Gout is a type of arthritis (joint inflammation) that causes severe pain due to the accumulation of uric acid in the joints. The elevation and accumulation of uric acid can exist for a long time without causing any complaints. Various triggering factors initiate the condition called gout attack, and symptoms such as pain, redness and swelling suddenly appear in one or more joints. Gout attacks occur mostly at night and may develop due to reasons such as overeating or alcohol consumption. It most often involves the root of the big toe. If uric acid (urate) formed in the body as a result of metabolism cannot be eliminated from the kidneys at the same rate, it may collapse in and around the joint and cause joint inflammation. A gout attack usually goes away on its own within a week. However, if left untreated, the attacks will recur and affect more joints.
Stages of Gout
Asymptomatic hyperuricemia: It is called high uric acid in the blood without any symptoms.
Acute gout: If high uric acid (hyperuricemia) causes uric acid crystals to accumulate in the joint, the acute gout stage is entered. Very severe pain, edema, and sometimes redness are observed in the joint. Symptoms begin abruptly and continue for 3-10 days. In the first days, the joint sensitivity is so high that even touching the sheets or clothes can cause severe pain.
The period between attacks: It is also called the intercritical or interval period. No symptoms are seen.
Chronic gout with tophi: If the disease is not treated, it turns into chronic gout with tophi. The transition to this stage can take 10 years or longer. Hard swellings (tophus) occur in and around the joint. Tophus can also occur under the skin, in different places such as the ear.
Why Does It Happen?
Conditions that increase the body’s production of uric acid increase the risk of gout. Uric acid is formed by the breakdown of molecules called purines. Two-thirds of the purines that are broken down come from the body, while one-third comes from food and drink. Eating purine-rich foods such as red meat, offal, shellfish, fruit juices high in fructose, and drinking alcohol (especially beer) increase uric acid. Its incidence increases in those with obesity, diabetes, high blood pressure, thyroid disease, heart and kidney diseases. Especially diuretic drugs from the thiazide group can increase the level of uric acid. Medicines used to suppress the immune system in various diseases or medical conditions can have a similar effect.
A high level of uric acid in the blood does not necessarily mean that you will develop gout. Over the years, these crystals can accumulate in the cartilage tissue in the joints and spill into the joint, causing sudden complaints (gout attack).
Gout is more common in men than women. While it is more likely to occur in men between the ages of 30-50, it also increases in women after menopause. Its incidence increases with age in both sexes. Having a family history of gout is another factor that increases the risk.
Trauma and surgery can trigger a gout attack. Being dehydrated (dehydration) poses a risk by reducing the excretion of uric acid from the kidneys.
The diagnosis is made based on the medical history and physical examination. The location of joint pain, its onset, and examination provide important information. If a sample of the joint fluid is taken with a needle and examined under a microscope, uric acid crystals can be seen. Complaints can also be caused by a microbial infection. Therefore, the two need to be distinguished. Antibiotic treatment is given in microbial inflammation. The presence of bacteria and many immune system cells in the joint fluid indicates infection (septic arthritis). Gout and septic arthritis can coexist. X-rays are useful for examining bone structures. Early disease X-ray may be normal, but in the chronic stage, abrasions such as mouse bites, cysts, hardening of the bone and needle-like extensions can be seen in the bone adjacent to the joint. Gout crystals can be visualized by ultrasonography. In blood tests, the uric acid level may be high or normal. What makes the diagnosis of gout clearly is not the high level of uric acid in the blood, but the presence of crystals in the joint fluid.
Regulation of nutrition, limiting alcohol intake, losing excess weight, drinking plenty of water, quitting smoking are the first things to be done. There are two types of drug therapy as treatments given during an attack and preventive treatments. Non-steroidal anti-inflammatory group pain relievers, colchicine, steroid drugs can be preferred during an attack. Preventive treatment can be started in people who have attacks several times a year. Preventive treatments act by reducing uric acid production or increasing its excretion.