Gout is a disease in which elevated levels of uric acid (a product of the body’s metabolism of a substance called purine, which is ingested through food) in the blood lead to the deposition of urate (uric acid is found in the form of urate in the blood, body fluids, and joint fluid) crystals in the cartilage, tendons, and surrounding tissue of the joints.
This causes inflammation of the joints, resulting in recurrent attacks that are extremely painful, and the deposition of gouty nodules (tophi) caused by urate crystals leads to joint deformity and disability.
In addition to joint abnormalities, it can cause various kidney diseases and nephrolithiasis (kidney stones) caused by uric acid in the kidneys.
The older you are and the higher the level of uric acid in your blood, the more likely you are to develop gout.
Uric acid is a product of the body’s metabolism of purines from food, and is found in the form of urate in the blood, body fluids, and joint fluids.
When the concentration of uric acid in the blood exceeds a certain level, it is called hyperuricemia. The causes of this condition can be divided into two main categories: overproduction of uric acid and decreased excretion of uric acid.
In each case, there are a variety of possible causes, but in some cases, the cause is unknown.
In addition, weight gain is closely linked to hyperuricemia.
On the other hand, gout is more common in men because the ability of the kidneys to remove uric acid decreases with age, whereas in women, the ability to remove uric acid is maintained by female hormones until menopause.
There are four classic stages of gout: 1) asymptomatic hyperuricemia, 2) acute gouty arthritis, 3) intermittent gout, and 4) chronic nodular gout.
1) Asymptomatic hyperuricemia
Serum uric acid levels are elevated, but arthritic symptoms, gouty nodules, and uric acid nephrolithiasis are not yet present, and most people with hyperuricemia remain asymptomatic for most of their lives.
2) Acute Gouty Arthritis
The first gout attack usually occurs after a period of hyperuricemia that lasts for at least 20 years.
The most characteristic symptom of gout is an acute attack of very painful arthritis.
The first attack usually involves a single joint and has no systemic symptoms, but subsequent attacks involve multiple joints and are accompanied by fever.
The big toe is the most common joint to be affected, but any of the joints of the extremities can be affected.
Most first acute gout attacks occur suddenly, usually at night when the patient is resting comfortably.
Some patients then experience symptoms when they wake up in the morning and take their first steps, while others wake up in pain.
The affected joint becomes hot, red, swollen, and excruciatingly painful within a few hours.
Mild attacks go away within a few hours or last a day or two, but severe attacks can last for weeks.
3) Intermittent gout
Intermittent gout is a symptom-free period between gout attacks.
Some patients never have an attack again, but most patients will experience a second attack between six months and two years.
The frequency of gout attacks increases over time in untreated patients.
Later on, attacks tend to come on gradually rather than acutely, involve multiple joints, and tend to be more severe and last longer.
4) Chronic nodular gout
After painless intermittent periods, chronic crystalline gout looks similar to other types of arthritis.
Gout nodule formation and gout attacks increase in proportion to the severity and duration of hyperuricemia.
It takes an average of 10 years after the first attack for gouty nodules to become visible, and by 20 years, a quarter of patients have nodules.
Gouty nodules are most commonly found in the auricles and can form asymmetrical, bumpy lumps on the fingers, hands, toes, ankles, and knees, requiring larger gloves or shoes.
The formation of the nodules occurs gradually, and although the pain of the nodules themselves is mild, progressive stiffness and constant pain in the affected joints often occurs.
Eventually, with extensive joint damage, large nodules form under the skin, giving the hands and feet a grotesque appearance.
It”s important to use the appropriate m
dications as directed by your doctor for preventive purposes.
Weight control, sobriety, and avoiding overeating can also help prevent gout attacks.
Diet and lifestyle
Eating a high-protein diet increases the production of uric acid in the body.
However, the antihyperuricemic drugs currently available are very effective, so special diets are not necessary for gout patients.
However, it’s important to lose weight through calorie restriction, avoid overeating, and stay sober.
An unsuccessful weight loss program can trigger a gout attack, as the concentration of uric acid in the body changes dramatically.
In addition, suddenly drinking a lot of alcohol can cause temporary hyperlactic acidemia while intoxicated, which worsens hyperuricemia.
Long-term alcohol consumption can also worsen gout.