Gout is a disease caused by the accumulation of microscopic crystals of uric acid in the joints that cause arthritis.
Occasionally, these crystals form bulging accumulations (tophi) under the skin that can be palpated or deposited in the urinary tract, causing nephritic colic or other alterations in the functioning of these organs. In fact, almost 20 percent of patients affected by gout develop kidney stones.
By sex, gout is 4 times more common in men, especially among middle-aged men, although it also manifests itself in women after menopause.
The reasons why this disease develops can be:
- Increases in uric acid in the blood.
- Inordinate intake of uric acid precursor foods: seafood, for example.
- Alcohol abuse.
- To a lesser extent, fatigue and emotional stress.
The constant destruction and formation of cells, as well as the intake of certain foods produce a certain amount of uric acid in blood that the organism eliminates thanks to the excretory function of the kidneys. When this does not happen, the level of uric acid increases abnormally, which translates into crystals that are deposited in the joints, leading to episodes of acute pain.
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Among the signs of acute gout are:
- Initially, only one or several joints are affected. These are usually, most often, the big toe, knee or ankle.
- This gout attack may disappear within a few days but may return from time to time.
- In general terms, pain usually occurs at night and is characterized by being oppressive and even unbearable.
- The affected joint is hot and flushed (inflamed) and is usually tender and swollen.
- Fever may occur.
After the first attack of gout, the symptoms usually disappear, but many people who suffer from this disease may have another attack in the next 6 or 12 months .
On the other hand, some people may develop chronic gout, which is called gouty arthritis. As for its symptoms, there is joint damage and loss of mobility in these joints and they will be longer in time than the symptoms of acute gout.
Finally, tophi can develop (lumps under the skin around the joints or in places such as the elbows, fingertips, or ears) that sometimes ooze whitish substances, but only in those patients who have had the disease for many years.
It is possible that the disease can not be prevented, although the factors that trigger the symptoms can be avoided.
Taking medicines to reduce uric acid can prevent the progression of this disease. It is advisable to drink plenty of fluids (avoiding alcoholic beverages) and eat a diet rich in cereals, starches and vegetables in front of the purines that can be found in seafood, red meat and blue fish. A low daily dose of colchicine can prevent attacks or, at least, reduce their frequency.
In the case of people with very high levels of uric acid in the blood, allopurinol (an inhibitor of uric acid production) may be the solution, although it can also cause stomach discomfort and liver damage.
Tophi, if any, are usually reduced as the value of uric acid in the blood decreases but it may be necessary to remove them surgically if they are excessively large.
The classification of this disease is summarized in three types:
- Acute: Painful condition that normally affects a single joint.
- Chronic: When episodes of pain are repetitive and cause inflammation. In this case, more than one joint is usually affected.
- Pseudogout: Disease due to calcium pyrophosphate crystals deposition dihydrate. It is a disorder characterized by intermittent attacks of pain and arthritis, caused by the accumulation of these crystals.
To diagnose the disease, the specialist will ask about the symptoms and if the patient has a family history of gout.
In addition, tests to determine blood uric acid concentrations should be performed if the fluid in the joints contains crystals of that acid (the specialist will take a sample of fluid from an inflamed joint) and a thorough monitoring of the patients will be carried out. who present episodes of arthritis in a discontinuous manner.
The most urgent is pain relief, for which Medicine has NSAIDs (Nonsteroidal Anti-Inflammatory), such as ibuprofen, indomethacin or, more frequently, colchicine. It may also be convenient to immobilize the joint.
Corticosteroids may also be effective in relieving pain, and pain usually resolves after 12 hours of starting treatment. In most cases the pain disappears after 48 hours.
It is important not to confuse the drop with the pseudogout. In this case, the disorder is caused by the accumulation of calcium pyrophosphate crystals in the joints (usually the knees or wrists), instead of urates.
It usually occurs in people of advanced age and, unlike gout, affects men and women equally. The episodes of pain are less severe than those of gout.