What is Gout?

Gout is a disease in which faulty metabolism of uric acid results in arthritis, especially in the smaller joints of the feet and is followed by regular episodes of acute pain and joint inflammation.

Gout is caused due to surplus uric acid in the body. An overload of uric acid in the blood causes a condition known as asymptomatic hyperuricemia. While asymptomatic hyperuricemia can be considered as a precursor to gout, it is only when the excessive amounts of uric acid result in the formation of minute urate crystal deposits in the tissues of the body, especially in the joints, that gout is developed. These crystal formations cause acute joint inflammation - a condition known to us as arthritis, characterized by sudden pain attacks, tenderness and swelling in the joints.

Gout is a chronic and progressive disease and is considered to be the most painful type of inflammatory arthritis, also known as metabolic arthritis. It can result in the deposit of hard lumps of uric acid in the joint tissues and cause joint destruction, decreased kidney function due to the blocking of the kidney-filtering tubules, formation of kidney stones and kidney failure.


Causes of Gout

Symptoms of Gout

Long-Term Effects of Gout


Causes of Gout

Gout arthritis is characterized by a sudden and extremely painful attack followed rapidly by joint inflammation. The urate crystals deposit in the joint fluid (synovial fluid) and joint lining (synovial lining) causing the inflammation. Joint inflammation is intensified when the immune system causes white blood cells to swallow up the urate crystals and releases chemical messengers of inflammation. This leads to pain, heat and redness in the joint tissues. With the progression of gout, the painful arthritis attacks become more frequent and also start affecting the additional surrounding joints.

Gout is one of the most frequently recorded medical illnesses in the world. It is often caused due to an inherited abnormality of our body to process uric acid derived from the food we eat. Such food items may include alcoholic beverages, anchovies, sardines in oil, fish roes, herring, yeast, organ meat (liver, kidneys, sweetbreads), legumes (dried beans, peas), gravies, mushrooms, spinach, asparagus, and cauliflower.

Apart from inherited malfunction of uric acid metabolism, some of the other factors that may cause gout include:

  • Heart attacks, strokes and surgeries
  • Obesity and excessive weight gain
  • High blood pressure
  • Moderate to heavy intake of alcohol
  • Abnormal kidney function
  • Intake of drugs such as thiazide diuretics, low-dose aspirin or cyclosporine and tuberculosis medication such as ethambutol and pyrazinamide
  • Certain diseases such as leukemia, lymphoma and hemoglobin disorders
  • Hypothyroidism or low thyroid hormone level


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Symptoms of Gout

Sudden intense pain in the affected joint is the first symptom of gout. The first site where gout can be noted is the small joint at the base of the big toe. In medical terminology, such acute gout developing at the base of the big toe is known as podagra. However, gout can also develop in the ankle, knees, wrists, fingers or elbows. But, the joints in the lower limbs are more vulnerable to the development of gout as compared to those of the upper limbs.

An acute gout attack is typified by the onset of acute pain in the affected joint, followed rapidly by swelling, heat, redness and tenderness. The tenderness can be so intense that even a thin blanket touching the skin in the affected area can seem unbearable by the patient. The pain, in most cases is excruciating and intolerable. A gout attack may also result in fever.

Typically, a gout attack lasts a few hours or a few days. In exceptional cases, it can last for weeks. Patients suffering from gout can experience recurring attacks of arthritis for years. The attacks become more frequent, last longer and also involve other joints apart from the affected one.


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Long-Term Effects of Gout

Development of kidney stones and tophi (nodular masses of uric acid crystals in soft tissues) are the most common long term effects of gout.

When not metabolized properly, excessive uric acid can develop into crystal deposits in the urinary tract of people suffering from gout. This causes kidney stones to develop.

Tophi are caused when these uric acid crystals develop under the skin of the patients suffering from gout. Tophi appear as yellowish or whiting nodules and become swollen and tender during the recurrent gout attacks. Tophi can destroy the affected joints completely, result in persistent pain and also cause carpal tunnel syndrome (pressure on the median nerve that affects the movement of the wrists, and provides feeling to other parts of the hand)

Gout calls for a long term treatment plan and certain changes in eating habits, lifestyle and exercise pattern to ensure that the overall health of a patient is maintained.


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