Gout - Pictures, Symptoms, Causes, Treatment
What is Gout?
Gout is a chronic progressive disease characterized by an abnormal excessive production of uric acid that builds up in the tissues of the body particularly of the joints after it has formed uric acid crystals. Episodes of recurrent attack of arthritis or joint inflammation are the result of this uric acid crystal buildup in the joint space that later deposits in the soft tissues. Gout is predominant in males with onset of symptoms on the 4th to 6th decade of life. Male genders usually have an increase level in uric acid during their puberty while the symptoms of gout may also occur in their early age of 20 especially to those who genetically predisposed and with lifestyles that put them at risk for gout. Gout is less common in women although the risk is high after cessation of monthly menstrual period or postmenopausal.
The development of gout usually begins after many years from the start of uric acid crystals buildup in the joints and the tissue surrounding it. Gout attack usually starts with inflammation in one joint and commonly in the big toe. Pain from gout attack occurs at night with intensity starting from moderate to worsening pain. Episodes of gout attack is usually debilitating while it is often mistaken for sprain or tendinitis in mild severity with cessation of symptoms that usually follow after 6 hours or 1 to days. Severe attack of gout on the other hand may last from several weeks to a month.
The attack of gout is usually at night and without admonition while general symptoms include:
Pain and inflammation of a single joint and the surrounding tissue and usually affects the small joint of the big toe. Podagra is the medical term for a gout attack affecting the big toe which is the most common site. Pain and inflammation characterized by abrupt joint swelling, redness and with warm sensation on the affected site is the initial symptoms of gout attack while pain is to occur during the night with severe intensity that even a mere touch of blanket is rather painful.
Discomfort with gout attack is lingering even after the pain has subside while discomfort of the joint may remain from number of days to few weeks. The recurrent attack on the other hand, may affect several joints and with lingering discomfort lasting longer than the initial attack.
For majority of patient with gout, second attack occurs after the initial attack and which is usually in a period of 6 months to a couple of years although the intervals may be in between many years from previous attacks.
Gout however, has three stages with each defining severity and symptoms.
The first stage is defined with an increase level of uric acid in the blood and gout is asymptomatic. The progression of increase in uric acid during this stage may never occur and symptoms of gout may not develop although kidney stones may arise even prior to a gout attack.
The second stage is defined with periods of gouty arthritis attack which may or may not have symptoms. Formation of uric acid crystals in the joint fluid begins during this stage most commonly affecting the big toe while the body’s rapid inflammatory reaction is the response for uric acid buildup. The most common part of the body affected of gout is the big toe although gout can also occur to other joints of the body such as the knee, foot joint, ankles, wrist and fingers. The attack on this stage is shorter and which is followed another attack that occurs within 2 years. Subsequent attack however, is more severe, involving more than one joint and lasts longer.
Third stage is rarely experienced by many patients and this stage is defined as chronic and often involves more than a single joint. This is especially experienced by patients who leave their condition untreated for number of years leaving enough uric acid crystals to form coarse nodules which is then called tophi. These tophi may later on progress and grow in the cartilage of the external ears or grow in the tissues surrounding the joints if left untreated. The progression of tophi can result to crippling and possible destruction of the bone and cartilage.
Gout is the result of an accumulation of uric acid crystals in the joint and tissues surrounding it. The deposition of uric acid crystals occurs when there is an excessive amount of uric acid in the blood. Uric acid is a combination of nitrogen, carbon, hydrogen and oxygen while it shapes urates and acid urates. Uric on the other is also the by-product of purines breakdown. Purines on the other hand is a substance that can be found in the tissues of the body and can also be found in certain foods such as mushroom, asparagus, herring, anchovies, dried beans and peas. Uric acid in general, dissolves in water and is sent out of the body through urine after it passed through the kidneys. High levels of uric acid in the blood happen when:
- The body produces excessive amount of uric acid
- Kidneys are unable to expel enough amount of uric acid out of the body
- Inability of the body to eliminate uric acid through urine
- Excessive intake of purines through food taken
Gout develops over a period of time when an amount of uric acid crystals has accumulated I the joints and its tissue. Predisposing factors are considered to put one at risk for gout attacks and these include the following:
- Family medical history of gout
- Male gender in the age level of between 30 to 60 years old
- Female gender postmenopausal
- Excessive alcohol intake
- Excessive intake of food rich in purines
- Use of medications such as diuretics, cyclosporine, aspirin and levodopa.
Gout treatment is aimed towards addressing acute attack while preventing recurrence in the future and complications such as developing tophi. It can be treated medically and this includes the following:
- Nonsteroidal anti-inflammatory drugs
Surgical intervention is rarely recommended except for cases with significant damage in the joints or bones brought by untreated gout.