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What is gout?

Gout is a type of arthritis and occurs when uric acid accumulates in the blood and causes inflammation in the joints. If the serum urate concentration exceeds the physiological saturation zone (about 7.6 mg/dl (milligrams per deciliter)), monosodium urate crystals originate and are stored in the cartilage and periarticular tissues of the peripheral joints. From the clinical point of view, the continuous deposit is silent and almost 10% of the patients present hyperuricemia, thus developing clinical gout. On the other hand, acute gout is a very painful condition affecting only one joint. Chronic gout is repetitive episodes of pain and inflammation, in which more than one joint may be affected.

Prognosis of the disease

If the disease is diagnosed at the onset of symptoms, most of those affected can lead a normal life if they follow the treatment correctly. For other people of advanced age, the reduction of uric acid levels in the blood can lead to the disappearance of the tophi and achieve a functional improvement of the joints. In general, gout is more serious if the first symptoms appear before the age of 30. Metabolic syndrome and heart disease contribute to premature death in patients affected by gout. In some cases treatments are not effective with patients, and reasons include lack of follow-up treatment, low doses of drugs and alcoholism.

In general, gout is more serious if the first symptoms appear before the age of 30.

Symptoms of gout

Symptoms of acute gout include:

• Only one or a few joints are affected. The joints of the big toe, knee or ankle are most often affected.
• The pain starts suddenly, in many cases at night. The pain is intense and may be described as throbbing, squeezing or excruciating.
• The joint is warm and red in color. It regularly appears very tender and swollen (the sensation of pain is brought on by simply putting a sheet or cushion over it).
• Fever may develop.
• The outbreak may disappear after a few days, but may return intermittently. Additional flare-ups are of longer duration.

After the first gout flare-up, patients with gout will not have any symptoms. However, many people may have another outbreak in the next 6 to 12 months. Some sufferers may develop chronic gout, also called gouty arthritis. This type of gout can lead to joint damage and loss of movement in the joints. People with this chronic gout will have joint pain and other symptoms most of the time.

Medical tests for gout

There are several types of medical tests to diagnose gout, some of them are:

• Synovial fluid analysis
• Blood uric acid
• X-ray of the joint
• Synovial biopsy
• Uric acid in urine

It should be remembered that a blood uric acid level above 7 mg/dl (milligrams per deciliter) is high. However, not all people with a high uric acid level have gout.

What causes gout?

Gout is caused when uric acid levels in the body are higher than normal. This occurs in cases where the body produces too much uric acid or when the body has difficulty eliminating uric acid. When too much uric acid builds up in the fluid around the joints, so-called uric acid crystals form. These crystals cause inflammation of the joint and lead to pain, swelling and a rise in temperature in the affected area. To date, the exact cause of gout is not known. This disease can be hereditary and males, postmenopausal women and alcoholics are more susceptible to gout. On the other hand, as people age, gout becomes more common.

On the other hand, gout can manifest itself in people with:

• Diabetes
• Kidney disease
• Obesity
• Sickle cell anemia and other anemias
• Leukemia and other blood cancers

Gout can also appear after taking medications that prevent the elimination of uric acid from the body. People taking some medications, such as hydrochlorothiazide and other diuretics, may have an increased level of uric acid in the blood.

Can it be prevented?

There is a possibility that gout cannot be prevented, however the patient can avoid at all costs the risk factors that can cause gout symptoms to appear. Taking medications to reduce uric acid can prevent the progression of gout in the body.

Treatments for gout

The patient should see his or her nearest specialist and start taking gout medication as soon as possible to reduce pain if he or she suffers an immediate flare-up. It is also advisable to take anti-inflammatory drugs such as ibuprofen or indomethacin as soon as possible. If symptoms worsen, it will be necessary to increase the dose in the following days.

The patient will need another type of medication in cases where he/she suffers:

• Several attacks during the same year or outbreaks of very high intensity.
• Joint damage.
• Tophi.
• Kidney disease or kidney stones.

Another effective treatment is to change diet and lifestyle to prevent gout attacks:

• Decrease alcohol consumption, especially beer.
• Lose weight.
• Exercise regularly.
• Reduce consumption of red meat and sugar-containing beverages.
• Choose healthy foods, such as dairy products, vegetables, nuts, legumes, fruits and whole grains (those that contain less sugar).
• Drinking coffee and taking vitamin supplements may also help some people.

Which specialist treats gout?

The specialist who treats gout disease is the rheumatologist. The rheumatologist will be in charge of correctly diagnosing the patient and offering a treatment to reduce the levels of uric acid in the blood, so that the urate crystals dissolve definitively. The rheumatologist considers gout as a disease that can be cured. To achieve this goal, an adequate level of uric acid in the blood must be reached in order to dissolve the crystals little by little. Eventually the symptoms will disappear and in the long term there will be no irreparable damage to the joints.