Because symptoms can often be vague or subtle, gout can be difficult to diagnosis. The presence of hyperuricemia does not guarantee an individual has gout or will ever get it. Most who do have hyperuricemia never progress to developing gout.
To confirm the presence of gout, a doctor or health care professional may insert a needle into the enflamed joint and draw a sample of synovial fluid, the liquid that provides lubrication for each joint. This joint fluid is placed on a slide and examined beneath a microscope in search of uric acid crystals.
Gout can sometimes mimic other conditions such as joint infections and it is essential to rule out opposing conditions in order to receive proper treatment. The presence of uric acid crystals in addition to common symptoms of gout including more than one attack of acute arthritis, arthritis that develops in one day producing a swollen joint and an acute attack in only one joint can mean an individual has gout.
Gout is a condition that occurs when uric acid, a waste product produced during metabolism, is deposited as needle-like crystals into the joints and soft tissues in the body. Once inside the joints, the uric acid crystals cause inflammatory arthritis which leads to swelling, redness, heat, stiffness and pain in and around the joints.
Uric acid is a substance created from the breakdown of purines, a component of human tissue found in a variety of foods. Usually, uric acid becomes dissolved in our bloodstream and passed through the kidneys into the urine. However, if there is an increase in the production of uric acid or if the kidneys do not eliminate enough of the uric acid from the body, it begins to build up in the blood resulting in a condition known as hyperuricemia.
Hyperuricemia may be brought on by eating high-purine foods which include liver, dried beans, peas, anchovies and gravies. By itself, hyperuricemia is not dangerous. But if uric acid crystals build up from the excess of purines caused by hyperuricemia, gout can develop.
In many cases, gout first begins to affect the joints in the big toe. Other common points of origin include insteps, ankles, heels, knees, wrists, fingers and elbows. Chalky deposits of uric acid can start to appear as lumps under the skin around the joints and the rim of the ear. These deposits also can collect in the kidneys and can cause kidney stones.
Gout can progress through four main stages: Asymptomatic hyperuricemia, acute gout or acute gouty arthritis, interval or intercritical gout and chronic tophaceous gout.
Asymptomatic hyperuricemia is the initial stage of the condition when the individual has elevated levels of uric acid in the bloodstream but no other symptoms. Acute gout, or acute gouty arthritis, occurs when the crystallized uric acid seeps into the joints causing sudden onset of intense pain and swelling in the joints.
Interval or intercritical gout is the symptomless period in-between acute attacks of pain. Chronic tophaceous gout is the most debilitating stage of the condition, developing over a long period of time. During this time the disease can cause permanent damage to joints and even the kidneys. With prompt treatment, patients with gout typically do not reach this stage.
There are many causes and risk factors associated with gout. Genetics and those who have a family history of the disease are at more risk of developing the condition. Gender and age play a role too, as men are more likely to get gout and it is overall more common in adults than in children.
Overindulgence in alcohol can lead to hyperuricemia as alcohol interferes with the removal or uric acid from the body. Also, eating foods rich in purines can cause build up and aggravate gout in some individuals.
Lead exposure and health problems such as high blood pressure, hypothyroidism or an underactive thyroid gland, psoriasis, hemolytic anemia and cancer can raise the risk of developing gout.
The presence of Kelley-Seegmiller or Lesch-Nyhan syndrome, both rare conditions in which the enzyme needed to control uric acid levels is not present of in insufficient quantities can also lead to gout.
Certain medications can also put people at risk.
- Diuretics: A drug taken to eliminate excess fluid from conditions like hypertension, edema and heart disease can decrease the amount of uric acid passed through urine therefore allowing build up
- Salicylate-containing drugs: Such as aspirin
- Niacin or nicotinic acid
- Cyclosporine: A medication that suppresses the body’s immune system is often taken in the treatment of some autoimmune diseases and to prevent the body’s rejection of transplanted organs
- Levodopa: A medicine used to support communication along nerve pathways used often in the treatment of Parkinson’s Disease
Frequently Asked Questions:
Is there any treatment available besides pharmaceutical medication?
- Medications are widely used in treating gout primarily because they are so effective. Caught early enough, gout can be incredibly manageable with the right medication treatment plan. However, as research into gout continues, there are new therapies on the horizon that could provide alternative treatment therapies for those who do not wish to rely on medicine. Biologic agents that block a chemical called tumor necrosis factor is currently in development. This chemical is believed to play a role in the inflammation gout causes to the body’s joints.
Who is most at risk for developing gout?
- Researchers believe 6 million adults age 20 and older report having gout sometime in their lives. Gout is much more rare in children and young adults. Men between the ages of 40 and 50 are more likely to develop gout than women who rarely ever develop the condition before the onset of menopause. Also, people who have had organ transplants are more at risk for developing gout. To lower your risk, drink plenty of water and avoid high purine foods that carry heightened amounts of uric acid.
What are tophi?
- Tophi are the chalky deposits of uric acid which develop beneath the surface of the skin. These appear like lumps beneath the epidermis and usually are located around the affected joints and the rim of the ear. These crystal deposits can also collect in the kidneys causing kidney stones. If you see these around or near your joints, notify your doctor to consult a treatment plan.
Generic symptoms of gout include intermittent swelling, redness, heat, pain and stiffness of the joints.
Acute attacks of gout occur once the uric acid crystallizes and leaks into the joints. These attacks are sudden and can cause significant amounts of pain focused on the joints commonly the big toe, ankles, heels, wrists, fingers, insteps and elbows. There often is a feeling of heat or warmth as well as swelling, irritability, redness and rigidity or stiffness. Additionally, there can be chalky lumps beneath the surface of the skin which can be a sign of hyperuricemia.
However, each of gout’s four progressive stages hosts different symptoms, which can indicate how far the condition has progressed.
During gout’s initial stage, asymptomatic hyperuricemia, there are no symptoms except heightened levels of uric acid in the bloodstream which does not require treatment.
Acute gout or acute gouty arthritis is the second stage of the condition caused by the deposit of uric acid crystals into the joint spaces. This stage brings the sudden onset of intense pain and swelling in the joints which may also feel warm and tender. Usually, attacks occur at night and are triggered by stressful events or triggers like alcohol or drug usage.
The third stage, interval or intercritical gout, is another stage of no symptoms. The final stage, chronic tophaceous gout is the most debilitating of all four stages. With proper and prompt treatment, the majority of patients do not progress to this last advanced stage. This stage brings permanent damage to the body’s joints and kidneys, creating lasting inflammation and irritability.
Maintaining a healthy lifestyle as well as remaining vigilant about the approach and onset of symptoms is vital to regulating gout and living with the condition pain free. Because gout can progress into more serious stages, it is important to report your symptoms when you first see them.
Avoid medication that can be harmful and ask your doctor about additional triggers that can set off acute attacks. Since acute attacks occur at times of stress, form routines that aid you in winding down. Drink water throughout the day as it will help in draining the necessary amounts of uric acid from the body with urination. Avoid alcohol and foods high in purines.
Gout can be well controlled through attention and commitment. Acute gout is most easily controlled and easily regulated if medications and treatments are taken at the first sign of pain or inflammation. So if you believe you have gout or display symptoms of the condition, see your doctor or health care professional.
You can take active steps in minimizing gout’s effects on your day to day living by being thorough in your treatment plan. Tell your doctor about all medications and vitamins you are currently taking in case one or more are increasing your risk of hyperuricemia. Plan followup visits to your doctor to track your progress once you begin to take medication. Drink plenty of nonalcoholic fluids, especially water. This will help to remove uric acid from the body whereas alcohol can have the opposite effect and raise the levels of uric acid in your bloodstream.
Form a stable and maintainable exercise routine and avoid foods high in purines. Anchovies, asparagus, beef kidneys, brains, dried beans and peas, game meats, gravy, herring, liver, mackerel, mushrooms, sardines, scallops and sweetbreads should be avoided.
The goals in treatment of gout are to ease the onset of sudden pain, to prevent future attacks and to avoid the formation of chalky deposits known as tophi and kidney stones. Getting treatment is essential as it can prevent long-term damage the fourth stage of gout produces.
Nonsteroidal anti-inflammatory drugs (NSAIDs) taken orally or corticosteroids, taken orally or injected into the infected joints, are the most common treatment approach for acute attacks. While these drugs reduce overall inflammation caused by uric acid crystals, they have no effect on the amount of uric acid inside the body.
Corticosteroids are potent anti-inflammatory hormones that aid patients in healing from acute attacks with improvement within a few hours and the entire attack fading within a week. The most commonly used corticosteroid is prednisone.
If NSAIDs and corticosteroids do not help in clearing up and preventing future attacks, a medication called colchicine can be taken orally within the first twelve hours of an acute attack.
Losing weight, limiting alcohol consumption and avoiding high-purine foods that lead to the build up of hyperuricemia and uric acid can also help in symptom relief. Stay clear of foods such as anchovies, asparagus, beef kidneys, brains, dried beans and peas, game meats, gravy, herring, liver, mackerel, mushrooms, sardines, scallops and sweetbreads.