Gout: The Silent Damager!

What is Gout?

Gout is a type of arthritis that causes severe pain, swelling, and redness in the joints. It usually affects the big toe but can occur in any joint. The pain often comes suddenly and can be very intense.

Why Does Gout Occur?

Gout happens when there is too much uric acid in the blood. Uric acid is a waste product that is formed when the body breaks down purines, which are substances found in certain foods as well as it is naturally present in body. When uric acid builds up, it can form sharp crystals in the joints, leading to the painful symptoms of gout.

Uric acid may build up due to overproduction or less secretion of Uric acid by the kidney.

Who is More Prone to Gout: Men or Women?

Gout is more common in men than in women. However, women become more susceptible to gout after menopause.

What is the Incidence of Gout in India?

Gout is increasingly common in India, affecting many due to changes in diet and lifestyle. While exact numbers are not well-documented (almost 3-27 per 1000 men suffer from it.)  Gout is recognized as a growing health issue.

What is the Common Age for Gout?

Gout typically appears in men between the ages of 30 and 50. In women, it is more common after the age of 60.

What are the Symptoms and Signs of Gout?

• Sudden, intense joint pain, often in the big toe (Please see the image below)
• Swelling and redness around the affected joint
• Warmth in the joint area
• Limited range of motion in the affected joint
• Can occur in any joint of the Body.

What are the Tests that is Prescribed?

a. Blood Tests : Most important test is blood Uric acid Levels. The Normal Range for Males is 3.4-7.0 mg/dl     For Females is 2.4-5.7 mg/dl anything higher than the level must be looked into.

But Remember during an acute attack of Gout (Severe Pain) most of the time uric acid stays at normal levels only if tested.

                     Blood CBC and CRP : They help to determine the level of seriousness of the gout attack 

b. Synovial Fluid Analysis: If any joint has swollen, doctor may take out the fluid and send it to tests to look out Crystalls in the fluid to confirm the diagnosis. ( see the below microscopic image)

c. USG Scans: Another Non Invasive method is to see your joints with a USG machine to look for Signs of Tophi (The deposits of crystals due to gout)

d. X-ray: To check the extent of Joint Destruction (Remember, once a joint is destroyed its almost permanent)

Why is Diet Important in Gout?

Diet plays a crucial role in managing gout because certain foods which are high in purines can increase uric acid levels in the blood. By choosing the right foods, you can help prevent gout attacks and reduce symptoms.

So what are the Good Foods for Gout?

• Fruits and Vegetables: These are low in purines and can help lower uric acid levels.
• Whole Grains: Foods like brown rice, oats, and whole wheat can be part of a healthy diet for gout.
• Low-fat Dairy: Milk, yogurt, and cheese can help lower uric acid levels.
• Water: Staying hydrated helps the kidneys flush out uric acid.

And What about Bad Foods for Gout?

• Red Meat: Beef, lamb, and pork are high in purines and can increase uric acid levels.
• Seafood: Shellfish, sardines, and anchovies are particularly high in purines.
• Sugary Drinks: Soft drinks and fruit juices with high sugar content can raise uric acid levels.
• Alcohol: Beer and spirits can increase uric acid and trigger gout attacks.

Does Raised Uric Acid Means I Have to start Medicines?

No, Lets get this clear Raised Uric acid and Gout are different. Raised uric acid is Hyperuricemia and generally, it is without any Symptoms and when Uric acid crystals are formed and deposited in joints we call it Gout. 

Hyperuricemia may lead to Gout but not always, so at this stage, your doctor based on various other parameters like your kidney status or blood pressure status depending on the level of uric acid may start medications or advice just Lifestyle Modifications.

What are the Complications if Gout is Neglected?

Gout is simple arthritis if treated early does not cause any serious issue but if neglected may result in some serious joint issues as well as major internal organ damage.

• Tophi: Hard lumps of uric acid crystals under the skin (See Image below)
• Joint Damage: Chronic gout can cause permanent damage to joints
• Kidney Stones: High uric acid levels can lead to the formation of stones in the kidneys
• Heart Problems: Gout can affect your Heart too.

How Can Gout be Treated?

1. Medications:
   • Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine to reduce pain and inflammation.
   • Uric Acid-Lowering Drugs: Allopurinol and febuxostat help reduce uric acid levels. (starting drugs for uric acid has lots of criteria, raised uric acid does not mean you have to take medicines)
2. Lifestyle Changes:
   • Dietary Adjustments: Avoid high-purine foods, reduce alcohol consumption, and stay hydrated.
   • Weight Management: Maintaining a healthy weight can lower the risk of gout attacks.
   • ( This is the Best and Recommended Management)
3. Home Remedies:
   • Applying ice packs to reduce joint pain
   • Resting the affected joint

Doctor, how long should I take Medications?

Lots of studies have been done yet no definite answer to this question. Presently it is recommended to continue medication for Life long. As it is seen on stopping medication the level of Uric acid shoots up. 

Hence, medications are started only if Lifestyle modifications and diet have failed to lower your uric acid level.

What is the Importance of Early Treatment?

Early treatment of gout can prevent joint damage and other complications. It also helps manage symptoms more effectively, reducing the frequency and severity of gout attacks.

Additional Tips

• Regular Check-Ups: Regular monitoring of uric acid levels can help manage gout.
• Exercise: Regular physical activity can help maintain a healthy weight and reduce the risk of gout attacks.

By understanding gout and making simple changes to your diet and lifestyle, you can manage this condition effectively and enjoy a better quality of life. Always consult your doctor for personalized advice and treatment options.