Gout

Gout is an inflammatory form of arthritis characterised by sudden, severe attacks of pain, swelling, and redness in joints. It occurs when excess uric acid crystallises and accumulates in joints, most commonly affecting the big toe. The condition can significantly affect daily activities, sleep patterns, and overall quality of life, with attacks potentially lasting several days to weeks if left untreated.

Symptoms causes diagnosis treatments prevention FAQ

Symptoms of Gout

Gout presents with a set of noticeable symptoms that typically appear suddenly and progress over several hours.

Intense Joint Pain: Attacks often begin in the big toe, though they can affect other joints. The pain intensifies within 12-24 hours of onset.
Swelling and Inflammation: Swelling occurs in the affected joint, accompanied by redness, shininess, and warmth in the surrounding skin.
Limited Range of Motion: The affected joint becomes stiff, and movement becomes restricted, affecting regular activities.
Lingering Discomfort: After the severe pain subsides, joint discomfort can last from a few days to several weeks, with varying intensity.
Tophi Formation: In advanced stages, hard lumps called tophi may develop under the skin around joints and in other areas like the ears, leading to visible deformities.

Causes and Risk Factors

Several factors contribute to the development of gout and increase the likelihood of experiencing attacks.

Diet

Regular consumption of foods high in purines, such as red meat, organ meats, and certain seafood, leads to increased uric acid production.
High Uric Acid Levels

Also known as hyperuricaemia, this occurs when the body produces excessive uric acid or the kidneys do not eliminate it efficiently.
Medical Conditions

Obesity, diabetes, kidney disease, and high blood pressure can raise uric acid levels in the body.
Medications

Certain medications, particularly diuretics and low-dose aspirin, can affect uric acid levels in the blood.
Age and Gender

Men typically develop gout earlier than women, with risk increasing after age 30 for men and after menopause for women.
Family History

Genetic factors influence how effectively the body processes and eliminates uric acid.

Diagnostic Methods

Medical History and Physical Examination: The doctor assesses symptoms, medical history, and affected joint. Assessing the pain patterns, swelling, and redness helps identify gout and rule out other conditions.
Blood Tests: A blood test measures uric acid levels, though levels may remain normal during an acute attack. Additional tests may evaluate kidney function and rule out other inflammatory or metabolic conditions.
Imaging Studies: X-rays help detect joint damage and tophi in long-standing gout. Ultrasound can identify urate crystal deposits, while dual-energy CT provides detailed imaging of crystal accumulation and joint damage in more complex cases.
Joint Fluid Analysis: In uncertain cases, a needle may be used to extract fluid from the affected joint for microscopic examination. The presence of uric acid crystals confirms gout, making this the most definitive diagnostic test.

Treatment Options

Gout treatment focuses on managing acute attacks, preventing future episodes, and reducing complications.

Non-Steroidal Anti-Inflammatory Drugs

NSAIDs help relieve pain and inflammation during an acute gout attack. Treatment typically lasts 3–10 days, with the dosage adjusted based on symptoms and patient tolerance.

Colchicine

Effective in reducing gout inflammation, colchicine works best when taken early in an attack. Due to potential side effects, careful dosing and monitoring are required.

Corticosteroids

When NSAIDs or colchicine are unsuitable, corticosteroids may be prescribed as oral tablets or joint injections to control inflammation. Treatment duration depends on attack severity and response.

Uric Acid-Lowering Medications

For patients with recurrent gout, medications such as allopurinol or febuxostat help lower uric acid levels and prevent future attacks. These require long-term use and regular monitoring to maintain effectiveness and minimise side effects.

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Prevention and Management

Regular blood tests help monitor uric acid levels and guide treatment adjustments. Dietary changes, such as reducing high-purine foods, limiting alcohol, and staying well-hydrated, can help lower gout risk. Maintaining a healthy weight, engaging in regular physical activity, and avoiding known triggers further reduce the likelihood of attacks. Long-term medication use is necessary for preventing flares and minimising joint damage in recurrent cases.

Frequently Asked Questions (FAQ)

Can gout affect joints other than the big toe?

Gout affects multiple joints, including ankles, knees, elbows, and wrists. While the big toe is most commonly affected, any joint may experience gout attacks, particularly as the condition advances.

How quickly do gout medications work?

Acute attack medications typically provide relief within 24-48 hours when started promptly. Long-term uric acid-lowering medications require months to stabilise uric acid levels and prevent future attacks.

Can diet alone control gout?

Dietary changes support gout management, but most patients with recurring attacks need medication for adequate control. A combination of diet, medication, and lifestyle adjustments provides the best approach to preventing flares and reducing long-term complications.

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