or colchicine.
Side effects of colchicine are nausea, vomiting, and diarrhea, while corticosteroids can elevate your blood sugar and blood pressure.
Medications for Flushing Out Uric Acid. Uricosuric is the drug that improves uric acid elimination from the body. Uricosuric works effectively in lowering uric acid in the blood and hence treating gout. However, it increases renal uric acid levels to cause more complications, such as kidney stones.
Medication to Limit Uric Acid Production. XOIs (xanthine oxidase inhibitors), allopurinol, and febuxostat may limit your uric acid by inhibiting its production. Side effects are rash, nausea, and low blood count.
If you leave your case of gout untreated, you may develop other severe complications such as:
Kidney stones: When the urate crystals increase and collect in your urinary tract, they cause kidney stones.
Kidney damage: When the urate crystals continue collecting in the urinary tract, the condition can worsen to damage your kidneys.
Recurrent gout: While some people may experience only one flare-up, others may have recurrence gout that can occur several times every year. Recurring gout can advance to become chronic if you leave it untreated.
Chronic gout: If you fail to seek medical attention or treatment for your gout, you risk progressing to chronic gout. However, it may take a long time of flare-ups and recesses that you may sometimes forget that you have gouts. And when you do that, your condition advances to chronic gout.
How to Prevent Gout
Whether you have gout or not, you need to be at the top of the condition by preventing it from happening or preventing future flare-ups. The following are some of the measures you need to observe:
Diet: Be conscious of what you eat. Avoid eating red meat, including organ meat such as liver and limit poultry, and fish.
Alcohol: You should avoid alcohol, such as beer, whisky, and vodka.
High fructose products: Avoid drinks such as sodas, some juices, candy, and ice cream.
Water: Drink plenty of plain water as you can to avoid taking high fructose drinks when you are thirsty. Drinking water can not only keep you hydrated but help you to flush out uric acid.
Low-fat dairy products: Avoid high protein food and instead eat low-fat dairy products for your protein.
Maintain a healthy weight: Eat carefully by selecting whatever you put on your plate. Fill your plate with plenty of vegetables, grains, and nuts.
If you observe the recommended gout preventive measures, you are sure to prevent gout attacks. On the other hand, you can prevent flare-ups if you continue taking your medications as per your doctor's advice while observing the preventive measures.
Would you like to discuss more about gout and natural treatment choices? You can talk to our Natural Health Practitioner, Yvonne Dollard Perc, who has over three decades of experience using herbs and other natural remedies in various treatments.
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