Gout is a complex form of arthritis that affects millions of people worldwide and continues to grow at an alarming rate. Deya Obaidat, MD, Parkview Rheumatology, further explains this painful condition, how it presents and the best strategies for managing it.
Gout is a systemic disease triggered by chronically elevated uric acid levels in the blood. These high levels trigger uric acid crystals to accumulate in the soft tissue, causing inflammatory arthritis that can affect one or several joints due to the buildup of crystals within the space.
Uric acid occurs when the body breaks down a chemical called purine, which occurs naturally in the body and certain foods. Diets high in purine have been linked to the condition and can increase the frequency of attacks. Foods containing high levels of purine include shellfish, shrimp, seafood, red meat, high fructose corn syrup, beer and more. Consuming foods low in purine, such as fruits, whole grains, rice, peanut butter, eggs, and cheese, could help manage gout attacks.
Symptoms
Gout usually affects the base of the big toe (Podagra) but can also affect the rest of the toes, ankles, knees, elbows, wrists and fingers. The most common symptoms include intermittent attacks of severe pain, swelling, redness and an inability to use the affected joints. Typically, these attacks can last anywhere from several days to several weeks.
For most people, intermittent joint inflammation is the only symptom. However, in the later stages of gout, some might experience other issues like kidney stones, kidney disease (due to uric acid crystals in the kidneys) and tophi formations (uric acid crystals build up under the skin and in soft tissue areas).
Risk factors
As previously mentioned, individuals with high uric acid levels in their bodies are more likely to develop gout. Factors that could further increase someone’s risk include:
- A diet high in purine
- Gender (occurs more often in men)
- Age (prevalent in men between 30 and 50)
- A genetic predisposition or family history of the disease
- Certain medications (water pills, ACE inhibitors, beta-blockers)
- Chronic conditions (diabetes, obesity, heart and kidney disease)
Diagnosis
A gout diagnosis can only be confirmed during a flare-up when the joint is swollen and painful. Waiting until an attack allows a provider to obtain a sample of fluid from inside the joint. If a lab test finds uric acid crystals in the affected joint, then gout is present. However, in certain situations where obtaining a fluid sample may be difficult, a clinical diagnosis can be made depending on the history, physical exam, imaging like X-rays, ultrasounds or CT scans, and the uric acid level in the blood.
Management and treatment
Gout is a joint-deforming disease that, if not caught early or left untreated, can result in different irreversible manifestations of arthritis (even after treatment), causing significant disabilities for some individuals. Gout can also increase the chances of other conditions like heart attack, stroke and kidney diseases. Therefore, managing the disease is crucial, but this looks different for acute attacks versus chronic pain.
- Acute attacks: For acute attacks, the focus is on fast relief. We can achieve this by using short-acting nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin or naproxen to relieve inflammation. Colchicine or steroids can also be given by mouth, intramuscular, intravenous or directly into the affected joint for short periods unless given for prophylactic reasons.
- Chronic pain: While diet changes are important in managing gout, sometimes, it’s not enough. Some people may need to be on a chronic medication that will lower the uric acid in the blood to prevent further disease flare-ups. Some of those medications could include allopurinol, febuxostat, probenecid and pegloticase. However, the choice of medicine depends on the individual, if there are any co-morbidities present and the severity of the disease.
A rheumatologist’s role in treating gout
A rheumatologist can confirm the diagnosis and rule out other conditions that may look like gout, including pseudogout, rheumatoid arthritis and osteoarthritis. They will also work with the patient to establish a treatment plan that includes selecting an appropriate long-term therapy to help control the disease and monitor for any potential side effects of medications.
Sources
[1] Arthritis Foundation: Foods that are safe for gout
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