Gout – Causes, Symptoms and Treatment

Gout is a form of arthritis, an umbrella term for over 100 forms of rheumatic diseases in the bones and joints, muscles, and other tissues. Gout comprises about 5% of all arthritis cases.

Gout can be an excruciatingly painful condition. Uric acid crystals accumulate in connective tissues and/or in the space between bone joints, eventually leading to an inflammation. The gout sufferer will experience swelling, redness of the skin, sharp pain, and stiffness in the joints. There is a condition that is similar to gout in its symptoms but arises from a build-up of calcium phosphate crystals; this is called pseudo-gout and requires different treatment.

Uric acid is a byproduct of the breakdown purines, protein-like substances which are components of human tissues and can be found in the foods you eat. If your level of uric acid is normal, the crystals will dissolve easily in the blood and filtered by the kidneys for disposal via the urine. If you have too much of it – either because your body is producing more or your kidneys are not disposing enough – uric acid crystals gradually accumulate in the bone joint spaces and cause inflammation. That’s when you experience gout.

Like many people, your big toe will likely be the first to be affected – gout usually affects the big toe in three-fourths of gout sufferers. Eventually, you will have it in the arch of the foot and other key parts of the feet, legs, arms and hands – which are intricate assemblies of bone joints. There are four stages of the disease.

You’re not likely to feel anything in the first stage, as uric acid is just building up. In the second stage, significant deposits of uric acid have accumulated in the joint spaces, causing intense pain and swelling. Acute gout usually occurs at night, and may last up to ten days before subsiding, even without treatment. Over time the attacks will last longer and intervals of occurrence will be shorter. Attacks can also be triggered by stress, illness, alcohol or drugs.

The third stage is benign: it is the interval between acute bouts of gout. You will have normal joint functions at this stage. The most disabling stage is chronic gout. This may develop over long periods, say 10 years; by that time, there may already be permanent damage to the joints and even the kidneys. If you get proper treatment, you will not reach this stage.

The high uric acid levels that cause gout will affect your body in other ways. Uric acid crystals may be deposited and appear as lumps under the skin around the joints or at the edge of your ear. In a more undesirable way, the crystals can accumulate in your kidneys to form kidney stones.

What Causes Gout?

Few diseases are as painful as gout. This rheumatic disease can see its sufferers double up in pain with their joints all swollen up, reddening and heating up as the inflammation vents its fury. It used to be called the ‘royal disease’ because in olden times, apparently only kings and nobles suffered from it. That was largely because it was only they who could afford to eat meats and other high-protein foods.

The metabolism of protein or the synthesis of protein-related substances (called purines) in your tissues produces a waste product, uric acid. It is circulated in the blood en route to the kidneys where it is filtered out and disposed. Too much uric acid will result in high levels of uric acid in the blood.

The body cannot tolerate uric acid in the blood, but the kidneys just cannot cope with the overload. So the body removes the uric acid from the blood by causing it to crystallise and depositing the crystals somewhere else, usually in connective tissue and joints. Once the uric acid crystal deposits in the joints reach excessive levels, hyperuricemia sets in, which could lead to gout.

You may be wondering what risk factors lead to the development of gout. There are quite a number of them:

1. Genetics is a significant influence, since body metabolism is largely determined genetically. Up to 18 percent of those who suffer from gout have it in their family history.
2. Age and gender are also important risk factors. Gout affects mostly adults and rarely occurs in children. It also is more common in men, especially those aged 40 and above, than women, especially those before the age of menopause.
3. Body weight is a key indicator. Those who are overweight have much tissue that when broken down produces a lot of uric acid. Overweight people thus tend to develop hyperuricemia which can (but not always will) lead to gout.
4. Excessive alcohol consumption increases uric acid levels in the blood since alcohol disrupts the disposal of uric acid from the body.
5. Consumption of too many foods containing protein and purines can lead to gout, or aggravate an existing condition.

There are some diseases for which the medicines that are prescribed may, as their side effect, dampen the body’s ability to dispose of uric acid: These include:

• Diuretics, which are medications prescribed to help dispose of excess body fluids resulting from certain diseases like hypertension, edema, and other cardiovascular diseases.
• Salicylates, usually found in anti-inflammatory medicines that are based on salicylic acid.
• Cyclosporine, which may be prescribed in cases where it is necessary to suppress the body’s immune system, as in those who have organ transplants.
• Levodopa, which is used to treat Parkinson’s disease.

The important thing to realise is that weight and protein intakes play large roles in development of gout. Even if you have a family history of gout, you can minimise the probabilities by regulating your lifestyle to exclude the other risk factors for gout.

Gout Symptoms – The 4 Stages of Gout

Severe attacks of gout often occur at nighttime. You may suddenly wake up to extremely painful sensations pulsating in your big toe or other small joints. When you are roused from sleep like that, no pain can possibly exceed what you feel. That only means you have not paid enough attention to your body. Gout does not just happen, it develops slowly in four main stages.

Stage 1: Asymptomatic Hyperuricemia – Asymptomatic means without symptoms. At this stage your uric acid level in the blood remains at a high level. You do not feel anything (yet) but the excess uric acid forms its crystalline needles that gradually get deposited in your joint spaces.

Stage 2: Gouty Arthritis, or acute gout – At this stage, the accumulation of crystals in your joints has reached near saturation. Yet, the uric acid in your blood remains at high levels which caused more crystals to form and deposit in your joints. The excess at one part of your body led to an excess in another.

This causes that sudden attack of intense pain; your joints become swollen and very tender; the tissues around the joint become inflamed and heat up. Stress, alcohol, or drugs may trigger the attack. It usually comes at night, lasts maybe three to ten days, and then subsides. The subsequent attacks may not happen until several months later or years, but they will become progressively more painful, more frequent, and last longer.

Stage 3: Inter-critical gout, or interval – This is a peaceful interval between acute attacks. Everything appears and feels normal, the crystal deposits in your joint are still high but some stable equilibrium has been reached. It is easy to get complacent and forget about gout at this stage. You should not. You should find a way to get treated and be rid of it.

Stage 4: Chronic or Tophaceous gout – This is the most destructive, most disabling stage. It takes a long while to progress to this stage, perhaps 10 years. By the time you get here, there is already permanent damage inflicted on your joints, advanced deterioration has set in, and extreme pain becomes rather regular. The worst scenario that can happen here is damage to the kidneys, which can lead to renal failure in extreme cases. This is terrible, but with proper treatment, most gout sufferers never get to this advanced stage.

Gout Diagnosis and Treatment

Diagnosis

The roots of gout are in that high level of uric acid content in the blood called hyperuricemia. The excess uric acid crystals accumulate in the bone joint spaces, eventually causing gout. You can have hyperuricemia without developing gout; however, you cannot develop gout without having undergone hyperuricemia.

Because its symptoms are not distinct, physicians don’t find it easy to diagnose gout. When you get an attack of acute gout, you may not necessarily show a high uric acid reading. To have a better basis for diagnosis, the doctor inserts a needle into your swollen joint and extracts some fluid for microscopic examination.

If you have those lumps called tophi (which actually are deposits of uric acid), the doctor will also examine samples of it. You normally find tophi under the skin around the joints. The doctor will test whether you are having a bacterial infection (rather than gout) since their symptoms are very similar. The doctor will also check if the arthritic attack occurs in one joint only and/or has quickly developed in just a day, resulting in the inflamed, reddish, and warm joint.

Gout Treatment

Your doctor will probably combine approaches to treat this complex disease. The long term goal would be to prevent the formation of kidney stones and tophi, and to avert further acute attacks; the immediate goal is to ease the acute pain of gout.

One common approach is to fight it with heavy doses of anti-inflammatory drugs, either steroid-based or not. Non-steroid based drugs, usually taken daily in capsule form, will simply reduce the inflammation but cannot lower the uric acid levels circulating in your body. These are known as NSAIDs (non-steroidal anti-inflammatory drugs) and the common generic forms are indomethacin and naproxen.

The effects of steroid-based drugs on inflammation are felt more quickly. Corticosteroids, often prednisone, may be taken orally or directly injected for faster relief. Within a few hours of corticosteroid treatment, there is marked improvement.

If your symptoms are too severe to be relieved by NSAIDs or corticosteroids, colchicine may be the next alternative. This drug is best taken within the first 12 hours from the onset of acute gout. There are oral versions to be taken every hour until the symptoms subside. Colchicine may upset your digestive system.

For the long-term, you may be advised to take moderated daily doses of either NSAIDs or oral colchicine to stave off future attacks. To reduce uric acid levels, tophi formation, and sudden attacks, allopurinol or probenecid may be prescribed.

Proper treatment may allow you to control gout symptoms and live normally. It will work better if you also undergo physical exercise and alter your dietary patterns to reduce uric acid levels.

If you have a gout attack, many doctors recommend oral doses of ibuprofen or naproxen, available in both prescription and nonprescription versions, or other anti-inflammatory drugs. If you are taking aspirin, your doctor may recommend that you stop it temporarily. Aspirin can slow the elimination of uric acid and make gout worse. But if you take a low dose of aspirin to prevent other problems such as a heart attack, check with your doctor before stopping it.

Can certain foods treat or cure gout?

If you are suffering from gout, paying attention to your diet will help greatly in controlling this painful disease. Gout is caused by a buildup of metabolic byproducts of uric acid in joints. The pain of gout comes from the accumulated needle-like crystals of a uric-acid salt known as monosodium urate. These crystals accumulate in joints and invade surrounding tissues during an acute attack. The immune system then floods the joints with neutrophils to remove injured tissue. The influx of neutrophils increases the pain and swelling; over the long term, this can destroy a joint.

Uric acid comes from the breakdown of purines, one of two classes of components of the complex proteins and amino acids that make up your DNA, RNA, and ATP. Your body can recycle purine, using the enzyme xanthine oxidase. But over-consumption of purine-rich foods will produce more uric acid than the xanthine oxidase system can handle. Also, excessive consumption of alcohol (and some medical conditions or their medications) can impair the enzyme system so that it cannot process normal levels of purine. Any of these imbalances can trigger an attack.

To control gout, you must control uric acid. The first step in controlling uric acid is reducing consumption of foods containing purines, since these foods increase uric acid production.

Alcohol must be avoided, since alcohol impairs kidney function and accelerates the buildup of uric acid in your system. It is also important to reduce consumption of refined carbohydrates and saturated fats, since these increase uric acid retention. High-protein diets introduce amino acids into the body which displace uric acid in the kidney’s cleansing apparatus and force it back into the bloodstream, raising uric acid concentration.

Good Gout Foods

You can eat as much of cherries as you want. Consuming 250 grams of fresh or canned cherries every day helps to lower uric acid levels and forestall gout attacks. Cherries, blueberries, and other dark and red-blue cherries are rich sources of anthocyanidins and other flavonoids. These natural healing agents reinforce the collagen matrix of cartilage and tendons. They also prevent the synthesis and release of histamine, leukotrienes, and prostaglandins, compounds that cause the intense pain of gout.

If you cannot eat cherries, try taking 125-250 milligrams of quercetin 3 times a day between meals. Quercetin also stops the synthesis and release of histamine, leukotrienes, and prostaglandins, and has some actions similar to the drug allopurinol.

Bromelain, taken in doses of 125-250 milligrams with quercetin 3 times a day, increases the body’s absorption of quercetin and may break up uric acid crystal deposits. There are indications dandelion and stinging nettle may also break up uric acid deposits, since they help dissolve uric acid kidney stones.

Here’s a general diet guideline when you are diagnosed with Gout:

• Eliminate foods high in purine from your diet, including anchovies, baker’s and brewer’s yeast, bouillon, broth, caviar, consomme, dried beans and peas, goose, gravy, herring, mackerel, meat extracts (like Bovril), partridge, sardines, scallops, shrimp, sweetbreads, yeast extracts (such as Marmite and Vegemite), and organs like brain, heart, liver and kidneys.
• Curtail consumption of foods containing moderate amounts of purines, including asparagus, dried beans and legumes, fish, mushrooms, poultry, and spinach.
• Lose weight by reducing calories rather than by vigorous exercise (which increase uric acid production).
• Drink at least 8 glasses of water daily to dilute the uric acid concentration of urine.
• Avoid alcohol, especially beer (with its brewer’s yeast content).
• Eat cherries.

Nutritional Supplements

• Take quercetin and bromelain if you cannot eat cherries.
• Avoid trace mineral supplements containing molybdenum. Molybdenum surplus causes a condition very similar to gout.
• Avoid megadoses of Vitamn C. They may increase the production of uric acid.
• Avoid high doses (over 50 milligrams per day) of niacin. Niacin competes with uric acid for excretion into the urine.
• Avoid iron supplements. Excess iron in the bloodstream can cause uric acids to form in joints.