Gouts are a kind of inflammatory arthritis; recurrent swelling, tenderness, redness and hot attacks in joints characterize gouts. Gout pain comes quickly in duration of less than 12 hours. In almost half of the gout cases, the most affected part is the joint present at the base of the first (big) toe. Sometimes gouts also end up in kidney stones or urate nephropathy, or sometimes tophus due to the deposit of uric acid crystals. An attack of gout is always due to the high crystallization of uric acid deposited in joints and the surrounding tendons and tissues in crystallized form.
Causes of Gouts
Excess of uric acid in the blood (hyperuricemia) is the initial cause of gouts. Production of uric acid in the body is due to the breakdown of purines- in foods such as seafood, poultry, and meat, purine a specific chemical compound is very high. Kidneys filter the uric acid dissolved in the blood to excrete it from the body through urine, the excess of uric acid builds up needle-like crystals which cause inflammation in nearby tissues.
Factors that increase hyperuricemia and therefore gout
Sweetened drinks (fructose), alcohol consumption in a large amount, seafood, meat, poultry etc are rich in purine, this purine-rich diet cannot be broken down by the body and therefore the removal of uric acid is difficult. This lifestyle of purine-rich diet is a major cause of gouts.
Some genes like- SLC2A9, ABCG2, SLC22A12 are linked with gouts, variations caused in these genes double the risk of gouts. If during mutation SLC2A9 and SLC22A12 genes don’t mutate, hereditary hyperuricemia is caused which reduce urate reabsorption and secretion.
- Age and Gender
Production of uric acid is more in men as compared to women. But, during menopause, the production of uric acid in women reaches the level of men.
- Exposure to lead
Some rare cases of gouts are a result of prolonged exposure to lead. Chronic lead increases the level of uric acid and crystallizes, causing gouts.
- Medical conditions
The occurrence of gouts is sometimes come along with other medical issues. Metabolic syndrome is a major cause found in approx. 75% cases, this is a combination of abnormal lipid levels, hypertension, abdominal obesity, and insulin resistance. Kidney failure, psoriasis, hemolytic anemia, myeloproliferative disorders, and solid organ transplant are some other conditions. Gouty arthritis is often related to Lesch-Nyhan Syndrome.
Overweight or obesity cause the extra turnover of the tissues, which is more production of uric acid. Production of proinflammatory cytokines by fat cells increase systemic inflammation, this is due to high level of fat cells caused by body fat.
Symptoms and signs
The main symptom is the recurrent attack of severe inflammatory arthritis. Gouts mainly affect the joint of the big toes, Fingers, ankles, elbows, knees and wrists. There are four stages:
- Asymptomatic hyperuricemia
At this stage, uric acid forms crystals and cause slight damages due to its deposit in the tissues and cells.
- Acute Gouts
At this stage, the deposited urate crystals cause sudden severe inflammation and stinking pain. This attack is also known as ‘flare’ which subsides, usually within 3-10 days.
- Interval or inter-critical Gouts
At this stage, more urate crystals get deposited. Flares may or may not occur for months altogether, but if not treated immediately they may occur more frequently and last longer.
- Chronic tophaceous gouts
This is the final stage, at this time joints and kidneys may have been permanently damaged. The patient may suffer from tophus and chronic arthritis.
Severe attacks can be avoided by medications that decrease the levels of uric acid. Settling the symptoms of a severe attack is the first aim of the treatment. A decrease in pain can be observed by the application of ice for 20-30 minutes according to tentative evidence. Avoiding purine-rich diet or reducing the levels of uric acid intake can also be of great help.
Non-steroidal anti-inflammatory drugs are the initial treatment for gouts. These are taken orally and reduce pain and inflammation in the places affected by gouts.
If NSAIDS are intolerable due to side effects, Colchicine is a good alternative. It may intermingle with other supplementary prescribed drugs like atorvastatin and erythromycin.
Improvements can be seen if steroids are injected. In the case of joint infection, steroids must be excluded as they worsen the condition.
It reduces the levels of uric acid; it’s given out through intravenous infusion every two weeks. It can be used to treat tophi, but has a lot of side effects.