Introduction

Gout is a form of inflammatory arthritis that causes pain and swelling in your joints. Gout happens when there’s a buildup of uric acid in your body.

  • Gout most commonly affects your big toe joint. But it can affect other joints, including your Knees, Ankles, Elbows, Feet, Hands and wrists.
  • An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the bedsheet on it may seem intolerable.
  • Gout symptoms may come and go, but there are ways to manage symptoms and prevent flares.

Causes:

Liver disease doesn’t always cause symptoms that can be seen or felt. If there are symptoms of liver disease, they may include:

  • A buildup of excess uric acid in your body causes gout. Your body naturally makes uric acid when it breaks down chemicals called purines found in certain foods and drinks. Your kidneys usually filter uric acid out of your blood, and then it leaves your body when you pee.
  • Sometimes your body makes too much uric acid, or your kidneys don’t remove it from your blood fast enough. When your body has high level of uric acid (hyperuricemia), uric acid crystals can build up and settle into your joints. The sharp crystals clump together and cause sudden episodes of pain, swelling and other symptoms.
  • Having temporarily high uric acid levels doesn’t mean you’ll definitely develop gout. Many people with hyperuricemia never get gout.

Symptoms :

The signs and symptoms of gout almost always occur suddenly, and often at night. They include:

  • Intense pain
  • Discolouration or Redness
  • Swelling and Stiffness
  • Tenderness, even to a light touch (like a bedsheet covering your affected joint).
  • Warmth, or a feeling like the joint is “on wire”.

Risk factors

Factors that increase the uric acid level in your body include:

  • Diet : Eating a diet rich in red meat and shellfish and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
  • Weight : If you’re overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.
  • Age and sex : Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
  • Family history : If other members of your family have had gout, you’re more likely to develop the disease.
  • Medical conditions : Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases.
  • Certain medications : Low-dose aspirin and some medications used to control hypertension — including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers — also can
    increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
  • Recent surgery or trauma : Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, receiving a vaccination can trigger a gout flare.

Complications:

People with gout can develop more-severe conditions, such as:

  • Recurrent gout : Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
  • Advanced gout : Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi. Tophi can develop in several areas, such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.
  • Kidney stones : Urate crystals may collect in the urinary tracts of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Diagnosis

Doctors usually diagnose gout based on your symptoms and the appearance of the affected joint. Tests to help diagnose gout may include:

  1. Blood tests : Your doctor may recommend a blood test to measure the levels of uric acid in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don’t have unusual levels of uric acid in their blood.
  2. Joint fluid test : Your doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope.
  3. X-ray imaging : Joint X-rays can be helpful to rule out other causes of joint inflammation.
  4. Ultrasound : This test uses sound waves to detect urate crystals in joints or in tophi.
  5. Magnetic Resonance Imaging (MRI)
  6. Dual-energy computerized tomography (DECT) : This test combines X-ray images taken from many different angles to visualize urate crystals in joints.

Treatment

  • Gout medications are available in two types and focus on two different problems. The first type helps reduce the inflammation and pain associated with gout attacks. The second type works to prevent gout complications by lowering the amount of uric acid in your blood.
  • Which type of medication is right for you depends on the frequency and severity of your symptoms, along with any other health problems you may have.
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Low purine diet for gout : Your healthcare provider may suggest you follow a low-purine diet encourages you to consume fewer foods and drinks with high purine content. This will help reduce uric acid in your body. It also encourages you to eat some select foods that may reduce your uric acid levels.