Gout
Gout is a common and complex form of arthritis that can affect anyone. It's characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the bedsheet on it may seem intolerable.
Gout symptoms may come and go, but there are ways to manage symptoms and prevent flares
Types
There are various stages through which gout progresses.
Asymptomatic hyperuricemia
A person can have elevated uric acid levels without any outward symptoms. While individuals do not need treatment at this stage, high uric acid levels in the blood can causeTrusted Source silent tissue damage.
As a result, a doctor may advise a person with high uric acid levels to address factors possibly contributing to its buildup.
Acute gout
This stage occurs when urate crystals in a joint suddenly cause acute inflammation and intense pain. This sudden attack is a “flare” and may last between 3 days and 2 weeksTrusted Source. Stressful live events and excessive alcohol consumption could be contributors to flare-ups.
Interval or intercritical gout
This stage is the period in between attacks of acute gout. As a person’s gout progresses, these intervals become shorter. Between these periods, urate crystals may continue to build up in tissue.
Chronic tophaceous gout
Chronic tophaceous gout is the most debilitating type of gout and may result in permanent damage to the joints and the kidneys. At this stage, people can have chronic arthritis and develop tophi in cooler areas of the body, such as the joints of the fingers.
Chronic tophaceous gout typically occurs after many yearsTrusted Source of acute gout attacks. However, it is unlikely that individuals who receive proper treatment progress to this stage.
Pseudogout
One condition that experts easily confuse with gout is calcium pyrophosphate deposition, known as pseudogout. The symptoms of pseudogout are very similar to those of gout, although the flare-ups are usually less severe.
Symptoms
The signs and symptoms of gout almost always occur suddenly, and often at night. They include:
- Intense joint pain. Gout usually affects the big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
- Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
- Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
- Limited range of motion. As gout progresses, you may not be able to move your joints normally.
Foods to Avoid if You Have Gout
Skip foods and drinks that are high in purines to help lower your chances of an attack.
You should stay away from these types of food:
- Beer and grain liquors (like vodka and whiskey)
- Red meat, lamb, and pork
- Organ meats, such as liver, kidneys, and glandular meats like the thymus or pancreas (you may hear them called sweetbreads)
- Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines
- High-fructose products like soda and some juices, cereal, ice cream, candy, and fast food
You’ll want to go for low-purine options like:
- Low-fat and nondairy fat products, such as yogurt and skim milk
- Fresh fruits and vegetables
- Nuts, peanut butter, and grains
- Fat and oil
- Potatoes, rice, bread, and pasta
- Eggs (in moderation)
- Meats like fish, chicken, and red meat are fine in moderation (around 4 to 6 ounces per day).
- Vegetables: You may see veggies like spinach and asparagus on the high-purine list, but studies show they don’t raise your risk of gout or gout attacks.
Causes
Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.
Purines are also found in certain foods, including red meat and organ meats, such as liver. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna. Alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose) promote higher levels of uric acid.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
Risk factors
You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:
- Diet. Eating a diet rich in red meat and shellfish and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
- Weight. If you're overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.
- Medical conditions. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases.
- Certain medications. Low-dose aspirin and some medications used to control hypertension — including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers — also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
- Family history of gout. If other members of your family have had gout, you're more likely to develop the disease.
- Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women's uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
Treatment for Gout
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