Gout
Description of the Disease
Gout is a chronic disorder of uric acid metabolism that leads to high uric acid levels in the blood and other body fluids. This condition results in the formation of sodium urate crystals that accumulate in joints, surrounding tissues, and internal organs. An excessive intake of purines from food, overproduction of uric acid, enzyme deficiencies or disruptions that breakdown uric acid, or impaired uric acid excretion can all lead to this accumulation. Gout affects men more commonly than women (with a ratio of 2-7:1), and women typically do not suffer from it until after menopause. Risk factors for gout include male gender, being over 40 years old, a family history of the disease, alcohol consumption, being overweight, high blood pressure, and kidney failure. However, not everyone who forms many urate crystals will develop gout; the disease occurs when these crystals deposit in or around the joints.
Symptoms
The course of the disease divides into four stages:
a) Asymptomatic hyperuricemia. Those affected may develop gout after several years. Often, hyperuricemia causes nephritis (inflammation of the kidneys).
b) Acute gouty arthritis. Inflammation typically begins in one joint, most frequently the big toe, though it can occur in the ankles, knees, wrists, elbows, and finger joints. This inflammation appears suddenly, usually at night or early in the morning, and features severe pain, swelling, redness, heat, and throbbing in the joint. Symptoms such as fatigue, weakness, headache, fever, and chills may precede joint symptoms. Triggers for a gout attack can include a fatty meal and alcohol, or alternatively, fasting, exposure to cold, injuries, and medications that affect uric acid metabolism. Untreated, this attack can last up to seven days, and the skin at the joint often peels afterward.
c) Inter-critical gout. Typically, the second gout attack recurs after 1-2 years.
d) Chronic tophaceous gout. Untreated gout attacks become more frequent, last longer, and affect multiple joints. Joints may become deformed and pain constant. Tophi—subcutaneous formations made of urate crystals with lipids and proteins—develop although less frequently, these can also form in bones, heart valves, and eyes. It typically appear on the earlobes, elbow and knee bursae, Achilles tendon, and the back of the wrist joints. Tophi are painless, whitish or yellowish, slightly stretch the skin above them, and release a white-yellow chalky fluid when they burst.
Diagnosis
Doctors diagnose gout by detecting urates in the synovial fluid of the joint or in tophi. Absence of these findings leads to a diagnosis based on clinical symptoms, laboratory tests (characteristic increase in uric acid, creatinine, proteins in daily urine, urates in blood and urine), and instrumental tests (swelling of tissues around the joint, fluid accumulation in the joint during acute periods, and formation of tophi in later stages).
Treatment
During acute periods, treatment includes glucocorticosteroids, colchicine, nonsteroidal anti-inflammatory drugs, and Anakinra. Resting the joint and applying cold compresses are recommended. A low-calorie diet and drinking 2-3 liters of alkaline mineral water per day are also beneficial.
To prevent recurring gout attacks, correcting the level of uric acid in the blood is necessary. This is achieved through diet—avoiding purine-rich foods such as legumes, fish, fatty meats, animal organs, wheat flour products, and limiting coffee, tea, and especially alcoholic beverages. Medications that decrease uric acid concentration in the blood or promote its elimination are also prescribed for prevention.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology