Ankle and Feet | Gout | Symptoms, Causes and Treatments

Gout

A Gout is a complex form of arthritis that begins suddenly and leads to inflammation and pain in the affected joint. Gout can affect anyone, and if left untreated, it can lead to irreversible joint damage and kidney diseases.

What is a gout?

Gout is an inflammation of the joints that occurs due to the accumulation of uric acid crystals in the joints. It usually affects a single joint, commonly involving the large joint, such as the big toe. However, it can also involve the joints of the ankles, knees, elbows, wrists, and fingers.

What are the symptoms of gout?

Symptoms of gout usually occur suddenly and are more common at night time. They include:

Severe joint pain: Pain is severe during the first 4 to 12 hours after it begins.
Lingering discomfort: Once the severe pain subsides, a small degree of joint discomfort continues for about a few days to weeks. The subsequent attacks usually affect more number of joints, causing severe pain.
Inflammation and redness: The affected joints appear swollen and red, and are warm and tender to touch.
Limited range of motion: With the progression of gout, it becomes difficult or impossible to move the affected joint.

Symptoms of gout occur suddenly in the form of flare-ups. The pain during the flar-ups may be severe enough to awaken the individual in the middle of the night.

What are the causes and risk factors of gout?

Gout occurs due to the deposition of uric acid crystals in the joints. Uric acid is a byproduct formed during the breakdown of certain proteins known as purines. If the levels of uric acid are high in the bloodstream or other body tissues, they accumulate in the joints and result in gout. Conditions such as dehydration, blood disorders, and metabolic disorders can lead to the excess production of uric acid. On the other hand, kidney disorders and thyroid problems can impair the removal of excess uric acid.

Factors which increase the likelihood of developing gout are:

Presence of medical conditions such as diabetes, obesity, hypertension, cardiovascular diseases
A family history of gout
Male gender
Women at the menopausal stage
Alcohol consumption
Recent trauma or surgery
Medications such as diuretics and drugs containing salicylates

How is gout diagnosed?

The medical history, the present history of the problems, and a physical examination may help to understand the disease's duration and severity. The diagnosis is likely based on the description of the pain, the frequency at which severe pain occurs, and the presence of redness and swelling near the joint.

The most reliable method is the examination of the joint fluid under the microscope to check for the presence of uric acid crystals. The doctor will also check for the presence of bacteria in the joint fluid to rule out bacterial causes with similar symptoms.

While blood tests to check for levels of uric acid may be advised, they are not a reliable indicator as gout can occur in individuals with normal blood uric acid levels. To rule out additional causes of joint inflammation, an x-ray may be required. Other tests include an ultrasound and a CT scan, which can detect the presence of uric acid crystals in a joint.

What are the treatment options?

It is very important to treat gout immediately, as it can lead to kidney disease. Treatment involves medications, the choice of which is based on the health of the patient and his or her preferences.

Medications to treat or prevent gout attacks include:

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, or more powerful drugs such as celecoxib or indomethacin can relieve gout pain.
Colchicine, a type of pain reliever, help decrease the gout pain.
Corticosteroids such as prednisone can control the inflammation and pain. They may be either given as oral pills or as injections and are prescribed for individuals who cannot take NSAIDs or colchicine.

In patients who experience several gout attacks every year or few but very painful gout attacks may be prescribed the below medications to prevent complications from occurring:

Drugs to lower the production of uric acid, such as allopurinol and febuxostat
Drugs to improve the removal of uric acid, such as lesinurad and probenecid

Self-care

Patients can manage the gout attacks by eating a balanced diet. Reducing the intake of purine-rich foods ensures that the levels of uric acid are within the limits. Such foods include: