Gout is a common type of inflammatory arthritis that causes sudden, severe pain, swelling and tenderness. It can affect any joint in the body including the feet, ankles, knees, hands, wrists, elbows and sometimes, soft tissue and tendons. It most often affects the large joint of the big toe. In most cases, it usually affects only one joint at a time, but as the disease becomes chronic several joints can be affected. Gout is more prevalent among men as they tend to have higher uric acid levels in their blood as compared with women. It affects women more commonly after they reach menopause.
What causes gout?
Gout is caused because of increase in blood levels of uric acid (hyperuricemia). Uric acid is formed in the body by the breakdown of waste products called purines. Uric acid levels may become elevated if you produce an excess of uric acid or if your kidneys can’t eliminate it quickly enough. An acute attack of gout occurs when excess uric acid that isn’t eliminated from the body forms crystals in the fluid that lubricates joint linings. This leads to inflammation and pain in the joint. If gout is left untreated or repeated attacks occur, it may cause these crystals to form tophi or lumps in the affected joints or surrounding tissues.
Signs and symptoms of gout
In an acute attack, the involved joint becomes painful. The small joint at the base of the big toe is the most commonly affected joint that gets involved in an acute attack of gout. The characteristic feature of acute gout attacks are rapid onset of pain in the affected joint, warmth, swelling, reddish discoloration and marked tenderness. Symptoms of an acute gouty attack last for about a week if left untreated and gradually subside during the following week or two. With treatment, pain subsides mostly within 12 to 24 hours. Only rarely does an acute attack last for weeks.
If uric acid crystals get deposited in tiny fluid-filled sacs (bursae) around the joints, it can cause inflammation of the bursa (bursitis). Bursitis cause pain and swelling around the joints.
Some patients may develop hard nodular masses of uric acid crystals (tophi) in different soft-tissue areas of the body. Tophi are most commonly found around the fingers, at the tips of the elbows, in the ears and around the big toe. Tophi are formed when the person has substantial overload of uric acid within the body for a long period.
Treatment of gout
There is no cure for gout, but treatment can help to treat acute attacks and prevent future attacks. NSAIDs (such as ibuprofen, naproxen, diclofenac), colchicines and steroids can control inflammation and pain in gout. The NSAIDs are good analgesics and most often prescribed to relieve pain. Your doctor may prescribe medications to prevent gout complications if you have repeated acute attacks or less frequent attacks, but they are particularly painful. Appropriate treatment can reduce the risk of complications from gout such as the development of tophi from urate crystal deposits.
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