Gout is a rheumatic disease, in which uric acid crystals are deposited in the joints. This may lead to sudden attacks of joint inflammation and is accompanied by pain. In many people, a first attack of gout passes into a chronic form. In case of chronic gout, inflammations occur more frequently and in multiple joints.

Cause

The uric acid accumulates in a joint or along the tendons. The uric acid crystals cause an intense inflammatory response. Uric acid is a normal waste product of metabolism. It is made of purin, which comes to a small extent directly from our diet, especially from high-protein foods. It’s still unclear why a person does or just doesn’t get gout. Uric acid normally dissolves in the bloodstream and we just pee it out.
The elevated uric acidity occurs when the body produces or supplies too much uric acid or discharges too little. The body produces or supplies too much uric acid, because of congenital defects in production (this is rare), psoriasis, cancer, chemotherapy, overweight, alcohol consumption or high-purin food. The body discharges too little uric acid, because of impaired kidney function, certain medications (such as diuretics) or alcohol consumption.
Hereditary factors particularly play a role in younger patients.

Symptoms

In case of a gout attack, a joint suddenly gets severely inflamed. Often this is the joint of the big toe. This causes a lot of pain. The joint becomes thicker, feels warm and can be moved less well. The skin around the joint almost always gets bright red and tight. The joint may be so sensitive that even the weight of a bed sheet is too much.
Gout is sometimes limited to a single attack, but in many people, gout attacks recur. These may take longer and expand to other joints, such as ankles, knees, fingers and/or wrists. Ultimately, a chronic inflammation may occur. It is not known why the disease can develop so differently.
Uric acid crystals can also be deposited in the kidneys, causing kidney malfunction. The deposited crystals cause gout nodules (tophi) now and then. A tophus can arise on the elbows, fingers, toes and outer edge of the ear. If the skin around a tofus breaks, a thick chalky substance can come out.

Diagnosis

To make the diagnosis of gout, mainly the symptoms and blood tests are important. The doctor acquires certainty about the diagnosis by conducting a joint puncture. Here, some fluid is sucked with a needle from an inflamed joint. The doctor examines this synovial fluid under a special microscope. An X-ray will usually not provide much additional information. This is because there’s just very little chance to see something on it. However, the doctor will do an X-ray if he is not sure about the diagnosis and wants to exclude other conditions. Once in a while, tophi or damage to the joint can be seen on the X-ray.

Treatment

In case of severe pain, the doctor can prescribe medication. There are medicines to combat the inflammation, medicines that prevent a new inflammation and medicines that lower the uric acid content in the blood. The symptoms usually diminish significantly and sometimes they even disappear completely.
Nowadays, it’s possible to combat gout structurally by deacidification of the body. In case of gout, the body acidificates. There are good possibilities to let the body get rid of excess uric acids and uric acid crystals, so gout can be tackled to the root. Upon successful deacidification, lifelong medications can be avoided.

Prognosis

An acute attack of gout usually passes on its own within a week. More than half of people who experience a first gout attack, however, get a second attack within one year. Acute gout can always evolve into chronic gout, in which the joints wear off by chronic inflammation. This can lead to deformations of joint structures and osteoarthritis.
About one in three people with untreated, chronic gout suffers from tophi. Part of the patients will have to deal with kidney stones. Furthermore, people with gout seem to be more likely to have some other diseases, such as diabetes, high blood pressure, kidney disease and heart diseases.

Considerations

Facts