Sometimes when you wake up in the morning, does a joint, especially your big toe, knee, or ankle, suddenly become red, swollen, and painful? Does it hurt so much that you can't even touch it? Does it feel like it's on fire? If so, you may have a condition called 'gout'. Many people also call it 'gout'. Let's talk about this simply, in a way that you can understand.
What exactly is Gout?
Simply put, gout is a type of inflammatory arthritis . It is caused by an excess of a chemical called uric acid in our bodies. Uric acid is produced when the body breaks down chemicals called purines found in certain foods. Normally, this uric acid is filtered out of our kidneys and excreted in our urine.
But, sometimes our bodies produce too much uric acid, or our kidneys can't properly excrete it. That's when the problem starts. This extra uric acid starts to deposit in our joints as sharp, thorn-like crystals. When these crystals accumulate, a 'gout attack' suddenly comes with severe pain and swelling.
Most often, this affects the big toe joint. However, this condition can affect other joints in your foot , too. For example:
- Knees
- Ankle
- Other joints of the feet
- Joints of the hands and wrists
- Elbows
Gout symptoms come and go repeatedly. We call these 'flares' or 'gout attacks'. Your doctor will prescribe medication to lower your uric acid levels, as well as dietary changes. This can help reduce the frequency of these gout attacks.
What are the symptoms of Gout?
A gout attack is a very painful experience. It can start suddenly, often in the middle of the night. When you have a gout attack, you may notice symptoms like these in your affected joint:
- Unbearable severe pain.
- Redness or discoloration of the skin around the joint.
- Stiffness in the joint, difficulty in bending and stretching.
- Swelling.
- Not only when I hold my hand, but even when I touch the bedsheet, the pain (tenderness) is unbearable.
- The joint feels warm, like it's "on fire."
How long can a gout attack last?
A gout attack usually lasts about a week or two. Some flares can last longer, and some can cause more severe symptoms. You may not have any gout symptoms between attacks.
What causes gout?
As we mentioned earlier, gout occurs when the body has too much uric acid (a condition we call 'hyperuricemia'). These uric acid crystals are what deposit in the joints and cause pain.
Remember, not everyone develops gout just because their blood uric acid levels are slightly elevated. Many people with hyperuricemia never develop gout. This means that other factors, not just elevated uric acid levels, can affect this.
Who is at higher risk of developing gout?
Anyone can develop gout. However, men are three times more likely to develop gout than women. In women, gout often develops after menopause. People with certain chronic diseases are also at higher risk of developing gout. Such diseases include:
- Overweight or obesity.
- Heart conditions, especially congestive heart failure.
- Diabetes.
- High blood pressure (Hypertension).
- Kidney disease.
- Blood cancer.
Also, you may be at increased risk of developing gout if you:
- If your parents or grandparents have gout (meaning it's hereditary).
- If you eat too much animal protein – especially red meat, seafood, and organ meats like liver and intestines.
- If you drink alcohol regularly.
- If you are taking diuretic medication (water pills).
- If you are taking immunosuppressants.
What foods aggravate gout?
As we mentioned earlier, foods high in purines can increase uric acid levels in the body and cause gout. Here are some of the foods that can cause this:
- Sugary drinks and sweet foods: Half of the sugar we consume is fructose, a type of fruit sugar. This is converted into uric acid in the body. Therefore, any food or drink that is high in sugar can increase gout.
- High fructose corn syrup: This is also a concentrated form of fructose. It can be found in high amounts in packaged foods and snacks with artificial flavors.
- Alcohol: Although not all alcohol is high in purines, alcohol stops the kidneys from excreting uric acid, which then gets reabsorbed and accumulates in the body.
- Organ meats: Things like liver, intestines, brain, and kidneys.
- Some game meats: Things like goose and venison are high in purines.
- Some seafood: Fish like herring, oysters, mussels, cod, tuna, trout, and haddock.
- Red meat: beef, goat meat, pork, bacon.
- Turkey: Especially seasoned turkey meat.
- Gravies and meat sauces.
Important: This does not mean that you should completely avoid these foods. However, it is very important for someone with gout to consume them in moderation.
How do you know if you have gout?
If you have symptoms of gout, see a doctor. He or she will examine you and ask about your symptoms. Tell the doctor when you first noticed joint pain and swelling, and how often these symptoms occur.
What tests are done to diagnose gout?
Your doctor may do some imaging tests to take pictures of your affected joints. These tests can also check for any joint damage caused by gout. You may need to have tests like these:
- X-rays.
- Ultrasound.
- MRI (Magnetic Resonance Imaging).
- CT scan – especially dual-energy CT scan.
Other common tests used to diagnose gout include:
- Blood tests that measure the level of uric acid in your blood.
- Joint aspiration: A procedure that uses a needle to remove a sample of fluid from inside a joint. This can accurately detect the presence of uric acid crystals.
How is gout treated?
When treating gout, there are two main things to consider. One is to control symptoms when a gout attack occurs, and the other is to reduce uric acid levels by reducing foods high in purines.
Medications for Gout
Your doctor may suggest medications such as these to help control symptoms:
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): These are painkillers and anti-inflammatory drugs. For example, you can buy drugs like ibuprofen and naproxen from the pharmacy. However, these are not suitable for people with problems like kidney disease or stomach ulcers. Therefore, do not take these without consulting a doctor.
- Colchicine: This is a prescription medication. If taken within 24 hours of the onset of a gout attack, it can reduce inflammation and pain.
- Corticosteroids: These are also medications that reduce inflammation. Your doctor may give you these as pills to take orally. They may also give you an injection into the affected joint or a nearby muscle.
Your doctor may also prescribe medication to lower your uric acid levels in the blood. The most commonly used medications are:
- Allopurinol.
- Febuxostat.
- Pegloticase.
- Probenecid.
Low purine diet for gout
Your doctor may recommend that you follow a low-purine diet . This involves cutting out foods high in purines and eating more of certain foods that help lower uric acid levels.
Can Gout be completely cured?
In fact, gout cannot be completely cured. However, by working with a doctor to find the right treatment to control your symptoms and lower your uric acid levels, you can greatly reduce the frequency of gout attacks.
What should someone with gout expect?
If you have gout, you should expect your symptoms to come and go. If you don't get a proper diagnosis and treatment, these flares can become more frequent.
For some people, even after starting treatment, as their uric acid levels adjust to new medications or dietary changes, they may experience a few more gout attacks in the early stages. This is normal.
What is the outlook for people with gout?
Many gout sufferers find a combination of treatments and lifestyle changes that work for them over time. These can help them control their symptoms and reduce the frequency of gout attacks. Gout is a treatable condition. Keeping blood uric acid levels below 6 mg/dL can greatly reduce the frequency of gout attacks.
However, if left untreated, gout can cause permanent joint damage. The lumps that form in the joints and soft tissues from uric acid are called tophi. Some people with untreated gout may also develop other health problems, such as:
- Severe joint inflammation and joint deformity.
- Tophi – lumps formed by the accumulation of uric acid crystals in joints and soft tissues.
- Kidney stones.
- Heart disease.
Can Gout be prevented?
The best way to prevent gout is to limit your intake of foods high in purines. Also, drink plenty of water to keep your kidneys functioning properly and prevent dehydration.
Regular exercise not only reduces stress on your joints, but also helps protect against obesity and other conditions that contribute to the development of gout.
How to control a gout attack?
When you have a gout attack, you can do these things to control your symptoms:
- Avoid alcohol and sugary drinks.
- Drink plenty of water.
- Keep the affected joint above the level of the heart as much as possible.
- Apply ice to the joint. Either wrap an ice pack in a thin towel or apply a cold pack for about 15-20 minutes several times a day.
- Reduce pressure on the joint by avoiding strenuous exercise or physical activity.
When should I see a doctor?
If you experience sudden, severe pain in any of your joints, especially if the joint is swollen, red, or discolored, see a doctor immediately. The symptoms of gout can be similar to those of infections that need to be treated immediately.
If you are having more gout attacks, or if your symptoms are worse than before, talk to your doctor about that too.
What questions should I ask my doctor?
- Do I have gout or another type of arthritis?
- What should I do to prevent future gout attacks?
- What foods and drinks should I avoid?
- Will I need medication to treat gout?
What are the first symptoms of gout?
A gout attack usually comes on suddenly, without much warning. You will often start to feel sudden, unbearable pain in the affected joint. Gout attacks often occur at night. So you may notice these symptoms when you wake up in the morning. It is common for a gout attack to go from having no symptoms to suddenly having severe symptoms.
If you have not been diagnosed with gout before, or have not had symptoms like these before, see a doctor as soon as possible to make sure you don't have another condition, such as an infection.
If you already know you have gout and feel like you're starting a flare-up, take the medication prescribed by your doctor right away to control your symptoms.
Finally, remember (Take-Home Message)
Gout is a painful inflammatory condition of the joints. Sharp crystals formed from excess uric acid in the body accumulate in the joints, causing symptoms such as pain and swelling. By talking to your doctor and learning about medications and dietary changes, you can control your symptoms and reduce the frequency of future gout attacks. Don't worry, this is a manageable condition. The most important thing is to follow your doctor's instructions.
` Gout, uric acid, joint pain, joint swelling, purines, gout, diet control
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