What is gout?
Gout is a metabolic disease in which the joints can become very inflamed. The disease occurs because too much uric acid builds up in the body and is deposited in different places. This initially leads to inflammation and later to damage to the joints.
Approx. 8.3 million people in United States live with gout. About 6.1 million patients are male and 2.2 million female. Most of the time the disease does not appear until after the age of 40, in women usually only after the onset of menopause.
The causes – how does gout come about?
The body cannot break down uric acid. Therefore, he excretes them, especially with the urine. In gout, the body either produces too much uric acid or it excretes too little through the kidneys.
With high concentrations of uric acid in the blood and other body fluids, uric acid salt crystals are formed. They are deposited in the joints, tendons, bursae or in the ear cartilage. There they then cause a violent inflammation, the gout attack.
It can take years before an attack of gout occurs. Often the disease manifests itself surprisingly, in many cases immediately after eating a lot of meat and drinking a lot of alcohol. Stress, other stress or an infectious disease can also trigger a gout attack.
Symptoms of gout – what are the warning signs?
In a third of all patients, the disease first occurs on the foot, usually on the metatarsophalangeal joint of the big toe. The joint becomes inflamed, very hot, swollen, and turns red to bluish in color. It is also extremely sensitive to touch.
After the first gout attack, further attacks can occur at irregular intervals. Other joints such as the knee, ankle, metatarsal, wrist, or finger joints can also be affected. In the first few years of gout, patients mostly have no pain between attacks.
A few years after the first attack of gout, so-called gout nodules (tophi) can form. They arise when the uric acid salt – urate – is deposited on the auricles, on the toes and finger joints, on the Achilles tendon or in the bursa on the elbow, for example. Most of the time, the gout nodules are not painful. Early treatment can prevent the gout nodules.
Uric acid salt can also build up in the kidneys. Initially, this does not cause any discomfort, but it restricts the function of the kidney. As a result, kidney stones can form, which cause pain.
The diagnosis – how does the doctor diagnose gout?
The medical history and clinical examination of the patient with the typical attack of gout indicate the disease. The determination of uric acid in the blood is the most important laboratory test. If the uric acid rises above 6.5 milligrams uric acid in 100 milliliters of blood serum (hyperuricemia), there is an indication of gout, but no evidence.
Other diseases can also cause the uric acid concentration to rise. In an acute gout attack, the uric acid can even be normal and requires a check-up after two to three weeks.
However, only 10 out of 100 people with hyperuricemia develop gout. Joint fluid can be obtained by puncturing a diseased joint. If the typical uric acid urate crystals are found there under the microscope, this is a sure sign of gout. During an ultrasound examination of an affected joint, the doctor sees typical signs of gout.
X-rays only make the disease visible after a few years. Accumulations of urate crystals can only be seen on them if they have grown over a certain period of time.
Treatment methods for gout – what treatment is there?
It is important that the disease is treated. If the uric acid level remains permanently high, the intervals between gout attacks become shorter and shorter. Then permanent damage to bones and joints occurs. And once that happens, the joints remain swollen between attacks, and movement causes pain.
In the case of an acute attack of gout, the focus is on combating pain and inflammation. This is done using conventional cortisone-free rheumatic drugs (NSAIDs). Colchicine can also be used, but be careful: many side effects. Cortisone, also as an injection into the joint, quickly resolves the attack.
Long-term drug therapy for gout is urgently needed in the case of multiple gout attacks, demonstrable gout toophy, joint damage or already existing restrictions in kidney function.
There are two groups of active ingredients that are suitable for the long-term treatment of gout:
This active ingredient causes the body to excrete more uric acid through the kidneys. This happens through the urine. Especially in the early days, patients have to go to the toilet much more frequently. Therefore, you should drink at least two liters a day.
With this active ingredient, even existing uric acid salt deposits are receded in the entire body. If kidney function is already impaired, febuxostat is used.
In small doses, colchicine can help prevent further gout attacks. Particularly in the case of kidney dysfunction, caution is advised with the dosage.
The doctor should decide about them. If this drug therapy is not sufficient, a biological agent, canakinumab, is even available. In the event of an attack, it is injected subcutaneously, i.e. under the skin.
Diet for gout
Through their lifestyle, gout patients can reduce the likelihood of seizures. It is important proper nutrition. In the case of gout, this means above all: those affected should avoid foods that contain a lot of purines if possible.
Uric acid is formed from this substance. Many types of meat, seafood and legumes have a high purine content. As a rule of thumb, gout patients should avoid foods with a purine content of more than 150 milligrams per 100 grams. You can find an overview of the purine and uric acid content of certain foods in our nutrition brochure.
Gout patients should also be extremely careful with alcohol, as it increases the uric acid concentration in the blood. The same applies to drinks containing fructose. Obesity is also a major risk factor.
However, gout patients should avoid diets that are too radical. Fasting can even trigger gout attacks. A lot of exercise and a healthy diet are advisable.