Gout is a common and painful form of inflammatory arthritis. It usually affects one or more joints (especially the first metatarsophalangeal joint of the big toe), causing intense pain and swelling. There is no cure for gout, but medications can manage the symptoms and prevent gout flares.
Gout, or gouty arthritis, typically presents with acute severe joint inflammation in one or more joints. It often affects the first metatarsophalangeal joint at the base of the big toe, known as podagra. Other joints commonly affected by gout are the ankle, foot, small joints of the hand, wrist, elbow and knee. Signs and symptoms of gout can become worse suddenly and quickly, known as the progress of gout attack or gout flare.
Gout happens when there is too much uric acid in the blood (hyperuricemia). Normally, the human body obtains uric acid by breaking down purines, which are natural substances found in the body and certain foods. Uric acid then passes through the kidneys and is excreted in urine. However, when there is excessive uric acid produced or too little uric acid excreted, sharp and needle-like urate crystals could build up in the joints, causing inflammation and pain in the joints and surrounding tissue.
The risk of developing gout increases with the amount of uric acid in the blood. The following factors contribute to a higher risk of gout.
Not everyone with hyperuricemia would develop signs and symptoms of gout. This condition is called asymptomatic hyperuricemia, which in general does not require treatment.
Gout attacks mostly happen in only one joint at a time suddenly (especially at midnight) and last for days or weeks. These attacks are followed by long periods of remission without symptoms before another attack begins (intercritical period). Typically, the patient would experience the following signs and symptoms during a gout attack:
Although gout attacks are recurrent, they can be treated and prevented. If left untreated, not only do they cause pain and discomfort, but they may also lead to the following serious complications:
In most cases, doctors could make the diagnosis of gout based on medical history and typical signs and symptoms of gout, such as intense pain and swelling of the joint. Other tests may also help to confirm the diagnosis, such as:
There are 2 types of gout medicines that focus on 2 different treatment purposes. The first type of gout medicine is used to relieve acute pain and inflammation of gout, while the other type lowers blood uric acid levels to prevent future gout attacks.
Management of acute gout attack:
During an acute gout attack, patients would experience extreme pain and inflammation, which can be alleviated by the following drugs:
Prevention of recurrent gout:
Long-term medications are indicated for patients with frequent gout attacks, abnormally high levels of uric acid, or developed complications such as tophi and kidney stones. These medications aim to reduce blood uric acid levels so as to reduce the frequency of gout attacks and prevent damage caused by crystal deposition. Exampels of urate-lowering drugs include:
After the initiation of urate-lowering therapy, there is a chance to trigger a gout attack so it is recommended to use after the gout flare subsides (~2 weeks), and cover with regular prophylactic drugs, such as NSAIDs or low-dose colchicine.
In addition to medications, lifestyle modifications are also important to relieve gout symptoms and prevent future gout attacks. Suggested self-management strategies to prevent gout attacks include:
Gout happens when there is too much uric acid in the blood (hyperuricemia). Sharp and needle-like urate crystals can then build up in the joints, causing inflammation and pain in the joints and surrounding tissue. Hyperuricemia can be triggered by high-purine foods and drinks (e.g. alcohol, red meat, seafood, etc.).
Many foods can trigger a gout attack, including red meat, organ meats (e.g. liver, kidneys), seafood (e.g. sardines, anchovies, tuna, trout), alcohol, fruit juices, and drinks sweetened with fruit sugar. Try to eat more vegetables, fruits, nuts, whole grains, and low-fat dairy products to lower uric acid levels.
You should take your gout medicines for acute attack (e.g. NSAIDs or colchicine) as soon as the symptoms show up. Also, you may apply an ice pack to the painful joint which may help ease pain and inflammation. Try to relax your body and limit any stress on the joints as well, such as stress from socks or shoes.
This article was medically reviewed by Dr. Eric Sze Tsun Yeung. Dr. Yeung is a specialist in Orthopaedics and Traumatology both in UK and HK who graduated from the University College London Medical School, University of London. Before his return to HK in 2011, Dr. Yeung was an Orthopaedic Consultant in a London teaching hospital. Dr. Yeung worked for the HK Hospital Authority at the Prince of Wales Hospital, Yan Chai Hospital and Queen Elizabeth Hospital. He is now the Honorary Clinical Associate Professor of the Department of Orthopaedics and Traumatology at both the University of Hong Kong and the Chinese University of Hong Kong. Dr. Yeung is actively practicing at the SINCERUS Orthopaedics & Rehabilitation Centre, Central, HK.
This article was independently written by Healthy Matters. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.
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