Frequently, the first gout attack is in the base of the big toe, radiating such intense pain that anything touching it causes severe discomfort.
Gout affecting the big toe joint is called podagra and can cause difficulty in walking or placing the foot down on the floor.
Monosodium urate crystals, or MSU crystals, readily form when body temperature is normal and uric acid concentration in the blood reaches seven milligrams per deciliter. However, since fingers and toes are usually slighter cooler than the rest of the body, crystals will form here first because less uric acid is necessary to facilitate production of solidified crystals.
Initially, gout usually affects only one joint at a time but may eventually affect several joints, including shoulders and even the spine.
Gout symptoms also affect ankle, knee and sometimes hip joints with the same intensity and painful manifestations.
Gout attacks may suddenly vanish after a week or two, only to return at some point in the future.
The next flare-up may target other joints, with each attack growing more frequent and more severe unless you seek treatment. Without treatment, the potential exists for permanent damage and joint deformation as well.
What is Gout?
Approximately 100 different kinds of arthritis exist, and gout is one of these arthritis types.
It is estimated that one out of every 20 individuals who develop arthritis have gouty arthritis that produce classic symptoms of gout such as joint pain, swelling and immobility.
Gout, or arthritic gout, develops due to high uric acid levels in the blood, which subsequently generates formation of tiny, sharp uric acid crystals within joints. When the immune system realizes that these crystals exist, it goes into attack mode and begins attempting to eliminate them.
A defensive immune system is the cause of the inflammation and pain in people who have developed uric acid crystals and gouty arthritis.
These sodium urate crystals inflame joint tissues and restrict flexibility of joints, causing pain, swelling and sensitivity in gout sufferers. Skin surrounding affected joints may turn reddish-purple due to the intensity of the inflammation.
Once inflammation subsides, however, joint area skin may itch, peel or flake as a result of the attack.
Symptoms of gout are the result of accumulation of uric acid that has been steadily increasing in the blood for several years.
Excessive levels of uric acid do not occur overnight.
Uric acid crystal deposits may have been developing on joints for some time without you experiencing any symptoms. Initial attacks commonly occur at night or early morning after the body has been physically inactive for several hours and crystals have had a chance to collect and weaken joints.
Uric acid is the result of purine break down. Purines are necessary chemicals constituting portions of human DNA. Purines comprise two of the four nitrogenous bases responsible for DNA functioning—adenine and guanine. Cellular waste contains uric acid after dead cells have been recycled, which is usually metabolized into water soluble molecules that the kidney efficiently eliminates from the body.
However, when an excessive amount of uric acid exists in the blood, the kidneys are unable to prevent this extra uric acid from forming crystals around joints. As a result, gout symptoms eventually manifest themselves by causing inflammation, swelling and pain.
How is Gout Diagnosed?
Doctors who suspect a patient is suffering from gout will additionally examine the cardiovascular and renal system since many gout patients are also afflicted with kidney or heart problems.
Tests administered by laboratories include blood urea nitrogen, urinalysis, serum acid measurements, blood cell count and serum creatinine.
Diagnosis is confirmed when doctors discover intracellular monosodium urate crystals and polymorphonuclear leukocytes (white blood cells sent by the immune system to combat crystal invasion) within fluid contained in an affected joint.
Doctors can also dismiss the presence of other disorders, which are gout-like, such as pseudogout and septic arthritis after inspecting joint fluid taken directly from the joint. Sometimes, people may not suffer from symptoms of gout because an insufficient amount of uric acid is in the blood.
However, when doctors repeat examination of joint fluid the next day, urate crystals are usually evident in the synovial fluid of gout patients.
What Causes Gout?
A high level of blood uric acid is a condition known as hyperuricemia.
Sometimes, certain events may trigger the initial gout attack in someone with hyperuricemia, events such as:
- Physical trauma—stubbing the big toe or bone injury to feet and hands may stimulate sodium urate crystal and instigate flammation.
- Experiencing serious surgery that requires extensive bed rest or immobilization
- Consuming a diet rich in foods containing high levels of purine
- Kidney disorders
- Extremely rapid weight loss
- Undergoing chemotherapy
Doctors can perform blood tests to check your uric acid level. Before having a blood sample drawn, you should not consume any of the following because these substances will increase the amount of uric acid in your blood:
Division of gout into four distinct phases helps doctors discern from what stage of this disease a person may be suffering. These four stages are:
- Asymptomatic hyperuricemia
- Acute gouty arthritis
- Intercritical gout
- Chronic tophaceous gout
Symptoms of gout in asymptomatic hyperuricemia are nonexistent or often so insignificant that they go unnoticed. This stage occurs is considered the initial stage of gout and may last as long as 20 years, depending on how rapid uric acid level increases during this time.
Gout attacks are contingent on several factors when someone has asymptomatic hyperuricemia, such as amount of high purine foods consumed, whether someone maintains a healthy weight and how much a person smokes and drinks alcohol, especially beer, since yeast is known to elevate blood uric levels.
However, people with asymptomatic hyperuricemia do not always develop full-blown gout.
By following a low-purine diet and avoiding a sedentary lifestyle, most with asymptomatic hyperuricemia have a less than 20% chance of suffering from gout symptoms in their lifetime.
Acute gouty arthritis is the condition occurring when initial symptoms of gout appear, usually consisting of short pain twinges (called petit attacks) or minor swelling in joints. These subtle bouts of gout may precede complete and intense gout attacks by five years or more, again depending on how well the sufferer controls their uric acid levels. Those suffering from acute gouty arthritis experience intense pain, sensitivity around the affected joint, extensive swelling, tightened, red skin and a general feeling of malaise.
Intercritical gout refers to time elapsing between gout attacks when the patient does not experience gout symptoms. If you leave the gout untreated during this remission and you continue to consume a high purine diet, pain and swelling returns to around 75% of those afflicted with high levels of uric acid. Research has indicated that within 10 years of experiencing an initial gout attack and remission, most people will have suffered repeated symptoms of gout.
When you don’t address gout adequately, intercritical periods diminish and attacks grow more intense and enduring. Chronic pain is the result of not treating gout by consuming low purine foods or medications. People who ignore treatment of gout suffer from the constant presence of pain, inflammation and stiffness. Gout can spread to other joints as well, such as the hips and spine.
Complications Caused by Gout
Those suffering from symptoms of gout may also experience additional symptoms due to complications of gout. Other disorders may arise as a result of hyperuricemia and being unaware of how to treat gout.
The presence of kidney stones, or uric acid nephrolithiasis, is a condition commonly co-morbid with gout. High uric acid levels also promote formation of kidney stones, causing additional pain and discomfort to gout sufferers.
Chronic uric acid interstitial nephropathy is uric acid crystal formation within the tubes carrying fluids away from the kidney. While initial symptoms of sharp pain or backache is experienced in some gout sufferers, this condition is treatable and usually does not impede kidney functioning.
When symptoms of gout are extreme and left untreated, kidney failure is a possibility due to an overwhelming and dangerous amount of uric acid flowing through the body without being eliminated. Sometimes sudden kidney failure occurs in hyperuricemic patients due to:
Chemotherapy for leukemia or lymphoma
Severe heat stress from heavy physical activity
Corticosteroid therapy for severe allergic reactions
Gout prevention is vitally important to not only reducing the risk of other diseases but also in leading a pain-free, healthy and optimally mobile life without being forced to deal with the devastating symptoms of gout. Prevention of gout is also important in those who have family members suffering from gout or who engage in the following actions:
- Excessive alcohol drinking
- Overeating that results in obesity
- Consistently carrying high blood pressure levels
- Eating high purine foods
- Taking medications that may increase uric acid levels
Diet is usually the primary villain in gout development and high blood uric acid. If you suddenly experience a gout attack, you should immediately start reducing consumption of high purine foods and eat only low purine foods such as:
Eat and drink:
- Raw fruits—strawberries, blueberries and especially cherries or cherry juice
- Green leafy vegetables—cabbage, lettuce, celery and broccoli
- Drink coffee, tea and plenty of water to flush the kidneys and facilitate elimination of uric acid
- Vitamin C foods such as red cabbage and potatoes are excellent at alleviating symptoms of gout
Eliminating seafood and organ meats from your diet, along with avoiding foods that contain high fructose corn syrup will reduce gout symptoms and regulate abnormally high levels of uric acid in the body.
How to Treat Gout Symptoms
By integrating a low purine diet into a healthy lifestyle of no smoking, extremely reduced alcohol consumption, weight management and exercise, you can effectively alleviate or totally eliminate the pain and unpleasantness of gout from your life. When you eat foods that contain little or no purine, your body, especially your kidneys, does not have to process nearly as much purine, resulting in suppression of uric acid crystal formation and no manifested symptoms of gout.
Low purine foods that should be included in any gout diet include:
- Complex carbohydrates such as breads, white rice, cereals, and pasta
- Low fat or no fat dairy products—cheese, milk, eggs and cottage cheese
- Tapioca pudding
- Foods rich in essential fatty acids (the kinds that the body cannot produce by itself), including salmon, nuts, tuna and sunflower seeds
- Low-protein foods, since purine is included in just about all protein foods. These foods include milk substitutes, thinly sliced deli meat (turkey, chicken); fruits and extremely lean hamburger
For relief of symptoms of gout, consult with your doctor to create a workable diet plan that includes low purine foods and weight loss if necessary.
Medications Causing Gout Symptoms
Certain medications enhanced by the presence of elevated blood uric acid levels may exacerbate the pain and swelling of gout. If you are taking any of the following medications and are experiencing intense joint pain, you should contact your doctor to determine whether the medication is causing gout.
- Diuretics—heart patients are frequently prescribed diuretics that contain metolazone, furosemide and hydrochlorothiazide which can stimulate uric acid crystal growth
- Immunosuppressive drugs—prescribed to organ transplant patients, these drugs such as tacrolimus may trigger attacks of gout
- Parkinson’s disease treatment—Laradopa or levodopa often provokes gout flare-ups in people who previously had not experienced gout. These drugs contain a dopamine precursor that may be implicated in uric acid crystal formation
- Antiuricosurics—drugs used to treat tuberculosis may inhibit the kidney’s ability to remove uric acid from the body, causing accumulation and resulting crystal formation
- Excessive amounts of niacin and vitamin C (absorbic acid) has been associated with producing symptoms of gout
In addition, antibiotics, while capable of destroying detrimental bacteria that causes many sickness, is also potent enough to eliminate beneficial bacteria that affects optimal kidney and bowel functioning. The intestines also play a vital role in keeping uric acid levels in check. However, antibiotics reduce certain probiotics in the body, compromising the ability for the kidneys and bowels to filter excess uric acid.
With the knowledge doctors and researchers have today concerning the pathology of gouty arthritis, relief from symptoms of gout is easily obtainable and manageable. If you are suffering from painful, swollen and tender joints, you may have gout and need to be properly diagnosed. If you already have gout, participating in a program consisting of proper weight management, no smoking or drinking, and consuming mostly low purine foods may allow you to lead a long, healthy and gout-free life.
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Symptoms of Gout