All about Gout

It is an inflammation that affects one or more joints and produces severe pain; it is caused by an excess of uric acid in the blood , or hyperuricemia.

Uric acid is a substance normally present in the body , which derives from catabolism, i.e. from the “demolition” of some DNA molecules (purines), and is generally eliminated through urine and faeces.

Purines are, in part, produced through cell turnover (i.e. cell renewal) and, in part, introduced into the body through food.

Basically, when uric acid levels in the blood remain high for a long time, this molecule forms small crystals in the joints or surrounding tissue, causing inflammation and pain. If left untreated the symptoms last, on average, two weeks.

The disorder, which was once attributed to a diet rich in meat, fish and alcohol, on the contrary, has a strong genetic component and almost exclusively affects men during middle age.

The causes of gout

An exaggerated production of uric acid on a genetic basis or a reduced excretion of the same due to inefficiency of the kidney are the two main causes.

These are accompanied by predisposing or triggering factors such as:

• taking certain medicines (such as diuretics, beta-blockers and other medicines used in the treatment of arterial hypertension );
• being overweight ;
• the abuse of alcohol (and in particular of beer, rich in purines); And
• a diet rich in red meat , game, seafood and other foods rich in purines (asparagus, beef, lamb, pork, liver , kidney, heart, mussels, herring, sardines, mackerel, anchovies and trout).

Common symptoms

It manifests itself as a sudden , very intense , throbbing pain in a joint . It usually appears at night and mainly involves the joints of the hands and feet, i.e. the coldest parts of the body.

The temperature, in fact, affects the crystallization of uric acid. In about 90% of cases, the first joint affected is that of the big toe (and then we speak of podragra ), but, at times, the inflammation can also affect the joints of the instep, ankle, knee, wrist and elbow.

The pain , very acute in the first two days, is associated with swelling, redness and a sense of pressure on the affected point. The overlying skin takes on a purplish-red color and appears taut, shiny and warm to the touch. Sometimes a generalized malaise appears, associated with rapid heart rate ( tachycardia ), fever, and chills.

Complications

Today it is quite rare, but if gout is not adequately treated, the frequency of attacks increases greatly, as well as the number of affected joints, causing a chronic form of arthritis (a joint inflammation that can impair the body’s mobility).

If, then, the long course of the pathology is added to the lack of adequate treatment, then one can also witness the formation of tophi , i.e. small white nodules made up of crystals of uric acid and inflammatory and fibrous tissue, hard to the touch and painful.

Furthermore, uric acid crystals can also be deposited outside the joints : for example under the skin (especially in the earlobes), on the tendons or in the kidneys, causing stones and kidney failure .

Early treatment eliminates the event early and avoids permanent damage to the joints and kidneys.

The diagnosis of gout

Because the symptoms of gout are similar to those of other forms of arthritis, diagnosing this condition isn’t always easy .

Doctors usually suspect gout when its most typical symptoms are present (ie, podagra, recurring inflammation of the instep, or sudden attacks that resolve on their own) and do blood tests to be sure . who measure the levels of uric acid and creatinine in the blood (uricemia and creatininemia) and an arthrocentesis ( an examination which consists in the aspiration of a sample of joint fluid to be analyzed using a special polarized light microscope).

Additional imaging tests, such as x-rays , ultrasound, or a CT (computed tomography) scan, can help quantify the extent of damage to the joint, detect any tophi, and locate uric acid deposits . 

The cures of gout

During an acute attack it is better to rest, drink at least 2 liters of water a day, avoid alcohol and foods rich in purines .

Nonsteroidal anti-inflammatory drugs may be used for inflammation and pain . You should ask your doctor or trusted pharmacist which one to choose. If these are not effective, the doctor can prescribe cortisone or colchicine.

In the long term , however, medicines are used to favor the elimination of uric acid from the blood and behavioral therapy for weight control, nutrition and alcohol consumption.

Did you know that dandelion , a medicinal plant, is useful in case of gout. Read this article .

When to see your doctor

If sudden joint pain , fever, stiffness or inability to use a joint appear, it is always advisable to seek medical advice. The same if the symptoms do not go away after two weeks or after taking the prescribed medicines and if you feel unwell after taking the recommended medicines.