What You Don't Know About Gout
Uric acid is the breakdown product of substances called purines. In cases where there is a problem with the excretion of uric acid — the form in which protein-based substances in particular are excreted — or when it is produced excessively, this substance accumulates in the body. The amount present in the blood increases. Inflammation occurs as a result of uric acid accumulating in the joints. This condition is called gout.
Gout is a rheumatic disease. Unlike other rheumatic diseases, it occurs intermittently. It most often manifests itself as inflammation in the big toe. Because gout is a chronic disease, it requires monitoring and treatment.
It is more common in men than in women. Gout occurs between the ages of 40 and 65. In women, it is generally seen after menopause. It is very unlikely to be seen in young people.
CAUSES OF GOUT
The cause of the disease is an increase in the amount of uric acid in the blood and tissues. Certain factors play a role in this increase in uric acid. Either the body's production of uric acid is excessively increased, or there is a disorder in the excretion of uric acid from the kidneys.
The amount of uric acid in the blood increases in those with chronic kidney inflammation and those using diuretic medications. Certain diseases such as diabetes, high blood pressure, and obesity contribute to the emergence of gout.
As with many diseases, hereditary factors (genetic predisposition) are also an important factor in gout. Certain congenital conditions are a risk factor for gout. It is more commonly seen in men. The risk of gout increases with advancing age.
Diet is an important risk factor in the emergence of the disease. There is a direct relationship between the disease's emergence and the amount of excess protein taken in through food and the proportion of purine, its metabolic product. In addition to improper nutrition, alcohol and cigarette use can also cause gout. Obesity increases the risk of gout.
SYMPTOMS OF GOUT
Gout occurs in attacks. The first attack is severe. There is pain and swelling in the joints. It is especially seen in the big toe. The toes become very sensitive, and the person wakes up with swelling, redness, and a feeling of pain. This pain is disturbing enough to wake a person from sleep, at night or toward morning.
After the attack, the disease continues without giving any symptoms. Tests reveal that the amount of uric acid in the blood is high. This period, until another attack occurs, is the interval period between two attacks.
Since salt crystals accumulate in the joints, restricted movement is seen. In addition, conditions such as deformities and the joints' inability to perform their function emerge. These salt crystals also cause swelling under the skin, in the palms, and at the fingertips. Such buildups are not harmful. However, in cases where they become very large, removal may be necessary.
DIAGNOSIS OF GOUT
First, a specialist physician should be consulted. The condition that suggests gout is a high amount of uric acid in the blood. This is detected through tests, but a high amount of uric acid does not necessarily mean the person has gout. Other than this, there is no specific blood test that would establish a diagnosis of gout.
Radiological imaging methods (such as X-ray film) can be guiding in diagnosis. However, for a definitive diagnosis, the presence of uric acid crystals must be detected in fluid taken from the joints. This joint fluid is taken from the swollen and painful joint.
GOUT GENERALLY PROGRESSES IN FOUR STAGES
ASYMPTOMATIC HYPERURICEMIC PERIOD: There are no clinical findings, but the amount of uric acid in the blood is high.
ACUTE GOUTY ARTHRITIS PERIOD: It often affects a single joint (85%) and usually the big toe. Less commonly, it can affect the ankle, knee, elbow, hand, and shoulder. During this period, there is pain, swelling, and redness in the joint. The pain increases greatly with movement but is also present at rest.
INTERCRITICAL PERIOD (INTERVAL PERIOD): There are occasional acute gouty arthritis attacks followed by silent periods. 62% of attacks occur within the first year. In 7% of patients, no further attack occurs. During silent periods, there are no clinical findings, and the patient has no complaints.
CHRONIC TOPHACEOUS GOUT PERIOD: This is the period in which deposits called tophi form, resulting from uric acid crystals gathering together and settling under the skin or in tissues. By the time this period is reached, the severity of joint pain decreases but becomes continuous, because the joint has been damaged.
Gout does not affect all patients in the same way. Some patients experience only a single attack in their lifetime, with no further problems. In others, over time, severe chronic attacks occur that cause damage and pain in the joints.
There is no treatment that provides a definitive cure for gout. However, with good treatment, the disease can be completely prevented. With appropriate treatment, the frequency of flare-ups can be reduced, flare-ups can even be prevented entirely, and the development of joint damage can be prevented.
In my next article, I will address the topic of "The Importance of Diet in Gout."
Prof. Dr. Hüseyin Nazlıkul