What is Gout – Symptoms, Causes and Diagnosis
Gout is a type of arthritis which was prevalent among the rich rulers of the old age who led a luxurious lifestyle indulging themselves in alcohol and meat. Due to this, gout earned the nickname – “disease of the kings” or “rich man’s disease”. However, gout is a fairly common and painful form of arthritis that has been on the rise due to changes in lifestyle and several other factors. Here we talk about what is gout, gout causes and much more. Read on!
What is Gout?
Gout is a common type of arthritis that causes intense pain and swelling in the joint. It generally affects the joint in the big toe but is not restricted to it. It can also occur in the feet, ankles, knees, wrist and fingers.
“Gout attacks” usually occurs in the middle of the night without warning. If such attacks occur again and again in the same region of the body, it can lead to degradation of tissues of the surrounding area.
Some common gout symptoms are –
- Inflammation and pain in joint around the big toe. Other areas include the joints around the ankles, elbows, knees and wrist.
- Joint swelling
- The skin may appear red and maybe hot
Different stages of Gout
Gout progresses through 4 stages. They are –
- Asymptomatic hyperuricemia
- Acute gout
- Interval gout
- Chronic tophaceous gout
It is the period prior to the first gout attack. At this stage, there are usually no symptoms but the level of uric acid is high in the blood which causes hyperuricemia.
Due to excess uric acid in the body, crystals form and collect in the spaces between the joints. This results in acute inflammation and intense pain. This sudden attack is known as flare and usually happens at night time. It may intensify over the next 8 to 12 hours but it usually subsides within 3 to 10 days.
This refers to the pain-free intervals between attacks and joint functions appear to be normal. During this period, uric acid continues to build up in the bloodstream and more urate crystals deposit in the tissues and joints. It is likely that the person will have another attack unless the level of uric acid is reduced.
Chronic tophaceous gout
It takes a long period of time around 10 years or so without treatment to reach this stage of gout. The patient can suffer from chronic arthritis and develop a big lump of urate crystals in the tissues and surrounding joints called tophi. It can result in permanent damage to the kidney, destruction of bones and joint deformity. With initial proper treatment, this stage is very much preventable.
Gout occurs due to the deposition of monosodium urate crystals in the body compartments such as the joints. It results in a high concentration of uric acid in the blood (hyperuricemia) where the level of uric acid in the blood exceeds 6.8 mg / dL.
Uric acid is a waste product which is produced in the liver by breaking down chemical compounds called purines. Purines are present in foods such as meat, poultry, seafood and alcohol. These are abundant in nature and are present in every living being. Purines are one of the two families of nitrogenous bases which help construct the DNA or deoxyribonucleic acid. Purines metabolize into xanthine in the liver and in the final step, xanthine oxidizes, resulting in the formation of uric acid.
Most mammalian species have an enzyme called urate oxidase to convert uric acid to allantoin, a highly soluble product that is readily excreted in the urine. As a result, they have a low level of uric acid in their blood. But humans, however, do not possess uric oxidase. Thus, uric acid is the end product and cannot be further metabolized by the human body.
In normal condition, the body excretes the uric acid in the blood via the kidney. However, when the uric acid content in the blood is too high or the body is unable to excrete it due to some diseases or disorders like kidney or thyroid problems, tiny needle-like crystals of urate starts depositing in the joints and tendons. These crystals cause intense inflammation leading to pain and swelling in the joints and surrounding tissues.
However, it should be noted that although hyperuricemia is the underlying condition for the development of gout, many people with hyperuricemia do not develop gout. Let’s look at some of the other gout causes.
Other Gout Causes
Several studies have identified many genes responsible for the development of gout. The most influential genes have been identified as SLC2A9 and ABCG2. Both of these genes contribute to the development of gout. Changes in the SLC2A9 gene can result in increased reabsorption of urate into the bloodstream. On the other hand, changes in ABCG2 can result in the protein’s ability to release urate into the gut, both affecting the level of uric acid in the blood.
Diuretic medication and immunosuppressant drugs can raise uric acid levels in the blood. This is due to the increase in urination which reduces the amount of fluid in the body. As a result, fluids concentrate in the body, which increases the risk of urate crystal formation.
Gender and age
Estrogen is a hormone that is naturally present in a woman and it causes uric acid to flush out from the body through urine. After menopause, estrogen production decreases in women, hence increasing the risk of gout. A lower level of estrogen may also be the reason why gout is more common in men than women and usually occurs in men around the age of 30-50 years.
Diet is one the major factor which can trigger the development of gout. Food containing more than 200 mg of purines per 100 gram is high purine food. Purine metabolizes to form uric acid in the body. Excess intake of high purine foods can lead to hyperuricemia.
There are also various scientific researches which confirm the role of purines in causing gout. A 12-year study (2004) published in The New England Journal of Medicine concluded that high consumption of purine-rich foods such as meat and seafood increased the risk of gout which is due to high production of uric acid.
Foods such as red meat and seafood can increase the risk of gout as these foods have a high purine content. A large amount of purine increases the level of uric acid in the body. People who love meat should try to stick to duck or chicken as they are low in purine. Additionally, seafood like anchovies, tuna, sardines, herrings, mussels or codfishes are high in purine in them and hence you eliminate it from the diet.
You should also avoid high fructose foods and sugar-sweetened beverages as they can increase the risk of gout attacks. Even though fructose and sugar-sweetened beverages are not purine-rich, they may raise the uric acid level in the body by accelerating several cellular processes.
A study published in 2016 which included 125,000 participants, found that people who consumed high fructose foods had a 62% higher risk of developing gout. According to studies, a high intake of fructose interferes with a gene’s (called SLC2A9) ability to transport uric acid.
A sedentary lifestyle combined with high purine foods can lead to gout as this can raise your uric acid levels. Research suggests that weight loss can help reduce insulin resistance and thus lower uric acid levels. Reduced uric acid level means a lower risk of gout attacks. However, one should be careful not to lose too much weight as rapid weight loss can raise the uric acid level too.
Staying hydrated also plays an important role as adequate water intake helps remove excess uric acid through urine and prevents the formation of urate crystals.
Alcohol is another important precursor for gout attacks. The body may prioritize removing alcohol from the body over removing uric acid resulting in accumulation of uric acid which may lead to the development of urate crystals – the reason for gout. Some beers contain a high amount of purines that develop during the fermentation process which can also increase the amount of uric acid in the blood and make gouts worse.
Additionally, it increases the level of lactic acid in the body which makes the kidney less efficient in eliminating uric acid. One study including 724 people found that drinking 1-2 beers increase the risk of gout by 36% as it supposedly stimulates the production of uric acid. The reason may be due to the presence of a principal constituent called guanosine, which is a readily absorbed dietary purine which accentuates the hyperuricemia.
The doctor is likely to base your gout diagnosis on the description of your joint pain and how long it has been and how swollen the area is. He/ she may review your medical history and also prescribe a blood test.
Fluid samples collected from the affected area might also be required to determine the level of uric acid in the blood. They may also require you to take an X-ray or ultrasound to examine soft tissues and bones.
Detection of uric acid crystals in the joint fluid is the surest way to make a gout diagnosis.
Awareness about gout causes can help you prevent it altogether. Although gout cannot be completely cured, if you have gout, following a proper diet can help you manage it effectively. You should be mindful and avoid certain foods that may trigger a gout attack. If you or anyone you know seem to be experiencing the symptoms of gout, do visit a doctor for a correct diagnosis and treatment plan. To know about the foods that help manage gout, click here.