Symptoms of Gout
Gout has long been known by the medical profession and was one of the earliest recorded conditions, in part due to a high prevalence of the condition with king’s and the aristocracy. It has been noted in medical diaries from the 17th century that sufferers of gouty arthritis were typically the elderly and those who had over enjoyed the excesses of their youth. However whilst diet has a role in attacks of gout, the association with the aristocracy is more likely to be genetic, with the condition having a strong hereditary component.
Gout is a progressive disease which without proper management and treatment will lead to chronic illness and permanent disfigurement and pain, however the symptoms of gout can be managed, and painful episodes controlled. Gout occurs due to an inability of the body to process uric acid, and is usually due to metabolic abnormalities although anything which leads to increased levels of uric acid in the blood can trigger the condition. When uric acid levels rise in the blood, it crystallizes out in the joints causing intense bouts of pain, swelling and inflammation. It most commonly affects the first joint of the big toe, although is not isolated to this area. Termed podagra when in this location, the build up of uric acid crystals triggers bouts of inflammatory arthritis, with the crystals forming not just in the joint (synovial) fluid, but also in the joint lining; the synovial membrane.
The condition can cause intense big toe pain, with considerable swelling and hotness to the touch of the tissue surrounding the joint. The bouts of painful arthritis can last for over a week before subsiding, and will reoccur, although it may be many months before the condition flares up again. In contrast to conditions such as pseudogout, the attacks can be predicted to some degree, and usually occur following consumption of foodstuffs rich in purines, the breakdown of which leads to increased uric acid levels. A bout of heavy drinking, overeating, fever and dehydration can all help to trigger a flare up. The pain can be intense and all consuming, however there is medication available which can help reduce the pain, swelling and help to prevent attacks from occurring.
Symptoms of Gouty Arthritis
Symptoms of gout can vary between individuals. Gout mainly affects men over 40, with men nine times as likely to suffer from gouty arthritis as women. The condition can strike any time past puberty in men, and usually in women it is limited until after the menopause. It has been estimated that symptoms of gout are displayed by 1% and 2% of the population in the western world at least some point during a lifetime. In the United States, 10% of men have no symptoms of gout but do have elevated levels of uric acid in the blood (hyperuricemia). Whilst this could be indicative of gout developing, for many people high levels of uric acid alone may not lead to gouty arthritis. It has been estimated that over 5 million American men display symptoms of gout.
Common Symptoms of Gout
- Intense pain in the joints, in particular the first joint of the big toe
- Gout can affect the ankle, foot, wrist, fingers, knees and elbows
- Rapid onset of pain without any trauma
- Swelling at the site of the pain
- Inflammation, heat and extreme tenderness of the tissue surrounding the joint
- Inflammatory arthritic episodes can also be accompanied by fever
Gout Risk Factors
- Gout is aggravated by obesity and low levels of fitness
- Those with a high alcohol intake are more likely to develop gouty arthritis
- High blood pressure and abnormal kidney function can cause gout
- Those with low thyroid activity may be more susceptible
- Any disease which can increase uric acid levels in the blood, such as some blood cancers, can produce symptoms of gout.
Treatment of Gout
Long term control of the condition targets one of two areas. Medication can block the production of uric acid by the body to reduce the level in the blood, or they will aid kidney function and speed up uric acid excretion via the urine. Allopurinol is prescribed to reduce uric acid, with Probenecid speeding up uric acid excretion. Medication is not taken until at least a week after a bout of pain so as not to exacerbate the problem.
The primary treatment is to reduce the level of inflammation of the joints with the use of anti-inflammatory medication, and also to them shrink the crystals in the joints and ensure that they do not build up again. Preventing future attacks is one of the most important ways of treating the condition. Reducing purines in the diet is one of the best ways of reducing the likelihood of further gouty arthritis attacks.