Overview

Gout is a chronic inflammatory arthritis that results in acute pain, soreness and inflammation in joints. Gout arises after many years of creation of uric acid crystals in the joints and adjoining tissues. A gout attack begins at the night with temperate pain that becomes worse. A gout attack produces pain, inflammation and redness in a single joint especially big toe. Gout can also affect the knees, ankles, heels, wrists, elbows and fingers. Minor attacks end after few hours or maximum of 2 days. Acute attacks can last for weeks with tenderness remaining for about a month. The second attack of gout can occur in 6 months to 24 months after first attack. If proper treatment is not given, the frequency of attacks increases. There are no symptoms for the period between acute attacks. Mostly, this period becomes shorter as the attacks increase the attacks become more severe and may involve more than one joint.

If gout symptoms come and go for many years without treatment, they might become chronic and have an impact on more than one joint. This stage of gout is called chronic tophaceous gout and is often confused with other types of arthritis. By this stage, uric acid crystals have build up in the body to form coarse nodules called tophi. These deposits are hard and movable. Initially, tophi are found on the elbow, on the fingers and toes or outer edge of the ear.

Symptoms of Gout

The symptoms of gout are:

• Pain, inflammation and soreness in a joint generally in big toe joint. This symptom is known as podagra.
• Pain begins at night and is very acute.
• The patient feels uncomfortable for some hours and might relax throughout the next some days.
• After the attack, the skin surrounding the joint may strip and get scratchy.
• Fever
• Restricted range of motion of affected joint.

The symptoms might crop up after an ailment or surgery. At times, people might not go through gout as a series of painful attacks but get chronic gout. Gout initially looks like nodules on the hands, elbows, or ears. When you get the symptoms of gout, uric acid deposits might have been there on one or more of the joints. The gout can also cause swelling of the fluid sacs or bursae that pad tissues

Causes of Gout

Gout is caused by excessive presence of uric acid in the blood or hyperuricemia. Hyperuricemia does not necessarily develop gout. When uric acid levels are very high, uric acid can form crystals that develop in the joints. Gout can flame up without any particular factors like:

• Excessive weight
• Alcohol intake specially beer
• Diet mainly containing meat and seafood
• Taking extremely low-calorie diets.
• Regular intake of aspirin or niacin.
• Diuretics
• Chemotherapy
• Medicines which are used to restrain the immune system like cyclosporine
• High blood pressure
• Kidney disease
• Lead poisoning
• Conditions like psoriasis, hemolytic anemia etc.
• Any major surgery.
• Genetic makeup causing high blood uric acid levels.

Examination and Tests

The only definite method to diagnose gout is to get a joint fluid aspiration (arthrocentesis) test to check for the presence of uric acid crystals. In case of people with severely inflamed big toe, it is problematic to acquire joint fluid so the diagnosis is based on high uric acid levels. For diagnosis of gout, a physician performs:

• Physical examination and takes medical history
• Tests to measure uric acid in blood and urine.

The X-rays of hands and feet are helpful in the late stages of the disease but not in its early stages. In late stages, nodules (tophi) or worn parts of bone can be seen near joints.

Treatment of Gout

The main aim of the treatment is quick pain relief and stopping any future gout attacks. The treatment also aims at prevention of complications of disease like joint damage or kidney problems.
Initial treatment

Initially medicines are given to ease symptoms and the particular treatment depends on the severity of attack. In order to decrease the pain, inflammation and soreness of the involved joint in a gout attack, you should:

• Give adequate rest to the affected joint(s).
• Use nonsteroidal anti-inflammatory drugs like ibuprofen, naproxen or indomethacin.
• Avoid aspirin
• Take corticosteroids as per the prescription.

To avoid any repeated attacks:

• Use a medicine which decreases uric acid levels in the blood. Uricosuric agents eliminate uric acid via kidneys. Allopurinol decreases uric acid production in the body.
• Keep a proper weight. Excessive weight is a major risk factor for gout.
• Restrict the usage of alcohol particularly beer. Alcohol decreases the release of uric acid into your urine which leads to increase of uric acid in your body. Beer contains purines and increases uric acid in blood.
• Restrict meat as well as seafood.
• You need to take medications under proper supervision as certain medicines decrease the amount of uric acid eliminated by the kidneys.
• Be active and have a moderate exercise program.

Prevention

Gout is a condition that occurs after many years of build up of high uric acid crystals in the joints as well as adjoining tissue. You may not know about high uric acid levels till you had the first gout attack. But you can help prevent or reduce the severity of future gout attacks.
If the doctor has given medicines for gout, you should take those medicines to avoid future attacks. Many people take the medicine for a long time

• Maintain a healthy weight
• Reduce alcohol usage 
• Changing your diet can help to prevent any further attacks