What is Gout? Causes, Symptoms, and Diagnosis

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Gout is a type of chronic inflammatory arthritis that causes sudden, painful joint swelling and tenderness. According to the World Health Organization, gout is one of the most common forms of arthritis worldwide and is associated with significant disability, especially in older adults. The disease is caused by the buildup of uric acid crystals in the joints and soft tissues, which leads to recurrent attacks of acute inflammation and long-term joint damage if not adequately managed (WHO, 2023).

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Understanding Gout

Gout arises when uric acid, a byproduct of purine metabolism, accumulates in the bloodstream and forms needle-like crystals in joints. These crystals initiate an immune response, causing episodes of intense pain, swelling, and redness, often in the big toe (Dalbeth, Merriman & Stamp, 2016).

Common Symptoms of Gout

  • Sudden onset of severe joint pain, often at night
  • Swelling, redness, and warmth around the affected joint
  • Commonly affects the big toe, but may also involve knees, ankles, wrists, and elbows
  • Limited movement during and after attacks

Gout attacks typically peak within 24 hours and can resolve in a few days, but they often recur if uric acid levels remain uncontrolled.

Causes and Risk Factors

Several factors influence the development of gout:

  • Diet: Foods rich in purines, such as red meats, seafood, and alcohol, can elevate uric acid levels (Choi et al., 2004).
  • Obesity: Increases uric acid production and reduces renal excretion (Choi & Curhan, 2005).
  • Kidney dysfunction: Reduces uric acid elimination (Feig, Kang & Johnson, 2008).
  • Medications: Diuretics, aspirin, and cyclosporine are associated with elevated uric acid (Richette & Bardin, 2010).
  • Genetics: Variants in genes like SLC2A9 and ABCG2 affect urate transport and predispose individuals to gout (Merriman, 2015).

Diagnosis

  • Joint fluid analysis is the gold standard: urate crystals are visible under polarized light.
  • Serum uric acid tests may support the diagnosis, though values can be normal during attacks.
  • Imaging techniques like ultrasound and dual-energy CT detect crystal deposits and chronic joint changes (Ottaviani, Bardin & Richette, 2015).

Treatment and Management

Managing Acute Flares

  • NSAIDs such as naproxen or indomethacin reduce inflammation (Khanna et al., 2012).
  • Colchicine is most effective when taken within 24 hours of symptom onset (Terkeltaub et al., 2013).
  • Corticosteroids may be prescribed if NSAIDs or colchicine are contraindicated.

Long-Term Management

  • Xanthine oxidase inhibitors like allopurinol and febuxostat lower uric acid synthesis (Khanna et al., 2012).
  • Uricosurics like probenecid enhance uric acid excretion.
  • Lifestyle interventions include dietary changes, weight reduction, and limiting alcohol intake (Choi et al., 2004).

Prevention Strategies

  • Drink plenty of water to aid urate excretion.
  • Avoid or limit high-purine foods, sugar-sweetened beverages, and alcohol.
  • Maintain a healthy body weight and stay physically active.
  • Treat underlying conditions such as hypertension or kidney disease.
  • For individuals with recurrent attacks, continuous urate-lowering therapy is essential.

Frequently Asked Questions (FAQ)

Can gout be cured?
Gout is a lifelong condition, but it can be well-controlled with proper treatment and prevention.

Is gout only a disease of the big toe?
No. While the big toe is often first affected, gout can involve many other joints.

Can women develop gout?
Yes, especially after menopause when protective estrogen levels decline (Choi et al., 2010).

Does high uric acid always mean gout?
Not always. Many people with hyperuricemia never develop gout, and some gout patients have normal uric acid levels during flares.

Is diet alone enough to manage gout?
In most cases, dietary changes help, but many patients require medication to prevent attacks and joint damage.

References

Choi, H. K., Atkinson, K., Karlson, E. W., Willett, W., & Curhan, G. (2004). Purine-rich foods, dairy and protein intake, and the risk of gout in men. The New England Journal of Medicine, 350(11), 1093–1103. https://doi.org/10.1056/NEJMoa035700

Choi, H. K., & Curhan, G. (2005). Soft drinks, fructose consumption, and the risk of gout in men: Prospective cohort study. BMJ, 336(7639), 309–312. https://doi.org/10.1136/bmj.39449.819271.BE

Choi, H. K., Ford, E. S., Li, C., & Curhan, G. (2010). Prevalence of the metabolic syndrome in patients with gout: The Third National Health and Nutrition Examination Survey. Arthritis & Rheumatism, 59(1), 109–115. https://doi.org/10.1002/art.23266

Dalbeth, N., Merriman, T. R., & Stamp, L. K. (2016). Gout. The Lancet, 388(10055), 2039–2052. https://doi.org/10.1016/S0140-6736(16)00346-9

Feig, D. I., Kang, D. H., & Johnson, R. J. (2008). Uric acid and cardiovascular risk. The New England Journal of Medicine, 359(17), 1811–1821. https://doi.org/10.1056/NEJMra0800885

Khanna, D., Fitzgerald, J. D., Khanna, P. P., Bae, S., Singh, M. K., Neogi, T., … & Terkeltaub, R. (2012). 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care & Research, 64(10), 1431–1446. https://doi.org/10.1002/acr.21772

Merriman, T. R. (2015). An update on the genetic architecture of hyperuricemia and gout. Arthritis Research & Therapy, 17, Article 98. https://doi.org/10.1186/s13075-015-0601-9

Ottaviani, S., Bardin, T., & Richette, P. (2015). Usefulness of ultrasound for the diagnosis of gout: A review. Joint Bone Spine, 82(3), 141–145. https://doi.org/10.1016/j.jbspin.2014.10.002

Richette, P., & Bardin, T. (2010). Gout. The Lancet, 375(9711), 318–328. https://doi.org/10.1016/S0140-6736(09)60883-7

Terkeltaub, R., Furst, D. E., Bennett, K., Kook, K. A., Crockett, R. S., & Davis, M. W. (2013). High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis & Rheumatism, 62(4), 1060–1068. https://doi.org/10.1002/art.27327

World Health Organization. (2023). Musculoskeletal conditions. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions