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Rheumatology

Gout

Causes, Symptoms, Diagnosis & Treatment

Gout

Gout is a common and complex type of arthritis, which can affect anyone. It is characteristic for its sudden and intense episodes of pain and inflammation; it produces redness and tenderness in the joints; on several occasions, it occurs at the big toe base.


A gout attack can happen suddenly. The affected joint is warm, swollen, and tender. Gout symptoms can be irregular; however, there are ways to control them and prevent irritations.


Causes


Gout is caused by the accumulation of urate crystals in a joint, causing inflammation and severe pain in a gout attack. Urate crystals can form when the body has high levels of uric acid in the blood.


Uric acid is formed when the body breaks down purines, which are found naturally in the body.


Certain foods cause high uric acid levels, such as alcoholic beverages and drinks sweetened with fruit sugar (fructose).


When the body accumulates too much uric acid, urate crystals in the shape of a pointed needle form in a joint or the tissue around it, causing pain, swelling, and a rise in temperature.


Symptoms

The signs and symptoms of gout usually happen suddenly and are common at night.

Following are the most common:

  • Intense joint pain can occur in any joint; however, it is more common in the big toe's large joint.

  • Inflammation and redness of the joints

  • Redness

  • Persistent discomfort, after the most intense pain disappears, there may be some joint discomfort, this may remain for a few days or weeks

  • Problems moving the joints normally 

Risk factor's

The probability of getting gout increases when you have high levels of uric acid in the body.

Following are the most common factors that increase uric acid level:

  • Diet. High consumption of meat, seafood, and beverages sweetened with fruit sugar (fructose) raises uric acid levels. Alcoholic beverages, especially beer

  • Obesity

  • Certain illnesses, untreated high blood pressure, and chronic conditions, such as diabetes, metabolic syndrome, and kidney and heart disease

  • Certain medications. use of thiazide diuretics and aspirin

  • Family history of gout

  • Age and sex Gout is more common in men, usually in their 30s and 50s, while women often have signs and symptoms after menopause

  • Recent surgery or trauma 

Diagnosis of Gout 

The Rheumatologist will perform a physical exam and ask questions about your symptoms, lifestyle, and medical history.

Following are some of the possible tests that the Rheumatologist could perform:

  • A blood test allows the doctor to measure uric acid levels

  • Synovial fluid test, the doctor, with the use of a needle, draws the fluid from the affected joint. This allows for analysis and microscopic examination of the fluid and urate crystals' visualization if they are present

  • X-rays

  • Ultrasound

  • CT Scan 

Treatment of Gout 

Through the supply of medications, it is possible to control and treat acute attacks and prevent future attacks. Medicines can help reduce complications from gout.

The medications your doctor provides will depend on your health status and your preferences.

Medicines to treat gout attacks

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications have over-the-counter options, such as ibuprofen and naproxen sodium; there are also more potent prescription drugs, such as indomethacin or celecoxib. NSAIDs can cause abdominal pain, bleeding, and ulcers

Your doctor may prescribe a higher dose if you have an acute attack, followed by a lower daily dose to prevent future attacks

  • Colchicine. It is a type of pain reliever used to reduce pain caused by gout. However, it can cause other effects, such as nausea, vomiting, and diarrhea, especially if taken in high doses

Once an acute gout attack subsides, the doctor may prescribe a low daily dose of colchicine to prevent future attacks.

  • Corticosteroids these medications can control inflammation and pain caused by gout. Its mode of use can be in a compressed form or by injection into the joint. They can cause other effects such as mood swings, high blood pressure, and increased blood sugar

These drugs are generally used for people with gout who cannot take NSAIDs or colchicine. 

Medications to prevent gout complications

If you have severe gout attacks every year, or if your gout attacks are very painful, your doctor may recommend medications to prevent gout complications. Some options are:

  • Medicines that block uric acid production

  • Medicines that facilitate the elimination of uric acid

Living with Gout

When you have already been diagnosed with Gout, follow the treatment provided by your Rheumatologist. Living a healthy lifestyle can help you manage this disease.

Some things to consider that could help improve the quality of life are:

  • Avoid alcoholic beverages and drinks sweetened with fruit sugar (fructose)

  • Limit consumption of foods rich in purines, such as red meat, organ meat, and shellfish

  • Watch your weight, exercise regularly

 

¿When to see a doctor?


It's important to consult a specialist in Rheumatology to diagnose Gout and to be able to start a treatment that helps you control the symptoms.


When consulting your Rheumatologist, try to keep a record of your pain with a detailed description of the symptoms, duration, and what you think triggered them. Also, mention any medications you are taking.


Make your appointment with the doctor in case of presenting any of the characteristics and symptoms mentioned; or in case of detecting another abnormal symptom.