The gout is one of the most painful forms of rheumatoid arthritis. It is an inflammatory joint disease (arthritis) related to the presence of high amounts of uric acid in the blood and its consequent deposit in the joint area. The big toe joint is the most affected by the disease but more generally it is the hands and feet that show signs and symptoms. However, uric acid can accumulate in any other tissue in the body, such as tendons and skin.
It usually appears suddenly with a very painful episode associated with joint swelling.
It is a disease that has afflicted humans since ancient times. It has a genetic basis but a number of risk factors can greatly affect the disease, such as lifestyle and nutrition .
Gout and symptoms of hyperuricaemia (uric acid values in the blood)
Hyperuricaemia is defined as a condition in which the serum uric acid concentration exceeds 7 mg / dl in men and 6.5 mg / dl in women.
When the threshold of 9 mg / dl is exceeded, the risk of gout is very high and it will therefore be necessary to proceed with the therapy.
Blood uric acid values are influenced by many environmental and genetic factors, gender and age.
Thus, we find an inheritance of about 40% in cases of hyperuricaemia, an upward trend in uric acid in middle-aged men and postmenopausal women, and a risk of increased uric acid concentration in overweight subjects. who consume alcohol and use a certain type of medication.
Furthermore, hyperuricemia can be diagnosed as primary , that is caused by alterations in the metabolism of uric acid, or secondary , in this case it is related to other pathologies that modify the metabolism or consequent to the use of drugs.
Gout: possible causes
Genetic predisposition is the main cause of gout. In fact, in subjects with a (genetically) altered metabolism of uric acid there will be difficulties in eliminating the latter and therefore an altered value in the blood (hyperuricemia).
The second key trigger , but still secondary to genetics, is found in nutrition. In fact, excessive consumption of purine-rich foods (e.g. meat) can lead to an increase in uric acid. Purines are organic substances present in every cellular organism and, once metabolized by the body, they release uric acid as their metabolite.
An alteration in the purine metabolism system (for example an enzyme deficiency) can lead to a situation of hyperuricemia.
Alcohol also negatively affects uric acid metabolism by reducing the kidney’s ability to dispose of it.
We have seen how acute episodes of gout are often preceded by large meals and with a large consumption of alcohol, a classic example of feast days.
However, gout can in some cases be caused by another disease , so let’s talk about secondary gout .
Kidney and metabolic diseases are the most common for the development of secondary gout, to which are added tumors.
But, in most cases, gout is related to the metabolic syndrome . The reason also in this case refers to a genetic predisposition but also to an incorrect lifestyle.
Overweight, poor physical activity, unbalanced diet, and unhealthy daily habits are a predisposing factor for metabolite syndrome.
Finally, among the causes we can still highlight the chemotherapy and diuretic drugs.
Symptoms of gout
A high level of uric acid (hyperuricemia), above 9 mg / dl, indicates an inevitable acute gout crisis. On the other hand, if the serological values are higher than 6 mg / dl, there is a possibility that the uric acid is deposited inside the tissues and joints.
It therefore does not appear suddenly but is anticipated by alarm signals that can also be detected randomly during blood tests.
The patient suffering from the acute gout crisis, usually during the night, complains of increasing and very intense pain. The affected area, usually the big toe, is swollen, red and extremely sensitive to touch.
At its first onset, It must be treated in a timely manner to avoid its chronicization by bringing the accumulations of uric acid into other tissues.
The consequences are widespread pain in the affected areas and the formation of gouty nodules.
In addition to damaging the tissues, it can also create problems in the kidneys, going to deposit uric acid inside them and creating an inflammatory state with related complications (gouty nephropathy).
It is the first acute and painful onset of gout . We recall the decisive genetic component among the causes of the disease. The cause of a gout crisis is often linked to nutrition.
The reported episodes are often related to extreme diets, weight loss treatments and excessive consumption of meat and alcohol.
Drugs are also among the possible triggers of acute gout, in particular diuretics which increase the amount of urine excreted but the amount of uric acid excreted remains constant.
A swollen, red and painful big toe is the typical sign of gout. Although, as highlighted in the previous paragraphs, uric acid can also be deposited in other joints and tissues.
If the episode of acute gout, or in the presence of high levels of uric acid, the patient is not treated adequately and in the right times, the gout can become chronic.
So, we’re talking about a consistently high uric acid level which can lead to acute episodes with ever shorter intervals.
The result is widespread joint and tissue damage, followed by tophi (gouty nodules) in various areas of the body such as the ears, elbows, feet and fingers.
The gottos nephropathy in is a disease caused by uric acid deposition in the kidneys, usually as a result of an untreated gout. The result will be the formation of kidney stones with the possible complications of the case, inflammation and renal colic .
In addition, chronic disease can degenerate into osteoarthritis, thus further damaging the joints and bone tissue, decreasing the function of the body segment and worsening the symptoms of the disease itself .
Gout is diagnosed with an initial medical history, a clinical exam, and a blood test. The increase in the uric acid value will confirm the diagnosis hypothesized by the doctor.
The symptomatology of gout is clear but can be confused with pseudogout , the differential diagnosis is therefore important.
To rule out the hypothesis of pseudogout, it will be necessary to collect synovial fluid from the symptomatic joint . If uric acid crystals are reported within the synovial fluid, the diagnosis of gout is confirmed. On the contrary, pyrophosphate crystals indicate pseudogout.
Instead, in cchronic cases , the doctor may prescribe x-rays to assess any damage to the joint.
How gout is treated
In the acute phase, the first goal is to block inflammation locally and thus limit pain.
NSAIDs are the most widely used short-term drugs for the treatment of acute gout. They can be taken orally or injected directly into the joint.
These non-steroidal anti-inflammatory drugs (NSAIDs) inhibit some inflammatory processes and also act as pain relievers.
Recent studies have highlighted possible advantages in the integration of enzymatic therapy with NSAIDs and antirheumatic drugs. Enzymatic therapy would mediate inflammation by precisely increasing the availability of enzymes involved in the inflammatory process and favoring the tissue repair process.
In the event that NSAIDs are not sufficient, the doctor may opt for a treatment based on corticosteroids. Cortisone can be injected and will have a more decisive effect on the inflammatory process but always and only in the short term.
Applying a pain reliever cream can bring relief.
All the aforementioned drugs act only on the symptoms of gout but not on its triggering causes. To do this, it will be necessary to work “upstream”, that is, to try to act where physiological processes lead to an accumulation of uric acid.
Gout: what you can eat and what to avoid
The key to this phase of therapy is the diet supplemented by the administration of drugs, when necessary. Diet and lifestyle are the two aspects to work on to reduce the risk of gout or its aggravation.
The first step should be to follow a diet low in purines, such as derivatives of cereals, milk and eggs.
Instead, to avoid, meat, alcohol and some vegetables such as asparagus and cauliflower
An optimal diet to combat gout does not stop only at the limitation of purines but also at a limitation of sugars , all framed in a diet with reduced caloric intake.
Furthermore, physical activity is important for:
- activate cell metabolism
- improve general health
- get rid of extra pounds.
How to prevent gout
We reiterate how the blame for the origin of gout spills over to the genetics of the individual. So, to prevent it, it is essential to play in advance by investigating among your relatives if anyone suffers from gout or has altered uric acid values.
If the answer is positive, it is advisable to contact your doctor who will prescribe blood tests, if he deems it appropriate.
If your blood results show a high uric acid value you will need to change your lifestyle and diet to reduce the risk of acute gout episodes.
Generally, prevention is based on the same preventive principles of any type of chronic disease related to lifestyle and environmental factors.
A healthy diet, physical activity and a balanced lifestyle are the three pillars of prevention, including gout.