Gout

Gout is a metabolic disorder that inflames the joints. When an attack occurs the joints swell up within a few hours and become extremely tender. Tiny, needle-shaped crystals made from uric acid, which tend to be deposited in the joints, trigger the inflammation.

At a glance

  • Gout is a metabolic disorder that inflames the joints.
  • Gout is the most common inflammatory joint disease (arthritis) in Germany.
  • When an attack occurs certain joints swell up within a few hours and become extremely tender.
  • Tiny, needle-shaped crystals made from uric acid, which tend to be deposited in the joints, trigger the inflammation.
  • The inflammation usually dies away completely, by itself, within one to two weeks.
  • Medication can alleviate the pain.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Gout: two bare feet of a man standing on the ground.

What is gout?

Gout is a metabolic disorder that inflames the joints. When a gout attack occurs certain joints swell up within a few hours and become extremely tender. Tiny, needle-shaped crystals made from uric acid, which tend to be deposited in the joints, trigger the inflammation. These crystals can form when there is too much uric acid in the body. The inflammation usually dies away completely, by itself, within one to two weeks. Medication can alleviate the pain.

Most people with gout suffer acute attacks once in a while. There may be months or even years between them. However, they can occur more frequently, too. There are various ways of preventing attacks. Some people who are affected, for example, cut out particular foods and other potential triggers. Others take medication that lowers the uric acid level over the long term. This option is of particular interest when gout attacks are frequent, but also in the case of complications such as chalkstones or kidney stones.

Many people have high uric acid levels but no pain. There is debate as to whether these levels mean anything for one's health. They do not need any treatment.

What are the signs of gout?

Gout attacks often occur at night or early in the morning. The joints suddenly swell up very painfully. The inflamed joints are then tender, hot to the touch and reddened. The swellings and pain is usually worst after six to twelve hours. The joints are often so sensitive that even the pressure from bedclothes is almost unbearable. If the swelling goes down after a few days the skin can become slightly flaky in that area.

The first gout attack often only affects one joint, usually the lower joint of the big toe. But the metatarsus and ankles, hand and finger joints, knee and elbow can also become inflamed. Gout attacks in the shoulders and hips are rare. In patients that suffer from chronic gout the joints are permanently slightly inflamed. Over time the joints may then become deformed and the sufferer's mobility can become restricted.

What are the causes of gout?

Gout can occur when the blood contains too much uric acid. However, according to estimates, only about one third of all those with a high uric acid level suffer from gout.

Uric acid is a by-product of the so-called purines. They are a component of key elements in the body, nucleic acids.

Some of the uric acid is normally excreted with urine. But as some people's kidneys do not excrete enough uric acid, the level increases. If a certain threshold is crossed the uric acid can form crystals that are deposited in the body's tissues. The crystals usually accumulate in the joints and can then trigger a gout attack.

Certain illnesses can also contribute to raising uric acid levels, for example blood disorders or cancers such as leukemia. In rare cases gout occurs because the body is producing too much uric acid. This may be due to a hereditary disease in which the function of certain proteins (enzymes) that are related to uric acid metabolism is faulty.

Other factors apart from the uric acid level play a role in gout. For example, if the joint tissue contains too little fluid, uric acid crystals tend to form. The acidity level (pH value) of the joint fluid and the joint temperature also affect the illness.

What increases the risk of suffering from gout?

Risk factors for gout include medication that increases uric acid levels, meat, fish and seafood, alcohol and sugary drinks, being overweight.

Gout is fostered by any factor that increases the uric acid level. In people who already suffer from gout, they increase the risk of further attacks. Scientifically proven risk factors for gout include:

Medications that raise the uric acid level

  • particularly diuretics
  • acetylsalicylic acids (ASA)
  • specific drugs that are used after an organ transplant
  • levodopa, the Parkinson's drug
  • cancer drugs

Meat, fish and seafood

These foods contain a lot of purine. When eaten in large quantities they slightly increase the risk of suffering from gout. In studies, purine-rich plant-based foods showed no impact on the occurrence of gout.

Alcohol

Alcoholic drinks promote the formation of uric acid and act as diuretics. Moreover, when alcohol is consumed, the kidneys excrete less uric acid. Beer, in particular, also contains a relatively large amount of purine. Studies show that beer and high-percentage alcohol can foster gout. Wine drunk in moderation does not appear to have any effect.

Sugary drinks

Drinks containing a lot of (fruit) sugar can also slightly increase the risk of gout. This applies both to colas and to fruit juices. Drinks sweetened with saccharin have no effect on gout.

Overweight

Excess weight increases the risk of gout. The risk rises along with an increase in the body mass index.

Certain foods and other factors can, indeed, slightly increase the risk of gout and gout attacks. However, what is most important is that the kidneys function well so that they can reliably excrete excess uric acid.

How common is gout?

Approximately 1-2% of people over 40 have gout.

Gout is the most common inflammatory joint disease (arthritis) in many industrialized countries, including Germany. According to estimates, one to two percent of the population are affected. Men suffer around five times more than women, and usually earlier. In men, gout usually occurs from the age of 40 onwards, while in women it is only after the menopause. This is due to hormonal influences on the kidneys.

How does gout develop?

The joint usually recovers from an attack of gout, all by itself, within one to 2 weeks. Most people who have had a gout attack suffer another one 6 months to 2 years afterwards. Repeated attacks can affect multiple joints and last somewhat longer.

After about 12 years gout may become chronic and damage the joints. However, acute gout does not become chronic in every sufferer. The risk of chronic gout depends, for instance, on how elevated the uric acid level is.

A potential consequence of gout is chalkstones. These are uric acid deposits in the soft tissue. These develop over a period of years. Chalkstones are not usually painful. They particularly occur in the toe and finger joints, the elbow, the Achilles tendons and on the ear.

Consequences

If gout becomes chronic and the joints are damaged, this restricts the sufferer's mobility. This can also weaken the muscles.

In rare cases uric acid crystals are deposited in atypical parts of the body. For example, if chalkstones form in the spinal cord area they can press on the nerves and cause signs of paralysis. In the case of chalkstones in the carpal tunnel in the hand joint, carpal tunnel syndrome may develop.

Gout patients also have an increased risk of kidney stones. Kidney stones can be painful and foster urinary tract infections. On average just under one man in every 100 who suffer from gout will develop kidney stones within a year.

How is gout diagnosed?

Doctors can often detect an acute case of gout from the risk factors and typical symptoms. A relatively reliable indication of gout is, in particular, a painful, reddened swelling on the lower or end joint of the big toe.

Gout is unequivocally proven by a joint puncture. This involves using a fine hollow needle to extract fluid from the joint and examine it in a laboratory. When uric acid crystals are found in the joint fluid, “gout” is diagnosed. A joint puncture is done when the condition is uncertain – or also to exclude other potential causes. These mainly include joints infected by bacteria, which may occur due to injury, for instance. This type of infection should be treated rapidly.

Ascertaining the uric acid level in the blood is not conclusive enough, because the level often drops to the normal range during a gout attack.

How is gout treated?

Gout treatment has various goals:

  • In the short term it aims to alleviate pain when a gout attack occurs.
  • In the long term it aims to prevent attacks, and also to reduce the risk of chronic inflammations and joint damage.
The following methods are used to treat gout: non-steroidal anti-inflammatory drugs (NSAIDs), cortisone products, medication for lowering uric acid levels, changes to diet.

Short-term gout treatment

Gout attacks are treated with anti-inflammatory drugs. These include

  • non-steroidal anti-inflammatory drugs: for example ibuprofen, indometacin and naproxen
  • cortisone products: usually tablets with the active ingredient prednisolone
  • gout drug colchicine: but because it takes effect more slowly and can have side effects, colchicine is no longer used so often.

If pain medication is not enough to alleviate the pain, more than one agent can be combined to provide treatment. It also probably helps to cool the affected joints. Many sufferers find this to be pleasant, at least.

Long-term gout treatment

Long-term gout treatment aims to prevent gout attacks and complications by reducing the uric acid level. This may be done as follows:

  • Changes in diet: particularly, by eating less meat, fish and seafood and drinking less alcohol.
  • Taking medication that reduces uric acid: usually allopurinol.

Not every sufferer needs drugs to reduce uric acid. These products are usually not needed after the first gout attack, in particular. This is because some gout patients have few or no problems for years afterwards.

Medication that reduces uric acid can particularly be used when gout attacks are frequent or especially painful. These products are also useful when there are complications such as chalkstones and kidney stones, or when kidney functionality is limited. Medication is also an option when dietary changes are insufficient.

For more detailed information, for example on treating an acute attack of gout, go to gesundheitsinformation.de.

How does one live with gout?

When a person has a gout attack the pain can be very debilitating and make many everyday activities impossible. Walking, cycling, putting shoes on or gripping and holding something may become a challenge. Over time, some patients develop a sense of when a new gout attack is about to occur.

But gout attacks do not just impose physical limitations. They can also affect sleep and harm the patient's mood. Sufferers are usually unable to go to work or do household chores. It can be an advantage to tell friends and family members how painful the illness is. They will then be able to understand more easily why the sufferers need to look after themselves and why they need peace and quiet. Gout sufferers ought not to feel guilty because they cannot work or are less available to partners and family.

Gout attacks can change one's own body image. In particular, it can be difficult for young people to have an illness which tends to be viewed as an older person's illness.

The gesundheitsinformation.de site has reports from two women who suffer from gout.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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