The Ultimate Guide to Gout

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What is gout?

Gout is an inflammatory type of arthritis most commonly affecting the big toe. It is most common in middle aged men. Gout is a crystal induced arthritis caused by excess buildup of uric acid in the blood. Recent epidemiological studies in many different countries have shown that the prevalence and incidence have risen over the last years and a possible explanation is the overconsumption of meat, fatty foods, processed food containing fructose and alcohol along with other factors. Gout is mostly seen in the big toe and presents itself with sudden severe pain, redness, tenderness and swelling. Gout attacks can happen overnight and usually last anywhere between 3 days to 2 weeks. Individuals may experience one to two attacks over a period and then no other attacks. However, if gout is left untreated or the individual does not change their diet, recurrent attacks may occur, which can be damaging for the joints. If left untreated, in the long term gout can also affect the soft tissue surrounding the joint such as ligaments, tendons and muscles and sometimes the joint itself.

What are the symptoms of gout?

Signs and symptoms are very similar between individuals, as the presentation of gout has some very specific symptoms. Usually, attacks happen overnight and the individual may wake up with excruciating pain. Attacks can last between a few days up to two weeks symptoms can include:

  • Intense & excruciating pain on the affected joint.
  • Swelling, redness and heat of the affected area.
  • Limited range of motion of the affected joint.

What are the common causes of gout?

The most common cause for the development of gout is high levels of uric acid in the blood. Uric acid is produced when purines are broken down and then flushed out by the kidneys. Purines are naturally found in the body however certain foods can increase the quantity found in the body.

  • Risk factors for developing gout may include the following:
  • Diet: high consumption of red meat, seafood, processed food and drinks containing fructose and alcoholic beverages including cider and beer.
  • Medical Conditions: kidney infections or kidney complications, diabetes, high blood pressure and metabolic syndromes and diseases including hypo or hyperthyroidism.
  • Medication: certain diuretics and beta blockers used to treat high blood pressure and aspirin.
  • Obesity: being overweight, poor diet and lack of exercise can be contributing factors in the development of gout.
  • Genes: studies have shown a positive correlation of gout in family history.
  • Sex: males are affected more than females, especially over the age of 30.
    History of osteoarthritis: joints already affected by osteoarthritis are more likely to experience a gout attack.

How is gout diagnosed?

If a gout diagnosis is suspected then your GP will refer you for further imaging and laboratory tests. According to recent studies the gold standard procedure for the diagnosis of gout is the identification of monosodium urate crystals in the synovial fluid of the affected joint. The important thing when screening for gout is to rule out any other systemic diseases.

  • Serum urate levels: A sample is taken from the affected joint to test the concentration and presence of urate crystals.
  • Blood test: This test is used to measure the levels of uric acid in the blood. High levels of uric acid may lead to development of gout however there is not enough evidence to suggest that anyone with high levels of uric acid will develop gout.
  • Ultrasound: Commonly used to detect urate crystals and tophus in the joints.
  • Polarized light microscopy: this is the gold standard procedure used to identify monosodium urate crystals in the synovial fluid of a joint.
  • Computerized tomography (CT) scan: This is widely used for most crystal arthropathies, including gout.
  • Dual-Energy CT (DECT): This is a highly precise equipment used to locate any urate crystal deposition.

What are the treatment options for gout?

An acute gout presentation may appear once in a lifetime however, there are numerous cases of people suffering from chronic gout, often in close relation with other systemic diseases such as diabetes mellitus, hypertension, high cholesterol and hyperuricemia. Since the causes of gout are known, different treatment options target the causes of gout and not its signs and symptoms. Some of the treatment options are listed below:

Lifestyle management: Obesity, hypertension, high cholesterol and other similar problems must be targeted through changes in diet and levels of exercise. A diet low in red meat, seafood, high fat dairy and processed foods, along with a reduction of alcohol is the first step. Increasing consumption of low-fat dairy products, plant oils, fruits and vegetables along with a higher vitamin C consumption have been shown to help reduce the levels of uric acid in the body. Good hydration and limited consumption of sweetened beverages may also help reduce gout episodes.

Management of acute episodes: Non-steroidal anti-inflammatory drugs (NSAIDs) and oral steroids may be given in an acute episode to help reduce inflammation and help with the management of pain. In certain occasions involving monoarthritis, steroid injections may be used.
Another drug commonly used in the treatment of gout is known as colchicine. The drug has shown very promising results in acute episodes of gout however, colchicine has numerous side effects including nausea, vomiting and diarrhea and is highly toxic. Therefore the dosage and length of time used is closely monitored by an expert.

Management of chronic episodes: These are usually managed by low doses of NSAIDs and prevention or improvement of hyperuricemia. Allopurinol is the most common drug used to treat gout by lowering the levels of uric acid found in the body.

How long does gout last?

Gout can present as acute or chronic with very similar presentations on both occasions.

Acute gout: An acute episode of gout can occur overnight and last for a few hours or up to two weeks if not managed properly.

Chronic gout: Cases of recurrent episodes of gout have been recorded but there is still not a standard and fully effective long-term treatment approach. Each episode will begin suddenly and last again between a few hours to two weeks.

Can gout be prevented?

Unfortunately not all causes of gout can be prevented, such as if there is a familial history of gout. However there are many lifestyle changes that can be made in order to reduce the frequency of gout episodes. This can include but not limited to: lifestyle changes such as diet, exercise, weight loss and medication.

  • Diet & Weight Loss: Targeting the management of obesity through a balanced diet by avoiding foods that raise the level of uric acid in the human body system. This means that meat, seafood, dairy, foods high in fructose, alcohol such as beer and cider and sugary drinks should be avoided.
  • Exercise: A minimum of 150 minutes of aerobic exercise during the week is advised to help weight loss.
  • Medication: Antihypertensive medication such as diuretics should be kept to a minimal use as they can promote the accumulation of uric acid in the body by causing dehydration. Any changes to your medication should be discussed with your GP or specialist consultant.

What are the best exercises for gout?

Gout is a metabolic disorder that cannot be altered by any type of exercise; however, exercise can help with the general health and indirectly reduce the chances of health complications that could lead to gout. The NHS website recommends a minimum of 150 minutes of aerobic exercise (running, jogging, cycling, or rowing) per week. Research has shown that 30 minutes of aerobic exercise 5 times a week can help reduce the systolic and diastolic blood pressure, whilst reducing the levels of cholesterol in the blood. Resistance training (using external resistance or one’s own body weight) can also be used to reduce the levels of cholesterol in the blood leading to a blood pressure reduction and an improved cardiovascular condition.

Regular stretching, yoga, Pilates and tai chi can be used as they provide the body with good muscle flexibility, allowing for an adequate blood and nutrient flow whilst aiding in the removal of toxins through the lymphatic system. This will decrease the chances of uric acid accumulation and indirectly reduce the chances of developing gout.

It is recommended to get the OK from your osteopath, physical therapist or GP before trying out any of these exercises.

Do I need to go to the GP or visit my local hospital?

Gout is a mono arthritic condition that presents with a sudden onset, usually overnight. The pain can be excruciating which can make the individual very anxious. If there has been an incidence of traumatic injury, open wound, or an insect bite around the area it is important to go to A&E to rule out bone fracture or septic arthritis (joint infection). The local hospital or GP can then accurately diagnose gout and start a management plan as soon as possible to decrease pain and inflammation levels.

References

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Reece CL, Susmarski A. Medial Epicondylitis. [Updated 2020 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557869/

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Vaquero-Picado, A., Barco, R., & Antuña, S. A. (2016). Lateral epicondylitis of the elbow. EFORT Open Reviews, 1(11), 391–397. https://doi.org/10.1302/2058-5241.1.000049

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