Gouty arthritis, or gout as it is colloquially known, is the most common arthritis affecting 2.4% of the Spanish population (EPISER Study 2016) and its origin is the deposit of microcrystals in the joints. Its presence is characterized by episodes of joint inflammation, especially in the ankles and toes, which start quickly, with a lot of intensity and pain and usually resolves in no more than a week.
Arthritis flare-ups initially affect one or a few joints, but if left untreated can lead to multi-site arthritis and the development of subcutaneous accumulations of uric acid called tophi. In addition, over time it can be associated with high blood pressure and cardiovascular events (heart attacks and strokes) if inflammation and uric acid levels are not controlled.
What are its causes?
The cause of gout is the deposit of uric acid in the joints, both in the cartilage and in the tendons, joint capsule and soft parts. Blood levels of rich acid above 6.8 mg/dl favor these deposits and may be caused by excessive intake or by a defect in its elimination through the kidney. Some drugs may also influence uric acid levels and the development or worsening of gouty arthritis.
Are there any signs that may indicate the early presence of gout?
The prevention of gouty arthritis is still controversial, although it has been determined that hyperuricemia increases the risk of gout, not all patients with hyperuricemia develop it. Therefore, at present there is still no consensus on the need to treat patients with elevated uric acid levels with drugs.
The main symptoms are rapid onset arthritis, very painful and resolving in less than a week, as previously discussed.
Diagnosis and treatment
The diagnosis of gout is clinical, based on the symptoms of arthritis, the location, the characteristics of the episode, family history and of course the demonstration of uric acid crystals in the patient’s joints. In recent times, ultrasound has made it possible to detect deposits of crystals in the joints, being useful for diagnosis and even in the follow-up and response to treatment. We must differentiate two phases in gouty arthritis: the arthritis flare-ups and the intercritical periods (between crises) where the patient is asymptomatic.
The basic treatment is to follow a low-purine diet, eliminating or reducing the consumption of red meat, seafood, blue fish, alcohol and above all beer, including non-alcoholic beer. If dietary control is not sufficient, the next step is to start treatments that reduce uric acid levels, choosing the most appropriate drug for each patient.