What Is Gout And How Does It Affect You – Here’s what to expect at each stage of gout and how to prevent it from getting worse in the first place.
Gout is a form of inflammatory arthritis that occurs when levels of uric acid, a normal byproduct of metabolic reactions in the body, are too high. When uric acid levels are too high for our body to easily dissolve and be excreted (through urine), uric acid crystals begin to form. Uric acid crystals accumulate in the joints, causing severe inflammation. The big toe is a well-known site for gout attacks, but gout can attack many different joints throughout the body.
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What Is Gout And How Does It Affect You
Gout is one of the oldest recorded diseases, with records dating back to ancient Egypt. In the 17th century Dr. As Thomas Sydenham describes, this painful form of arthritis affects millions of American adults today, as it has throughout history:
Gout (inflammatory Arthritis): How It Starts, Symptoms, And Treatments
“The victim went to bed and slept soundly. About 2 a.m. he awoke with a sharp pain in his great toe; rarely in the heel, ankle, or step…at first it was a moderate pain, then it became more severe. ..sensation of the affected part so delicate. and lively that she cannot bear the weight of the bed and the weight of the bowl of the person who walks in the room.”
Fortunately, rheumatoid arthritis is one of the most treatable forms of arthritis today—some rheumatologists say it can be cured. But for many people with gout, the disease goes untreated or undertreated. For example, in a recent study, only 37 percent of gout patients took the urate-lowering drug allopurinol; Only half of the patients with recurrent gout attacks took the drug.
Improper treatment of gout can worsen the condition. Over time, gout can affect more joints throughout the body and cause problems like tophi and permanent bone loss.
Learn more about how gout develops, how gout progresses through its different stages, and how to treat gout to prevent symptoms, lower uric acid levels, and prevent long-term gout complications.
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Also called silent hyperuricemia, in the early stages of gout, uric acid builds up in the blood and begins to crystallize around the joints, often in the legs.
Uric acid is produced when your body breaks down substances called purines, which are produced in your body and are also found in some foods and drinks. Although eating high-purine foods can lead to high uric acid levels, many experts believe that diet plays a more important role in the development of gout. High uric acid levels occur when your kidneys can’t effectively remove uric acid, which can happen for a variety of reasons, including:
“In the first stage of gout, patients have no joint pain, no redness or swelling in the joints, but blood tests show elevated uric acid,” says Theodore R. Fields, MD, FACP, a rheumatologist at the Hospital for Special Surgery. New York City. R. Fields) said city. “When uric acid or urate crystals accumulate in the joint, that can cause inflammation later.”
But high uric acid alone is not enough to diagnose gout. “Most patients with hyperuricemia never develop clinical gout,” says Alireza Mesami, MD, FACR, a rheumatologist at Henry Ford Health System in Michigan.
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“This refers to pain, redness, and swelling in a patient’s joint, usually the big toe, foot, ankle, or knee, but gout can also start in other joints,” Dr. Fields says. “This happens when urate crystals are released into the joint fluid and cause an inflammatory reaction, which causes many white blood cells to come in and release inflammatory chemicals, causing pain, redness and swelling.”
If you think you may be having a gout attack, talk to your primary care doctor or a rheumatologist to start treating the condition. It is important to see your doctor during a gout attack because your doctor can drain the affected joint fluid and look at it under a microscope to check for the presence of uric acid crystals. Identifying uric acid crystals in joint fluid can help diagnose gout.
After a first gout attack, 75 percent of people will have a second attack within a year; Dr. But some people can take action for years before having another attack, Fields said. The intermediate stage is when “a person has had a gout attack but doesn’t currently have joint pain or swelling,” he said. “Almost all gout patients go through this phase because the nature of gout is that you have a gout attack and then there’s a quiet period before the next gout attack.”
Even if nothing seems to be happening, patients should start long-term treatment. Lowering uric acid levels with medication can prevent future gout attacks and the long-term complications that come with them.
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This condition is also called “tophus gout” because the deposits of uric acid can form nodules called “tophus”, usually located on the bunion point of the big toe or on the elbow. But tophi can form anywhere on the body. “At this point, a person almost always has some joint pain from gout,” Dr. Fields says. “It usually takes years of uncontrolled gout to get to this stage.”
During this stage, progressive joint damage occurs, so people with gout need to be treated before this happens. “Delaying treatment can make gout worse,” Dr. Messami said.
As you become more familiar with the symptoms of gout, you may realize that a gout attack is coming. “Increased pain, swelling, redness, and warmth in the affected joints during an attack are signs that the attack is progressing,” Dr. Messami says.
In addition, the disease typically “progresses with recurrent or more frequent gout attacks, longer duration, more joint involvement, and the presence of tophi,” Dr. Messami said.
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Dr. If you have more than one gout attack a year, it’s important to take your gout medication regularly, Fields says.
If left untreated, gout usually progresses. Additionally, certain factors can trigger a gout attack. “A sudden increase or decrease in urate levels can lead to gout,” Dr. Fields says.
This may include eating foods rich in purines, which break down into urates, such as red meat and shellfish. Foods rich in fructose also increase the production of urate in the body. Alcohol reduces the excretion of uric acid in the urine, which increases uric acid levels. Specifically, “beer not only affects uric acid in the urine, but the protein in beer breaks down into purines, which then make uric acid, so it raises uric acid in two ways,” Dr. Fields says.
You may want to limit high-purine foods to prevent gout flare-ups, but both doctors we spoke to said diet alone is not enough to control gout. “Severe dietary purine restriction is rarely recommended because it only lowers serum [blood] uric acid levels by about 1 mg/dL, which is not enough in most patients,” Dr. Mesemi said.
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Gout was once called the “disease of kings,” but it was a misconception that it was caused only by overeating. “Gout is a genetic disease in which your body either excretes too much uric acid in the urine or produces too much uric acid instead of a dietary disease,” Dr. Fields said. “Watching your diet can certainly help relieve gout flare-ups, but to counteract the genetic predisposition to gout, you’ll almost always need medication.”
So if certain foods trigger gout symptoms, avoid them. “Consuming alcoholic beverages or fatty foods can trigger a gout attack in some patients, and individual patients should avoid triggers known to trigger gout attacks,” Dr. Mesemi said.
However, one of the risk factors for gout is obesity. In fact, gout has become more common recently, possibly due to rising levels of obesity. “Weight loss in obese people has a greater uric acid-lowering effect than a purine-free diet,” Dr. Mesemi said. For this reason, a healthy diet and exercise can help you lose weight and reduce the risk of disease progression.
Emotional stress can also trigger a gout attack. Physical injury to the foot, such as may occur while running, can also cause this condition, which can dislodge some of the crystals and cause an inflammatory reaction.
Gout Is A Type Of Arthritis. It Is Inflammation Of Joints By Uric Acid Crystals
“We don’t prevent people with gout from running or doing other activities,” Dr. Fields said. “However, if someone has a gout attack in the feet, ankles or knees, we recommend that they stay off their feet as much as possible, as further injury to the affected joints can prolong the gout attack.”
Starting a treatment regimen can also inadvertently trigger a flare-up. But other medications can also be taken to reduce this risk.
Fortunately, because of its long history, gout is one of the most understood and medically treatable forms of arthritis.
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