GOUT: SYMPTOMS, CAUSES, AND TREATMENT
GOUT: SYMPTOMS, CAUSES, AND TREATMENT
What is gout?
Gout is a common form of arthritis where crystals form in and around joints causing pain, swelling and redness. Gout often affects the big toe, but can also affect other joints including knees,ankles, elbows, thumbs or fingers. Gout affects around 1 in 45 people in the UK, and is more common in men than it is in women. When women develop gout, it is usually after the menopause. Attacks of gout can be unexpected and excruciatingly painful. With prompt treatment, the pain and inflammation usually disappear after a few days, but they may recur at any time.
Crystal deposits in the joints
Gout is the body's reaction to irritating crystal deposits in the joints. Here, uric acid crystals have affected the base of the joint of the big toe. The pain can be intense, but treatment usually works very well. In mild cases attacks may be prevented by diet alone, but recurring attacks of gout may require long-term medication to prevent recurrent attacks and damage to bones and cartilage and deterioration of the kidneys.
Chronic gout sufferers may feel tiny, hard lumps accumulating over time in the soft flesh of areas such as the hands, elbows, feet or earlobes. These deposits, called tophi, are concentrations of uric acid crystals and can cause pain and stiffness over time. If similar deposits form in the kidneys, they can lead to painful and potentially dangerous kidney stones.
What are the symptoms of gout?
Symptoms of gout usually strike unexpectedly. They typically do not last more than 10 days but may recur. Although less common, some patients may have chronic pain due to gout. Symptoms of a gout attack may include:
Sudden, intense pain in a joint, typically the big toe or ankle, sometimes the knee, hand or wrist
Swelling, inflammation and a feeling that the joint is very hot
Extreme tenderness of the joint to even the lightest touch
Red or purple skin around the joint
In extreme cases alternating chills and fever
With recurring attacks soft fleshy growths may appear, called tophi, which are accumulations of uric acid crystals.
Over time gout attacks may occur more frequently, involve more joints, have more severe symptoms and last longer.
What causes gout?
An excess of uric acid in the blood brings on gout. Uric acid comes from two places - produced by the body and from the diet. Any extra uric acid usually filters through the kidneys and gets passed in the urine. If the body produces too much uric acid, or fails to excrete it, crystals form and become concentrated in the joints and tendons. This causes swelling, pressure and severe pain.
Nobody knows exactly why gout develops. One of the most common factors that increase the chance of developing gout is excess consumption of alcohol, particularly beer because it is high in purines. Gout used to be known as “the disease of kings” since it was mainly seen in wealthy men who drank and ate too much. Now we know it can occur in anyone and can also be associated with an injury or surgical procedure, hospitalisation or periods of stress, or it can be a consequence of certain medication such as diuretics. Gout may also occur in the presence of some tumours or cancers. Research shows a relationship between gout and kidney disorders, enzyme deficiencies and lead poisoning. Gout may also accompany psoriasis or anaemia and is common in patients with transplanted organs. Susceptibility to gout can be inherited and is often associated with other common conditions such as high blood pressure, diabetes and obesity. Repeat attacks are common if the body's uric acid level is not kept under control.
Pseudogout is a similar but generally less painful condition caused by calcium pyrophosphate crystals in the joints. While it can affect the large toe, it is more commonly seen in larger joints such as the knee, wrist or ankle. More common after the age of 60 in both sexes, pseudogout is treated with anti-inflammatory agents or, in severe cases, surgery followed by cortisone injections.
Seek medical advice about gout if:
Severe pain in a joint recurs or lasts more than a few days, especially if chills or fever accompany the pain. These may be early signs of infection.
Symptoms of gout increase or side effects occur while you are taking allopurinol or colchicine. You may be having a dangerous medication interaction with other medications.
A rash develops while taking allopurinol.
Gout treatment - Self care at home
Take medication as prescribed.
While a joint is hot and swollen, you could use a walking stick or similar support to keep your weight off that joint.
It may be helpful to keep the swollen joint elevated above the level of your chest as much as possible to help reduce swelling, such as sitting with your leg up in front of you when resting.
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