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Gout

 

What is Gout?

Gout is a type of inflammatory arthritis that develops in those with elevated levels of uric acid in their blood. It’s common for Gout to begin in the big toe or in a lower extremity/limb. 

There are several stages of Gout starting with Hyperuricemia, which is when there are elevated levels of urate in the blood or crystals in the joint, but no symptoms of Gout. Gout flares are the next stage where a patient may experience periodic attacks of intense pain and swelling in the joints. Interval or intercritical gout is the time between attacks when no symptoms of gout are present. Tophi is a late stage of gout when crystals are built up on the skin and other areas of the body. This can lead to permanent damage in the joints and organs, such as the kidneys. 

Proper treatment can prevent Gout from progressing.

Causes and Symptoms of Gout:

The added levels of uric acid found in a patient with Gout can form crystals in the joints, which can lead to an onset of sudden and severe pain, along with redness and swelling. Most commonly, Gout affects the big toe, but can also happen in other joints throughout the body. It’s important to know that Gout is often the result of a prolonged build up of urate in the body over time, rather than an sudden occurrence/influx. Other areas that can be affected by Gout include:

  • Joints
  • Bursae, which are fluid-filled sacs between bones and soft tissues
  • Tendon sheaths
  • Kidneys (hence: kidney stones)

Diagnosing Gout:

To best diagnose Gout, your doctoral will explore the following options:

  • Joint fluid test – In this test, your doctor may use a needle to draw fluid from the affected joint. Urate crystal may be visible when examined under a microscope, which would confirm a diagnosis of Gout.
  • Blood test – To better measure the levels of uric acid in the blood, your doctor may order a blood draw. However, it’s important to note that blood tests can be deceiving, as some people have naturally occurring high levels of uric acid in their blood and never experience symptoms of Gout. In contrast, some people have gout and low or normal levels of uric acid in their blood.
  • X-rays – Scans of the affected joints can be helpful in ruling out other causes of gout symptoms, like inflammation.
  • Ultrasound – Using sound waves to detect urate crystals in affected joints can also be a way to confirm or rule out Gout.
  • Dual-energy computerized tomography (DECT) – This test brings together images taken from x-ray from various angles to visualize the joints and spot urate crystals.

Treatment for Gout:

Treatment for Gout will commonly include medication that aims to reduce inflammation and bring uric acid levels down to a normal range. In addition to NSAIDs, your doctor may also recommend colchicine, which reduces pain and inflammation, but causes some undesirable side effects like nausea, vomiting and diarrhea. Corticosteroids, like prednisone, can also control inflammation and pain that result from gout. These can be administered orally or by injection in the affected joint. Lifestyle changes, like maintaining a healthy diet and healthy weight, can help prevent Gout from occurring, as well. Upon receiving a diagnosis, your healthcare team will be able to provide their recommendation on a plan of action to manage your Gout.