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Gout

Ultimate Gout Guide – The Disease of Uric Acid Elevation and Accumulation

Gout was long considered as the disease of the rich people. Nowadays it’s no longer like that but still common in countries with a higher standard of living. “Guilt” of it is mainly the prevailing eating and drinking habits.

Overview

Gout was considered a disease of the wealthy. Until the end of the 17th century, no distinction was made between rheumatism and gout. Only a century later, in 1797, researchers discovered for the first time that uric acid crystals are found in the gout nodes that may develop during the course of the disease. Fifty years later it became clear that gout was a metabolic disorder. Until then, it was considered a “disorder of the humors”. However, early on it was known that there was a connection between the disease and increased consumption of meat and alcohol.

What is Gout ?

Gout is a metabolic disease . It accumulates too much uric acid in the blood . This form uric acid crystals that are at various points accumulate – especially in joints, bursae, tendons and internal organs.

The deposits typically lead to painful joint inflammation , which, if  left untreated, can lead to joint damage (so-called  arthritis urica ). Also in  internal organs , the crystals can be stored, for example, in the kidney , and cause malfunction.

If there is too much uric acid in the blood, doctors talk about hyperuricemia. Hyperuricemia either arises because the body produces excess uric acid or because it can not secrete enough uric acid.

Only when the uric acid concentration has exceeded a critical value, the first symptoms appear – in the form of an acute attack of gout : Affected suffer suddenly, as if out of the blue, severe pain in a joint, for example, the foot. Even small touches can intensify the pain. The painful area swells, becomes hot and discolored. After a few days, the attack has subsided and it can take a long time until another seizure occurs. Only rarely does a gout become  chronic . Then those affected suffer from permanent pain and joint changes.

How common is Gout ?

Gout is much more common in high-living areas than in developing countries. This is due to the different diet, especially the excessive consumption of foods such as offal and meat as well as alcohol can promote the development of gout.

Mainly older people are affected. Men develop gout more often than women.

Causes

A gout always develops when the body either

  • too little uric acid excretes  – which is the case in  most  people with gout – or
  • Too much uric acid forms  – but this is  rare  and occurs for example in the primary pediatric gout (so-called  Lesch-Nyhan syndrome ).

If the uric acid level is too high,  uric acid crystals form . They are the causes of the typical gout complaints: The crystals are deposited mainly in joints, bursa and tendons and can lead to painful  joint inflammation  .

Types of Gout

Physicians distinguish  two forms of gout: primary and secondary gout.

The  primary gout  (also: primary hyperuricemia) arises from hereditary predisposition. The body makes more uric acid than it excretes. As a result, uric acid accumulates in the body. The primary gout is the most common form of the disease.

The rarer  secondary gout  (secondary hyperuricemia) arises as a result of other diseases or medications. For example,  kidney disease  or  type 2 diabetes  may cause the kidneys to excrete less uric acid, increasing blood levels. Secondary gout can also occur when many of the body’s own cells die off – such as  leukemia  – so that many purines form in the body:  Purines  are natural substances that the body (in normal cell metabolism) produces itself and (via the so-called purine metabolism) to uric acid degrades. The more purines in the body, the more uric acid so arises.

Gout often has hereditary causes. An acute attack of gout can be triggered eg by purine-rich food.

Man absorbs purines through food. Although foods containing purine are not considered to be direct causes of gout, they can promote a gout attack  .

Anyone who is hereditary and is fed purine-rich, permanently increases his uric acid levels and thus promotes a gout attack.

Gout Attack Trigger

A gout attack can be favored by certain factors. Which includes

  • excessive alcohol consumption ,
  • the consumption of large quantities of purine-rich foods,
  • strong physical effort and
  • a high  weight loss , such as  fasting .

Typical Symptoms

Those who have gout, initially no symptoms. This  asymptomatic phase of gout can last for  years to decades  . During this time, the uric acid level in the blood increases unnoticed – it creates a so-called  hyperuricemia.

Acute gout attack

Significant symptoms of gout occur only when the uric acid concentration reaches a critical value: Then  uric acid crystals form , which can accumulate in the joints and  trigger an  acute attack of gout . Frequently, the metatarsophalangeal joint on one foot is affected (so-called podagra or foot gout).

Typical symptoms of an acute attack of gout : The joint

  • is inflamed,
  • feels hot,
  • turns suddenly red to bluish and
  • swells.

Symptoms of gout show up only when the uric acid concentration has exceeded a critical value. An acute attack of gout often occurs at the base of the big toe.

In about 90 percent of gout attacks, the uric acid concentration in the  blood is significantly increased. The symptoms of a gout attack occur in most cases  completely surprisingly  in apparently healthy people.

The causes of an acute gout attack include excessive high-fat food or excessive alcohol consumption , which increase the uric acid level. Also physical exertion can favor a gout attack.

Without treatment, it may take one to two weeks for symptoms of inflammation to resolve. This is usually followed by a period lasting months to years, during which no symptoms appear (so-called intercritical phase ).

Chronic gout

Only with long unrecognized or insufficiently treated gout can the disease become chronic. Typical symptoms of chronic gout are permanent pain and permanent joint changes that increasingly affect the function of the joint. The pain occurs both at rest and during exercise. However, chronic gout is  rare  .

Gout Tophus 

Chronic gout can cause uric acid crystals to build up and form gout nodules at the tendon attachments near a joint, such as the elbow, hand and foot . These are also called Gicht Tophi.

What are Gout Tophus ?

Gout Tophus are painless, hard nodules of less than one centimeter in size, which  lie just below the skin . If the gouty knots break open, a white mass that consists predominantly of uric acid is emptied.

Gout Tophus can also form outside of a joint: they often appear at the edge of the ear cartilage. Eyelids and nostrils may also be affected.

Diagnosis of Gout

The first suspicion of gout usually arises when the typical symptoms of acute gout attack occur. The first gout attack usually occurs on the big toe: The metatarsophalangeal joint becomes inflamed and hurts.

In gout, the uric acid level in the blood is usually increased (so-called hyperuricemia). To find out if it really is gout, the doctor will take a  blood sample to determine uric acid levels. The uric acid levels are considered elevated when they

  • in women over 6 milligrams per 100 milliliters of blood serum and
  • in men over 7 milligrams per 100 milliliters of blood serum.

The higher the uric acid level, the greater the likelihood of having an acute attack of gout.

In addition, the doctor can detect uric acid crystals in affected joints by examining synovial fluid.

In the further course of the gout causes increasingly recognizable changes in the joints and gout nodes, which can then be seen on the radiograph  . If, atypically, only the finger joints are affected by the nodules, the physician will possibly initiate further examinations to rule out possible other causes (eg arthritic changes of the finger joints).

Treatment

Even if the first symptoms of gout have disappeared by themselves,  early treatment isrecommended. The reason: Without therapy, gout can permanently damage the joints and also internal organs.

The goal of treating gout is to

  • to lower the  elevated uric acid level in the  blood
  • the relieve discomfort .

What to do with a gout attack ?

If your uric acid level has risen so much from the gout that a gout attack has developed, a quick therapy can relieve your acute symptoms. The acute (initial) treatment should start as early as possible. There are various medications available:

  • (non-steroidal) anti-inflammatory drugs  (NSAIDs):  Anti-inflammatory NSAIDs, such as naproxen  or  diclofenac , are the first-choice drug to relieve pain in gouty attacks. Alternatively, so-called COX-2 inhibitors can be used.
  • Cortisol-containing (steroidal)  glucocorticoids :  In addition or as an alternative to NSAIDs, the doctor may prescribe cortisone supplements. As a rule, these then contain the active ingredient prednisolone .
  • Colchicine :  In an acute attack of gout, colchicine is a very effective remedy for joint pain. The active substance is obtained from a plant, the Herbstzeitlose. Unlike in the past, colchicine is only used today because of its many side effects (eg abdominal cramps , diarrhea ), when other medicines are not an option.

Acetylsalicylic acid medications  are  not  suitable for initial gout treatment – on the contrary, taking this remedy for pain associated with gout can increase levels of uric acid in the blood – increasing the risk of recurring gout attacks.

As a rule, the symptoms disappear quickly through the medication, usually within one day. However, the uric acid level in the blood does not drop  .

Gout Attack: You can do that yourself

To the initial treatment  support , you can do something like:

  • Cool the inflamed joints with envelopes.
  • Store arms or legs or arms in a quiet position.
  • Drink a lot, but do without alcohol .

Long-term therapy

In case of gout, it is not only important to treat the acute attack. Permanent treatment should prevent further attacks of gout. In addition, the doctor wants to avoid that the gout becomes chronic. For this it is necessary to lower the elevated uric acid level in the blood and to stabilize it in the long term. Among other things, diet plays a major role. In some cases, additional medication is needed.

The goal of long-term therapy is  to bring your blood sugar uric acid to a value between 5.5 and 6 milligrams per deciliter – then you are well-adjusted.

Diet

A low-purine, healthy diet is the basic requirement for long-term therapy to be successful. Low-purine diet lowers and stabilizes the level of uric acid and has a beneficial effect on the development of gout so that you can take less medication or even give it up altogether.

The following nutritional rules should heed people with gout:

  • Remove excess weight  from : If your body weight to a  body mass index  equal to (BMI) of over 25, you should something  slimming . Alone by this measure the uric acid level in the blood drops. Proceed with the  weight loss  but cautiously: Strict  fasting  is not advisable. Move yourself!
  • Limit the amount of fat  in your food! Too much  dietary  fat inhibits the excretion of uric acid via the  kidneys  and thus increases the uric acid levels in the blood.
  • Pay attention to purinary food! Avoid purine-rich foods, such as meat such as offal, liver or kidney. By eliminating certain types of fish, you also help keep your uric acid levels at a safe level.
    • The following foods are rich in purines  : green peas, beef fillet, pork schnitzel, veal sirloin, roast chicken, veal liver, pork kidney, salami, trout, herring, haddock, anchovies and anchovies.
    • Purine-free or low-purine  foods include noodles (from durum wheat semolina), rice, oatmeal, mixed bread, potatoes, cauliflower, carrots, tomatoes, apples, bananas, orange juice, dairy products (drinking milk, buttermilk,  yogurt , cheese), eggs and dark chocolate.
  • If possible, avoid alcohol because alcohol increases the concentration of uric acid in the blood. This is especially true for beer and high percentages. Alcohol excesses and permanent alcohol consumption are unfavorable, since they can trigger a seizure in gout.
  • Even the smoking you should set as possible.
  • Vegetarian food is generally considered cheap.
  • Drink a lot,  at least  2 liters daily . Recommended are mineral water, unsweetened herbal tea or fruit tea. Black tea , coffee or cocoa you can also enjoy carefree: The purines it contains do not  rebuild the body  to uric acid, so they do not adversely affect the uric acid level. Caution: Sweetened drinks or fruit juices should only be consumed in moderation.

Who suffers from the disease should reduce any excess weight – for example, by plenty of exercise and a purinarme diet!

Drugs

If the uric acid levels cause discomfort and / or are far too high, medicines are suitable that can lower the uric acid level in the long term. These include:

  • Uricostatic drugs eg Allopurinol, Febuxostat : These drugs work against gout by inhibiting the formation of uric acid. The resulting increased precursors of uric acid are much better water-soluble and can be excreted more easily via the kidneys.
  • Uricosuric drugs eg  Probenecid, Benzbromarone : These drugs work against gout by promoting increased excretion of uric acid.

Complications

A gout can subsequently lead to various complications, especially if left untreated. In addition to pronounced joint damage (arthritis urica)  kidney stones  can arise. If too much uric acid  deposits in the  kidneys , the  kidneys may fail  (so-called chronic  gout ).

How to prevent ?

Most people with gout have a hereditary predisposition. Therefore, it is not possible to prevent gout to 100 percent.

However, if you already have gout, you can do some things to prevent acute gout attacks or chronic gout. If your doctor has prescribed medication for you: be sure to take the medicine regularly.

In addition, diet plays  an important role – not only in the treatment, but also to prevent gout attacks or chronic gout. With a suitable nutritional plan, you may be able to influence the gout so positively that you need to take less or even no medication.

You can prevent new gout attacks by following these tips:

  • Weight Loss : It is important that your  body mass index  (BMI) is less than 25.
  • Pay attention to a low- purine diet: In gout, eat purine-  rich foods only in small quantities, as the body converts the purines contained in the diet into uric acid. If you follow a low-purine diet, this helps to lower or stabilize the uric acid level.
  • Take a lot of fluids:  Drink a lot, at least two liters a day, preferably in the form of mineral water, herbal tea and / or fruit tea.
  • Do not drink alcohol if possible with Gicht , especially no beer or spirits.

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