Gout Basics: Understanding the Reason behind Your Joint Pain

What is gout?

Gout is a type of inflammatory arthritis that causes pain and swelling in the joints – usually in the big toe but may also occur in the forefoot, ankles, knees, elbows, wrists, and fingers. Pain and swelling are often accompanied by redness, tenderness, and warmth around the affected joint.

The episodes of gout symptoms, known as gout attacks or flare-ups, often strike without warning, typically occurring at night or in the early morning.

Each gout attack can cause excruciating pain and discomfort but slowly resolve on their own even without treatment within a week or two. However, frequent attacks may lead to lasting joint damage, hard lumps under the skin (tophi), and other complications when not effectively managed.

What causes gout?

Gout is mainly caused by having too much uric acid in the blood, a condition called hyperuricemia. When uric acid levels are high, they can crystallize into needle-like formations within joints, triggering inflammation, swelling, and pain—a gout attack.

Uric acid is a natural waste product that forms when the body breaks down purines - compounds present in various foods and naturally produced by the body. It normally does not cause any issues because the body can maintain balance by removing excess uric acid through the urine and sometimes stool.

However, in individuals with gout, the uric acid builds up in the blood either because the body produces too much uric acid or does not properly excrete excess uric acid through the kidneys.

What are the risk factors for gout?

The risk factors for gout can vary from person to person, but they all lead to the same thing: elevated uric acid level.

Here are some common factors that can contribute to gout development:

• Genetics: Some people have a genetic predisposition to produce excessive amounts of uric acid or have reduced efficiency in excreting it through the kidneys.
• Diet: A diet high in purine-rich foods, such as red meat, organ meats, seafood, and certain alcoholic beverages (especially beer) can increase the uric acid levels in the body.
• Medical Conditions: Certain underlying medical conditions such as hypertension (high blood pressure), kidney disease, metabolic syndrome, hyperlipidemia, and diabetes are said to increase the risk of gout.
• Medications: Some medications, like diuretics (water pills) and aspirin, can raise uric acid levels in the blood, increasing the risk of gout.
• Age and Gender: Gout is more common in men than in women, and the risk tends to increase with age. Women are less likely to develop gout before menopause, but the risk becomes more comparable after menopause.

How frequent are gout attacks?

Gout attacks can vary in frequency. Some individuals experience infrequent or occasional episodes with long intervals in between attacks (1-2 times per year or even just a couple of times in their lifetime). Others suffer from frequent attacks occurring multiple times throughout the year, known as chronic gout. Chronic gout is often linked to significant joint damage and necessitates continuous medical management.

The frequency of gout attacks can be influenced by risk factors, lifestyle choices, and the effectiveness of gout management.

What triggers a gout attack?

Gout attacks can be triggered by any factor that elevates uric acid levels in the blood, including stress (related to medical conditions, surgery, trauma, dehydration, or starvation), dietary choices (high-purine foods, alcohol), and certain medications (including aspirin and diuretics). It's worth noting that even medications used to lower uric acid levels can initially trigger gout attacks during treatment.

What to do during a gout attack?

During a gout attack, the primary goal of treatment is to alleviate inflammation and pain. This often involves taking anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs (e.g., ibuprofen), colchicine, or oral steroids for a few days to manage symptoms. Some self-management strategies can also help ease pain and swelling while waiting for medication to take effect.

Here are the things you can do if you experience a gout attack:

• Take an over-the-counter anti-inflammatory painkiller that you have on hand to ease your symptoms. If you have had previous attacks and were prescribed another anti-inflammatory drug by your doctor, take it as directed.
• Apply ice (wrapped in a towel) on the affected joint for at least 20 minutes at a time. Repeat as needed.
• If your toe or foot is affected, elevate it by reclining on a sofa with your leg up on a cushion.
• Rest the affected joint and keep pressure off it. Use a cane when walking to keep the pressure off the affected joint.
• Try to relax as much as possible. Stress can aggravate gout flares.

What to do to prevent future gout attacks?

For individuals with chronic gout, the goal of treatment is to reduce the frequency of attacks and ultimately prevent complications. This typically involves long-term use of uric acid-lowering medications as prescribed by a healthcare professional and making lifestyle adjustments.

To prevent future gout attacks, you may be advised to do the following:

• Take uric acid-lowering medications as directed (if prescribed by your doctor).
• Limit alcohol consumption, particularly beer.
• Achieve and maintain a healthy weight.
• Limit intake of high purine foods such as organ meats (e.g., liver, kidney), red meats (e.g., pork, beef), and seafood (anchovies, sardines, herring, mussels, codfish, scallops).
• Limit intake of sugar-sweetened beverages, particularly those with fructose.
• Ensure adequate hydration.
• Manage coexisting medical conditions like hypertension, diabetes, and hyperlipidemia effectively.

References:

• https://www.ncbi.nlm.nih.gov/books/NBK546606/
• https://www.cdc.gov/arthritis/types/gout.html
• https://www.aafp.org/pubs/afp/issues/1999/0215/p925.html
• https://www.hopkinsarthritis.org/arthritis-info/gout/clinical-presentation-of-gout/#
• https://www.arthritis.org/diseases/more-about/managing-a-gout-attack
• https://www.hss.edu/conditions_gout-risk-factors-diagnosis-treatment.asp
• https://www.nhs.uk/conditions/gout/