Gout is a disease that causes attacks of acute inflammation in the joints. It is one of the most common causes of arthritis worldwide. Accumulations of uric acid (tophi) visible under the skin of elbows, hands, knees, etc. can also form. On the other hand, crystals can accumulate in the urinary tract (stones) and cause colic or kidney failure. Finally, numerous studies highlight the important role played by uric acid in increasing cardiovascular risk.
Causes and symptoms
Gout is a disease produced by the deposit of urate crystals in the tissues, either by excess production of uric acid, by a defect in its renal elimination, or by a combination of both.
There may be a genetic predisposition, but bad habits, dietary excesses and some medications and diseases also play a role. Thus, an excess of purines in the diet (beer, seafood, offal, etc.), “light” drinks with fructose or diuretics to treat hypertension can favor the appearance of gout.
It produces episodes of very acute and intense joint pain (usually starting at night or early in the morning), associated with swelling, increased local temperature and skin reddening. They usually resolve in a few days with anti-inflammatory drugs, or spontaneously, but can sometimes be disabling and affect several joints, even producing fever.
The attacks can be separated by several years, but if gout is not treated, the outbreaks become more intense and numerous, shortening the interval between them, until they become chronic gout.
What tests are performed for diagnosis?
The best method for obtaining a sample is a joint or subcutaneous puncture that allows detection of urate crystals under a microscope. But this procedure is not always possible, as sometimes the diagnosis is based on clinical history, supported by imaging tests such as ultrasound.
Treatment of gout
In a combination of healthy lifestyle habits and medications that decrease the production of uric acid, favor its renal excretion, or combine both mechanisms. It is important to reduce blood levels to below 6 mg/dl in a sustained manner over time.
In patients with tophi, further urate reduction should be forced to dissolve crystal deposits. To this end, it is important to achieve the highest intensity at the start of treatment.
Can it be prevented?
In many cases it is possible. Although it is very difficult to predict which patients with elevated uric acid in the blood will develop gout, this is a deposit disease based on high blood levels maintained over time, so it is advisable to monitor these levels periodically, especially if there is a history of gout in the family. In addition to this, insist on healthy lifestyle habits and a balanced Mediterranean diet.