Gout is a type of arthritis, which is the result of accumulation of crystals of uric acid in various joints. The uric acid is created as a result of purine metabolism. Purines are constituents of numerous foods we consume. An abnormal production or excretion of uric acid leads to its crystallization in the joints and attacks of gout which is an extremely painful condition.

What Are the Symptoms of Gout?

• Gout is an inflammatory condition and its symptoms include sudden appearance of painful, hot, red and swollen joints.
• Gout usually affects the big toe of the feet, which is called podagra; however, other joints can also be affected such as ankles, knees, fingers, elbows, wrists, etc.
• The skin may itch or peel after gout goes down.
• You have limited movement in the affected joints.
• A deposition of uric acid crystals formed outside joints is called tophi. Tophi can occur in earlobes, elbow and Achilles tendons. Uric acid crystals that form tophi in these regions can be removed and microscopically examined for diagnosing gout.
• The presence of kidney stones is more frequent in patients suffering from gout.
• Gout attacks often come at the night time, but they can occur at any time during the day.
• The gout can last from 3 to 10 days, but it can also be chronic.

Gout is caused by the deposition of uric acid crystals in the joints and in the synovial fluid present in the joints. The white blood cells engulf these deposited uric acid crystals and release inflammatory mediators. This results in the painful condition seen in gout, where even the touch of the bed sheet can cause pain.

The first attack of gout spontaneously disappears even without medical help, but it usually returns after sometime in the same or a different joint. As gout progresses, multiple joints can be affected and the duration of attacks gets longer. In between the attacks of gouty arthritis, inflammation and damage to the joints also occur.

Get Medical Attention Soon!

Any person who develops a sudden hot, swollen, red joint should seek immediate medical attention either at an emergency department, with a primary care physician or with a rheumatologist (a physician specializing in gout and arthritis). These symptoms may also occur due to cartilage loss, infection in the joint or other reasons. It is imperative to diagnose gout accurately to treat it optimally.

How Is Gout Diagnosed?

Though gout has distinct symptoms of pain and swelling during flare-ups, symptoms of gout can be vague at other times.

• Diagnosis of gout is made by extracting a sample of the joint fluid and examining it under the microscope for presence of urate crystals.
• Certain bacterial infections in the joints can also exhibit symptoms similar to gout. In order to avoid a misdiagnosis, doctors also test the joint fluids for bacterial infections.
• Blood tests are also performed to determine the levels of uric acid in the blood of patients. But the blood tests can be misleading, as some patients with high uric acid levels do not show gout symptoms while patients with low uric acid levels can still exhibit the symptoms.
• The results obtained by performing tests on blood and joint fluid samples are further corroborated using X-rays, CT scans and ultrasound.

How Is Gout Treated?

During a flare-up, the patient is first treated for the intense pain and other symptoms of gout. Further treatment is aimed at preventing the gout from progressing and damaging the joints. The intense pain, swelling, warmth and redness of the joints during a gout flare-up can be relieved by taking the following steps:

• Ice: Place an ice compress on the affected joint.
• Avoiding pressure: Avoid contact of the affected area with objects.
• Rest: Rest until the pain subsides; it will also help relieve the swelling.
• Elevation: Elevate the affected joint by propping up using a pillow or a foot stool.
• OTC medicines: Over-the-counter anti-inflammatory medications such as ibuprofen and naproxen are effective in relieving the pain if the patients take them as soon as they detect the first signs of a gout flare -up. Aspirin should be avoided, as it negatively impacts the kidney’s ability to filter uric acid, leading to worsening of gout symptoms.
• Prescription pain killers: In instances where over-the-counter pain killers are not effective, patients can approach their doctors for prescription pain killers such as codeine, hydrocodone and oxycodone.
• Colchicine: Colchicine has been found to be an effective prescription drug for gout. It completely alleviates the pain and other symptoms of gout. It should be taken within 12-24 hours of an attack, followed by smaller maintenance doses taken an hour or two after the first dose. In certain patients, colchicine is associated with side effects such as vomiting and diarrhea.
• Corticosteroid injections: In cases when patients cannot tolerate the usual medications for gout, corticosteroid injections are administered at the affected joints to relieve pain. Constant use of these steroids can have side effects such as weak bones and decreased wound healing capacity.
• Surgery: In extreme cases where untreated gout has resulted in buildup of tophi, surgery is performed to remove the crystals in the tophi.

Tips for Preventing Another Gout Attack

After an acute attack of gout, future attacks can be prevented by incorporating certain lifestyle modifications.

• Overweight patients should attempt to lose weight, which will help lower their blood uric acid levels. It is better to avoid high-protein diets and starvation diets for losing weight. The weight loss should be gradual, as sudden weight loss can lead to a gout flare-up.
• Patients should make dietary modifications to prevent future gout attacks. They should restrict the intake of high-purine foods such as anchovies, asparagus, dried beans, peas, mushrooms, sea foods and meats from liver and kidney which will increase the uric acid levels in their body. Foods rich in yeast extract should also be avoided. Consuming foods with low purine content such as vegetables, low fat dairy products (e.g. skim milk and yoghurt), protein from plant sources (e.g. nuts and legumes) and complex carbohydrates (e.g. fruit and whole grains) can lower uric acid levels in blood.
• Patients should also increase their consumption of water (at least 2L per day) while decreasing their alcohol intake, as alcohol increases blood uric acid levels.
• It is also advisable to avoid sweetened soft drinks that are rich in fructose and foods made of corn syrup.
• If you are on medications that cause gout as a side effect, then such medicines should be stopped and replaced by alternate medications. You should enquire your doctor about this.
• Patients should also regularly consume the medicines that have been prescribed by their doctors to prevent further gout attacks, such as allopurinol, febuxostat, etc.