Gout: General Knowledge
Gout is known as one of the most “painful type” of arthritis. Gout patients have to suffer from acute attacks which seem to last forever. So what is gout exactly? Why it is titled as one of the most “painful type” of arthritis. Keep reading the article and you will find the answer.
What is gout?
Gout is a type of arthritis. This is considered as one of the most “painful” types of arthritis. Gout occurs affecting severely mostly on the patient’s toes. In this disease, we can see affected skin turn red, hot, swollen especially under big toe or areas near the joints. This is due to the excess acid uric amount stored in the body. To be more specific, what will actually happen when the amount of acid uric piled up in the body are:
- Uric acid crystals would stagnate at joints, often joint of big toe
- Layers of uric acid, so-called “urate crystals” will creat swells under the skin
- This also leads to renal calculus forming from urate crystal
Gout has disturbed the lives of many people. It makes patients awake in the middle of their sleep because of the pain from affected areas in the body. Moreover, the disease can accompany other diseases like heart disease, kidney disease, blood disease, etc.
Gout often occurs among middle aged people. But there are also cases that younger ones or even children have to suffer this disease. According to a recent survey, in 200 adults, one of them is affected by gout. This number indicates how common the disease is. Anyone can, in fact, easily have this disease if he does not be aware and have suitable preventation. So, keep reading this article and get yourself some useful information about the disease, what causes it, what are its signs and symptoms, how it is treated and how you prevent it.
History of gout research
When first cases of gout appeared, the disease was believed to have been caused by dietary and physical reasons. The extreme pain it caused was even treated as a “curse” related to relious beliefs or blamed on some kinds of strange creatures that bit the sufferers.
Later, gout was identified more specifically, closer to its exact characteristic. A Greek physician around 400 BC noted its absence in eunuchs andpremenopausal women. After that, Aulus Cornelius Celsus at the time of 30AD discovered gout’s relation with alcohol, kidney problems.
Not until 1679, after a research of Antoine van Leeuwenhoek did the world know the relevance of urate crystal in gout. Significantly, at the year of 1848, the real “culprit” causing gout was first identifed by an English physician named Alfred Baring Garrod. He indicated excess amount of uric acid as the main factor of this disease.
What can lead to the overload of acid uric in the body?
Having understood that gout is caused by excessive amount of acid uric, patients still need to look in details of how acid uric is formed.
Acid uric is produced from the breakdown of of substances called purines. Purines exist in every tissue of the body. These are also found in many foods, such as dried beans or anchovies.
Normally, acid uric is dissolved in blood, then led out through kidney, out of the body in urine. However, in gout cases, it is stored in the blood when:
- The consumed uric acid increases
- The kidney functioning does not go on well
- Patients take in too much rich-purin foods
When the level of uric acid in blood goes high, the condition is identified as hyperuricemia. Not everyone who has this condition will get gout. But the chance is relatively high when there are too much urate crystal formed in the body.
Ones face higher risk of gout, if:
- There is a member of their families who once had this disease
- They are male
- Being overweight
- Take in too much alcohol
- The diet consists purin-riched foods regularly
- Have enzim related problems which make the body’s process of purin decomposition difficult
- Get infected in the environment
- Have suffered from implanting surgery
- Use some kinds of medications like aspirin, cyclosporin or levodopa
- Use niacin vitamin
Gout signs and symptoms
Normally when the amount of uric acid crystals caught on joints and tissues increases at a certain level, the patient will suffer from hot and painful swelling, tenderness at some joints, which are usually at big toe. This symptom is called podagra. The pain often attack the patients at midnight and at a extreme level. Even a gentle touch of the draft could intensify the pain to higher extremeness which is impossible to handle. This annoyance seems to never end, it will last for hours then lighten in 2 to 7 days later. When the pain cut down, the skin around the hurt joints might be peeled of and feel scratchy.
The phases of gout are varied
At the first phase, although the amount of uric acid is relatively high in the blood, there might be no specific symptom. It is possible the amount would stand still, not increase and the patient can contain this phase for a long time. To some cases, the patient might even have to suffer from kidney stone before they first encounter the first painful attack of gout.
The sencond phase comes when the urate crystals start to be generated. The big toe is usually the “victim”. The patient surely gets attacked at this phase. But the pain at second phase is still bearable. The joints after the attacks feel quite normal in several days untill the next attacks. Moreover, the intensity of later attacks grows through time. The patient will have to encounter more throbbing, longer strikes which have more joints involved. If this phase is lengthened, it can lead to chronic gout and even more joints will be involved. There could be no waiting time between attacks. It is worth-noticing that this phase can be mistaken with other types of arthritis.
Moving to the third phase, the pain will never stop. Other joints will touched upon. This is the most severe phase the patient may have to face if the treatment is not getting good results. However, thanks to the advancement of medication research in gout treatment, the percentage of patients having suffered from this phase is low.
Gout dangerous complications
- Joint damage
Urate crystals are accumulated at joints and synovial bursa, triggering series of joint deformations and related areas.
Notably, uric acid crystals when invested under the microscope have lozenge shape; with 2 pointy and sharp tips which can easily hurt synovial bursa. These crystals can tear synovial bursa, and then cause inflammatory response.
Furthermore, uric acid accumulation can distort the shape of joints and make joint movements difficult. With serious cases, it can destroy the joints, capitulum. And the patients may have to remove the joints and become dissabled.
2. Bacterial contamination
When tophi breaks out, causing sore, inflammation; if no suitable interference is carried out, the patients will suffer from infection, poisoning, sepsis.
3. Damaging kidney and its functions
- Interstitial nephritis, glomerulonephritis, unrinary infections are common gout complications.
- Renal caculus, ureter stone, vesica stone, urethra stone are the results of uricacid accumulation process.
- Accumulation of pus in kidney pool can lead to CKD and kidney’s disfunction.
4. Other parts
Uric acid crystals can be accumulated at any parts of the body. When so, urate crystals will activate that part’s inflammatory response. Normally, tophi under the skin, soft issues, ear cartilage, myocardium and heart valve also can encourage the accumulation of urate crystals, resulting in dangerous complication.
5. Complications as results of treatment
Some kinds of medicines for gout treatment can have side effects and threatening complications. For example, colchicine and pain-killlers might lead to complications to gastric, hepatobiliary, coagulation. Moreover, medication that helps reduce uric acid level like Allopuribol might affect the operation of liver and kidney.
Gout tests and diagnoses
Despite those signs and symptoms that you can see it yourself when you have gout, you should go to see the doctor for a professional check-out and advices. The doctor will carry out a simple physical examination according to certain criteria before moving to in-depth examination and tests.
They can conduct diagnosis regarding to criteria proposed by Bennett and Wood in 1968 or distinguished diagnosis for the physical examination.
After that, tests will be taken. The possible tests would be:
- Joint fluid test: The doctor will extracted fluid from your infected joint and then see it under the microscope. By this way, you will know if there are urate crystals that cause gout.
- Blood test: This measure is commendable as it helps examine the level of uric acid in your blood. However, if the result shows high amount of uric acid in your blood, it does not mean you are suffering from this disease.
- X-ray: The causes of joint inflammation will be drawn out in the X-ray image.
- Ultrasound: This is another way to detect urate crystals. This high-technolgy method is widelu used in Europe.
- Dual energy CT scan: is also a method to rule out the existence of urate crystals. However, this measure is quite expensive and not often available in many areas.
When having gout, the patient has two main problems to deal with, which are the painful gout attacks of inflammation and his level of urate in the blood as well as urate crystals. These are two things causing the patient’s sufferings. Now, let’s in turn go in to details of possible treatments to get rid of gout.
- Relieving the pain of attacks
This, however, is only a short-term goal for a sufferer. But still it needs to be taken into serious considration as knowing how to manage an acute attack properly would help the patient a lot in his life with gout.
The first thing you should do when the attack come is to immediately rest the affected joints. You may need ice to reduce swelling. Remeber to not take aspirin. It can only excacerbate the pain. Instead, you may need the help of these short-term medicines at the first sign of the attack: Nonsteroidal anti-inflammatory drugs (NSAIDs), Colchicine, Oral corticosteroids.
Meanwhile, it is really important that you need to calm down. Drinking a glass of water will help for sure.
2. Managing long-term complications
Those advices above are just short-term solutions. What you really need to do is to contatin the level of uric acid in your body and remove urate crystals. This will prevent the complications of this disease, future attacks.
The first thing is to see the doctor and get the prescription, instruction from the doctor. Each case has its own unique method so make sure you know yours from professionals.
There will be medicines and steps the patient must conduct carefully to control the disease. For example, some of the long-term medicines would be: uricosuric agents, Drugs called xanthine oxidase inhibitors, colchicine, pegloticase.
And also there are ways to treat tophi. The doctor will suggest different treatment regarding to the patient’s situation. It could be drugs to gradually remove the tophi; or surgery in serious case that needed immediate intervention.
A proper diet is at utmost importance. A high-purins meal is not always beneficial. When it comes to easting, remember these following:
- Make sure you have low-cholesterol, low fat diet. This kind of diet will not only reduce your risk of having heart disease but also the risk of this disease.
- Avoid foods that high in purines (red meats and shellfish). This will help your level of uric acid in the blood stay low.
- Avoid alcohol as much as possible
- Consume diary products moderately
- Avoid fuctose
Besides, you should drink water regularly to stay hydrated. This is a good way to lower the chance of getting the disease, since water will regulate the body temperature, help relaxing tissues and joints, reduce uric acid in your body. Moreover, some helpful fruits like cherry, apple, grape, lemon juice, cucumer, strawberry, orange,… will help you contain uric acid.
Lastly, don’t forget to do exercise regularly. A healthy body always functions well.
We have just provided you some general information about gout. Understanding the causes, signs, symptoms, treatments and such things about the disease would help your life as well as lives of other to have timely actions toward gout. Hope you find this article helpful!