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.
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.
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.
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.
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.
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.
- Although nutrition is for a small part responsible for gout symptoms, it’s still advisable not to consume too many products that naturally contain a lot of purin. Products that contain a lot of purin are: organ meat, seafood, trout, salmon, cod, spinach and legumes.
- People with gout attacks do well to drink plenty of water.
- Too rapidly losing weight can be harmful. Fast results diets often contain many proteins, while little carbohydrates. As a result, the uric acid level in the blood can rise.
- Cooling of the joint can reduce the pain. When the gout is in the knee or foot, then it’s beneficial to put the leg high and try avoiding pressure on the joint (for example when walking). An attack often passes on its own within a week.
- The prevalence of gout is 1.7%.
- Gout is most common in people aged 40 to 60 years. In men younger than 30 years and in women before the menopause, the disease is rare. This is because estrogens have a protective effect on the development of gout.
- Men have a higher risk of having this condition than women.