Gout is a common form of arthritis that can occur in anyone. It causes excruciating pain, swelling and redness, most often in the joints of the big toe. The area is extremely sensitive. In this article, I will explain the symptoms, causes and treatment of gout.
A gout attack often comes on suddenly. It often “wakes” in the middle of the night with the big toe “on fire”. The joint is hot, swollen and so sensitive that even the weight of a blanket seems unbearable.
In some cases, the symptoms “come and go”, i.e. they resolve on their own. Most often, however, they need treatment and the person concerned needs to put themselves in a position to prevent flare-ups.
Symptoms of gout
Symptoms almost always appear suddenly, often at night. The most common ones are
- Severe, excruciating joint pain. Gout usually affects the metatarsophalangeal joint of the big toe, but it can occur in any other joint. Commonly affected joints include the ankle, knee, elbow, wrist and finger joints. Pain is most severe in the first 6-12 hours after onset.
- Delayed discomfort. After the most severe pain has subsided, joint discomfort may persist for a few days to a few weeks. Subsequent recurrences become longer and affect more joints.
- Inflammation and redness. The affected joint is swollen, warm and red.
- Restricted range of motion. Joint movement is restricted due to severe pain.
When to see a doctor
If you experience sudden, intense pain or swelling in the joint. Untreated gout can lead to increased pain and damage to the joint. See a doctor immediately if the joint becomes warm, red and feverish. This could be a sign of infection.
Causes of gout
It occurs when urate crystals build up in the joint. This triggers inflammation and intense pain. Urate crystals form when there is a persistent high level of uric acid in the blood. A healthy body also produces uric acid, i.e. it occurs naturally in the body.
Uric acid is derived from the breakdown of purine compounds. Certain foods, such as pork, beef, turkey, fish, offal (e.g. liver, spleen, kidney), can put a lot of purines into the body. Alcoholic beverages, especially beer, and drinks sweetened with fructose (fructose) increase higher levels of uric acid.
Uric acid is normally distributed in the blood, and passes through the kidneys, which “filter” it and excrete it into the urine. However, if too much is produced or the kidney excretes too little, uric acid can build up and form sharp, needle-like urate crystals in the joints and surrounding tissues. This causes pain, inflammation and swelling.
Gout is more likely to develop if you have high levels of uric acid in your blood. Factors that can increase uric acid levels include:
- Diet. A diet rich in meat and “seafood”, regular consumption of fructose-sweetened drinks increases uric acid levels. Alcohol consumption -especially beer- increases risk.
- Obesity. Being overweight causes the body to produce more uric acid and the kidneys cannot get rid of it quickly enough.
- Health condition. Certain diseases such as high blood pressure, diabetes, metabolic syndrome, and heart and kidney disease increase the risk of gout.
- Certain medications. Some diuretics (thiazides) commonly used to treat high blood pressure and aspirin may also increase uric acid levels.
- Family history. If you have a family history of gout, you are more likely to develop it.
- Age and gender. The disease is more common in men. Women usually have lower levels of uric acid, but it rises after menopause and approaches that of men.
In men, symptoms most often appear between 30 and 50 years of age, while in women symptoms appear after menopause.
- Recurrent gout. In some people, a gout attack occurs once and never recurs. Others may experience the condition several times a year. Medicines can help prevent recurrent flare-ups. If left untreated, recurrent gout slowly destroys the joint. Urate crystals are deposited in clumps under the skin. These nodules are called tophus. They appear in many areas such as fingers, hands, feet, elbows or Achilles tendons. Tophus is usually not painful but can be swollen and tender in gout attacks.
- Kidney stones. Urate crystals can collect in the urinary tract, causing kidney stones. The risk of kidney stone formation can be reduced with medication.
Lifestyle options for prevention
In periods without symptoms, the following dietary guidelines in particular can help prevent future gout attacks:
- Adequate fluid intake. Stay well hydrated, i.e. drink plenty of water. Avoid sweetened drinks, especially those that are high in fructose.
- Limit or even avoid alcohol intake. Recent studies show that beer in particular increases the risk of gout symptoms, especially in men.
- Low-fat foods. Low-fat foods may have a protective effect against gout, making them the most optimal sources of protein.
- Limit meat intake. A small amount is still “okay”, but pay attention to the type of meat and how much you eat.
- Maintain a weight that is right for your physique. Eat portions that are large enough to help maintain a healthy weight. Losing weight can lower uric acid levels, but avoid drastic consumption as this can temporarily increase uric acid levels.
Not much is usually needed to diagnose gout, the following are usually sufficient:
- Physical examination: The disease presents with symptoms so characteristic that it is usually immediately recognisable at first glance. The combination of localisation (the base joint of the big toe), swelling, redness and excruciating pain should immediately attract the doctor’s attention. Examinations should be used to rule out other diseases rather than to “prove” gout.
- Laboratory test. Measurement of blood levels of uric acid and creatinine. Lab results can sometimes be misleading. Some people have high uric acid levels but never develop gout. Some people have signs and symptoms of gout but no elevated levels.
- An X-ray. It may be useful in ruling out other forms of arthritis.
- Ultrasound scan. The scan can detect urate crystals in the joint or tophus.
- CT scan. Although this test accurately detects the presence of urate crystals in the joint, it is not routinely used in clinical practice because it is very expensive and does not add “extra” to diagnosis and treatment.
Treatment of gout
The first treatment is to reduce pain. Traditionally, this is done with non-steroidal anti-inflammatory drugs and painkillers.
Steroidal anti-inflammatory drugs relieve inflammation. They can be given in tablet form or injected directly into the joint. Steroids are mostly given only when NSAIDs cannot be used for some reason. Steroids can also have a number of undesirable side effects, especially when used on a long-term basis.
It can quickly and significantly reduce the pain, swelling and inflammation around the joint capsule associated with an acute gout attack. At the same time, it reduces the dose of medication needed.
High-power clinical lasers usually achieve complete pain relief after 1-3 treatments, whereas lower-powered home lasers may require more, up to 10 treatments (5-8 minutes of treatment with 5 minutes between).
A recent study on the treatment of acute gout showed that soft laser therapy was more effective than non-steroidal anti-inflammatory drugs.
Here are some soft lasers that could be useful in the treatment of gout or other arthritis:
[message title=”Personal Laser L400 soft laser” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]
- Laser power class 3
- Treatment of gout, arthritis, sciatica, lumbago etc.
- 808 nanometer laser beam
- CW (continuous wave) laser
- 400 mW power
- 12.5 sec / 5 Joule
The main goal of prevention is to avoid the recurrence of attacks, which requires lowering blood uric acid levels. Dietary and lifestyle options have been mentioned above. I will now mention the medication options. Note that if you do not follow the dietary suggestions above, you will still have recurrences despite the medication.
- Drugs that inhibit uric acid production. Xanthine oxidase inhibitors such as allopurinol are such drugs. They limit the body’s “production” of uric acid. This can lower blood levels of uric acid and reduce the risk of gout.
Side effects of allopurinol may include rash and low blood cell count. Other drugs may also cause nausea and reduced liver function.
- Drugs that stimulate the elimination of uric acid. Stimulates the kidney’s ability to remove uric acid. This can lower uric acid levels and reduce the risk of gout, but uric acid levels in urine increase. Side effects include skin rash, stomach pain and kidney stone formation.