Gout attacks consist of episodes of very acute and painful joint inflammation. This inflammation is due to the presence of uric acid salt crystals inside the joints.
The crystals form mainly in joints and tendons as a consequence of high levels of uric acid in the blood (hyperuricemia), which are frequently related to excessive dietary habits and alcohol intake – especially beer if it is excessive. About 7% of men have elevated blood uric acid levels, but only a smaller percentage form urate crystals and suffer from gout. On the other hand, women of childbearing age or during menopause may have higher uric acid levels, but without reaching those of men, and gout is much less frequent in them – although it may appear in women after menopause, especially if they take diuretics -.
Causes of the appearance of gout
Excessive eating habits, besides being able to produce what has been called Metabolic Syndrome (obesity, hypertension, diabetes, high levels of cholesterol and lipids in the blood), increase uric acid in the blood (hyperuricemia) and are the most frequent cause of hyperuricemia and gout. Gout is never due to the ingestion of one or a few foods. The intake of diuretics, renal insufficiency and, rarely, other diseases or genetic predisposition, also produce hyperuricemia and cause gout. Sometimes, it is associated with decreased renal function in which case it is particularly convenient to treat it.
Accumulation of urate crystals and gout attacks
The accumulation of urate crystals precedes the first attack of gout, which can take time to arrive. Most often, gout manifests itself by producing acute and intense joint inflammation, almost always in a single joint, which goes from asymptomatic inflammation to intense inflammation. Following inflammation, the joint becomes swollen and its surface may become reddened, causing intense pain. The most common areas where gout appears are the base of the big toe, the instep, ankle, knee, wrist or some joints of the fingers.
An accurate and precise diagnosis
The identification of crystals in the joint fluid allows an accurate diagnosis. Diagnosis based on the clinical features of the disease and the existence of elevated uric acid levels in the blood is uncertain. X-rays or MRI cannot diagnose gout.
Consequences of gout
In addition to the attacks which can be very painful and temporarily disabling (they tend to become more frequent and intense as time goes on if gout is not treated), they can later damage joints or cause nodules to appear near some joints called tophi. The most disturbing consequence is that gout increases the risk of cardiovascular disease – such as myocardial infarction and other complications of arteriosclerosis. Recently, it has been associated with impotence whose origin is often vascular.
Treatment of the disease
Gout is a disease with a very effective treatment and is considered curable, since the deposition of crystals is reversible by reducing uricemia to normal levels. Attacks are generally easily treatable.