After the rain, the sun will reappear. There is life. After the pain, the joy will still be here. – Walt Disney

What is gout?

Gout is a common and complex form of arthritis. People suffering from gout experience sudden and severe attacks of pain, swelling, redness and tenderness in the joints. Gout often afflicts the joint at the base of the big toe. If you feel a sudden and intense pain in a joint, you should consult your doctor, as gout that is not treated leads to more pain and joint damage.

Gout is a chronic, progressive disease that results from deposition of crystals of uric acid in the tissues of the body.  Gout usually begins as sudden severe pain in the foot (big toe more often) that can wake you up in the middle of the night. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable. Fortunately, gout is treatable and there are ways to reduce the risk that gout will recur.

Possible Causes:

The human body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as beef, organ meats, anchovies, herring, asparagus and mushrooms. 

Normally, uric acid dissolves in the blood and passes through the kidneys and get excreted in the urine. But sometimes the body either produces too much uric acid or the kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or in the kidneys. In the joints these crystals can attract white blood cells and cause gouty arthritis.

Risk Factors:

High uric acid in the body (Hyperuricemia) is the most important factor in the development of gout. The normal levels of uric acid in the blood is 2-5 mg/dL Those factors which increase the uric acid level puts one at risk for gout. The more the number of risk factors a patient has for a high uric acid, the greater the risk of developing gout.

Risk factors for high uric acid are:

  • Male sex.
  • Family history of gout. 
  • Obesity (BMI>30).
  • Alcohol.
  • High purine diet.
  • Untreated high blood pressure, diabetes or high cholesterol.
  • Medications-diuretics (commonly used to treat hypertension), low-dose aspirin, anti-tuberculosis drugs, anti-rejection medications. 
  • Kidney disease.

Signs and Symptoms:

Severe pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. The small joint at the base of the big toe is the most common site for a gout attack. 

Other joints that can be affected include the instep, ankle, heel, knee, Achilles tendon, wrist, finger or elbow. These painful attacks usually subside with or without medication, but some discomfort remains. In rare instances, an attack can last for weeks. As gout progresses, you may not be able to move your joints normally.

Diagnosis:

After having observed the inflammation of your joints and understanding your symptoms your doctor may recommend a joint fluid test to check for urate crystals which are visible only under a microscope. He may ask you to do a blood test to determine the level of uric acid. Other tests include joint X-rays, ultrasound or a dual energy CT scan.

Treatment:

Gout medications like nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids can be used to treat acute attacks and prevent future attacks.
If you have tophi, chronic kidney disease or kidney stones or damage to your joints as a result of gout, then medications to lower your body's level of uric acid may be recommended.

FAQs:الأسئلة الشائعة:
  • What can trigger an attack?

    A: Gout attacks can be precipitated by dehydration, injury, fever, heavy eating, heavy alcohol consumption, recent stress (trauma, stroke, heart attack or surgery).

  • How can gout be prevented?

    A: Maintaining a healthy diet, adequate fluid intake, exercising regularly and maintaining healthy body weight are all important to help prevent and minimize gout attacks. The aim is to maintain serum uric acid level to less than 6.0 mg/dL. It is essential to monitor the blood level of uric acid regularly once uric acid-lowering medications are used for optimal maintenance, as the uric acid metabolism can change over time.

  • What diet restrictions need to be followed if I suffer from periodic attacks of gout?

    A: Avoid or limit alcohol consumption, drink 6 - 8 glasses of filtered water daily to help flush uric acid from the body as dehydration often triggers a gout attack. Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers) and follow a low fructose diet. Eat high fiber foods, including oats, root vegetables (such as potatoes and yams), and psyllium seed. Avoid refined foods, such as white breads, pastas, and sugar. 

    Avoid foods with a high purine content like beef, organ meats, sweetbreads, mussels, anchovies, herring, mackerel, and yeast. Foods with a moderate amount of purines include meats, poultry, fish, spinach, asparagus, beans, lentils, mushrooms, and dried peas. Eliminate trans-fatty acids, found in commercially baked goods, such as cookies, cakes, french fries, onion rings, processed foods, and margarine. Avoid sugar-sweetened soft drinks.