What Is Gout? Why Does It Occur? What Is Its Treatment?

Gout is a type of inflammatory arthritis characterized by pain and swelling in the joints due to uric acid accumulation. Although it most commonly affects the big toe, it can also be seen in different joints such as the knee and ankle. In gout, pain usually occurs in attacks. In some people, the pain can be severe enough to make walking or sleeping at night difficult. Although symptoms may subside after a while, they can recur if not treated.
Although excessive meat consumption is usually the first thing that comes to mind when gout is mentioned, genetic predisposition, health problems affecting kidney function, and certain medications used can also play a role in the development of the disease. Therefore, in treatment, in addition to changing dietary habits, specialist doctors may plan medication therapy to relieve pain and swelling, lower uric acid levels, and prevent new attacks. With regular follow-up and appropriate treatment, it is possible to keep the disease under control.

What Is Gout?

Gout is a common type of inflammatory arthritis that occurs as a result of uric acid crystals accumulating in the joints. Uric acid is a waste product released when chemical substances called purines are broken down in the body. Under normal conditions, two-thirds of the uric acid in the human body is excreted through the kidneys via urine, and one-third is removed from the body through the intestines. If, for any reason, excessive amounts of uric acid are synthesized in the body or if uric acid cannot be excreted from the body as it should be, uric acid crystals can accumulate in the joints and cause gout, a painful type of arthritis.
Gout is the most common type of inflammatory arthritis among adults. Some studies report that gout is approximately 3-4 times more common in adults than rheumatoid arthritis. The history of the disease dates back to Ancient Egypt. In the past, it was also known as the "Disease of Kings" because it was associated with meat-heavy tables and excessive alcohol consumption, which were mostly accessible to wealthy people.
Today, because more people can access meat and meat products and the consumption of health-damaging products such as alcohol has become widespread, gout is also seen in people from different segments of society. However, reducing gout solely to lifestyle habits would be misleading. Gout can also be seen in people who do not consume excessive meat due to certain health problems that make it difficult to remove uric acid from the body or certain medications used.

What Are the Symptoms of Gout?

Gout usually manifests itself with sudden-onset joint pain and swelling, redness around the joint. In some patients, joint tenderness may accompany the pain. Patients may have difficulty even when stepping on their feet, walking, or wearing shoes. However, gout may not always show symptoms. There are also patients with hyperuricemia, meaning high blood uric acid levels, who do not show any symptoms. In most patients, symptoms have a sudden onset and usually occur at night.
The first attack usually occurs in the joint where the big toe connects to the foot. However, complaints can also arise in different areas such as the ankle, knee, fingers, elbow, and wrist. During an attack, usually only one joint is affected. The main symptoms of gout can be listed as follows:

• Sudden-onset joint pain that gradually intensifies,
• Swelling in and around the affected joint,Redness and burning sensation in the skin over the joint,
• Pain that increases even with a light touch,
• Stiffness in the joints, difficulty when bending or moving the joint,
• Itching and peeling of the skin around the joint as the attack subsides.

The severity and duration of symptoms can vary from person to person. In some patients, symptoms disappear completely after an attack, while in patients who remain untreated for a long time, joint pain and movement restriction can become permanent.

What Are the Types of Gout?

The course of gout can vary from person to person. While some patients continue their lives for years after the first attack without any problems, in others gout attacks may recur more frequently. To evaluate the course and severity of the disease, experts generally use the terms acute and chronic gout.

What Is Acute Gout?

In acute gout, pain starts suddenly and reaches its most severe level within 12-24 hours. Symptoms such as pain, swelling, and redness usually affect a single joint. During attacks, using the affected joint can be quite painful for patients. For example, a patient with an affected big toe may not want to step on their foot due to pain. Acute gout symptoms usually subside on their own within 1-2 weeks. However, the disappearance of symptoms does not mean
that the disease has healed; there is a risk of new attacks occurring in the following periods.

What Is Chronic Gout?

When gout is not kept under control for a long time, crystal accumulation in the joints can cause permanent damage. In this case, pain, stiffness, and difficulty moving can continue both during and between attacks. While the disease initially usually affects a single joint, when untreated and when it becomes chronic, it can affect more than one joint.
In addition, hard swellings called tophi can form when urate crystals accumulate under the skin. Although these swellings are initially painless, if appropriate treatment is not applied, they can lead to deformities in the joints over time.

Why Does Gout Occur?

Gout occurs when uric acid, the waste product of substances called purines, forms crystals in the joints and surrounding tissues. The crystals accumulating in the joints activate the immune system and initiate an inflammatory response. As a result, symptoms such as pain, swelling, and redness develop.
There can be many different reasons for high uric acid levels in the blood. The body producing too much uric acid, uric acid not being removed from the body sufficiently, and excessive intake of purines through food are among the main causes. Therefore, the causes and risks of gout cannot be explained by a single factor. Many factors such as genetic predisposition, kidney diseases, dietary habits, and certain medications used can increase the risk of developing gout. The main causes of gout can be explained as follows:

• Uric acid not being removed from the body sufficiently: One of the most common problems encountered in gout patients is that the kidneys cannot remove uric acid from the body sufficiently. Especially in people with chronic kidney disease, blood uric acid levels may be higher for this reason. However, uric acid excretion may also be low in people without kidney disease due to hereditary characteristics.
• Excessive uric acid formation in the body: Purines are not only taken into the body through food. They are also naturally present in the body's own cells. Situations in which cells break down faster than normal cause more purines to be released and the amount of uric acid formed by their breakdown to increase. Although the exact reason for excessive uric acid synthesis in the body is not known, there are studies showing that health problems such as leukemia, lymphoma, and psoriasis may increase this risk. In addition, health problems such as hemolytic anemia, in which red blood cells break down earlier than normal, and some cancer treatments can also increase uric acid production. In rarer cases, there may be hereditary problems in the enzymes involved in the breakdown of purines.
• Excessive consumption of foods rich in purines: Organ meats such as liver and kidney, red meat, and some fish such as anchovies and sardines contain high amounts of purines. Frequent and high consumption of these foods can increase the amount of uric acid formed in the body.
  Sugary drinks: Excessive consumption of carbonated drinks sweetened especially with fructose and other sugary drinks can also raise uric acid levels.
• Alcohol use: Alcohol consumption can both increase uric acid production and make it harder for the kidneys to excrete uric acid. Especially consuming large amounts of alcohol in a short time can cause symptoms to restart in people who have had a gout attack before.
• Genetic predisposition: Gout is more common in people who have gout in their family. This is because some characteristics that affect the formation and removal of uric acid from the body are passed between family members. Some studies show that approximately 40-50% of people with gout also have a family history of gout.
• Age and gender: Uric acid levels are generally higher in men compared to women. Accordingly, gout can be seen at earlier ages and more frequently in men. In women, the risk of developing the disease increases after menopause as uric acid levels rise.
• Certain medications used: Some diuretics and certain immunosuppressive drugs used after organ transplantation can reduce uric acid excretion. High-dose vitamin B3, namely niacin, can also raise uric acid levels. However, it is important not to discontinue these medications without a doctor's recommendation. When necessary, a specialist doctor can review the medications used and prepare a treatment plan suitable for the patient.
• Being overweight: People with a high body mass index can synthesize more uric acid, and removing uric acid from the body can be more difficult.

In addition to those listed, health problems such as hypertension and diabetes can increase gout risk when not kept under control.

How Is Gout Diagnosed?

In patients presenting with complaints such as joint pain, swelling around the joint, and redness, the specialist doctor first begins by taking the patient's medical history. Questions may be asked about when the pain started, whether they have had similar attacks before, whether they have any chronic disease, and the medications they regularly use.
The sudden onset of pain, reaching its most severe level within 12-24 hours, and especially the involvement of the big toe during the first attack may suggest gout. However, other health problems such as joint infections can also cause similar symptoms. Therefore, in some patients, experts usually resort to additional tests to confirm the diagnosis. The main methods used for gout diagnosis are as follows:

• Blood tests: A blood test can be performed to measure the uric acid level in the blood. However, high uric acid alone is not sufficient to diagnose gout. Some people with high uric acid may not develop the disease.
• Examination of joint fluid: A fluid sample can be taken from the painful and swollen joint with the help of a thin needle. The sample taken is examined under a special microscope to see whether uric acid crystals are present. Seeing crystals in the joint fluid confirms the diagnosis of gout. When infection is suspected, a culture examination can also be performed from the same fluid.
• Imaging methods: When joint fluid cannot be obtained or the diagnosis is not clear, methods such as ultrasound and computed tomography can be used. Imaging methods help show crystal accumulation in the joint and surrounding tissues. Especially in long-standing gout, X-rays can be used to evaluate possible damage occurring in the joints.

When gout is not kept under control for a long time, it can increase the risk of health problems such as kidney disease as well as deformities in the joints. Therefore, it is important for patients showing gout symptoms to consult a specialist doctor without delay.

What Is the Treatment for Gout?

Gout treatment can vary depending on the severity of the disease, the underlying cause, and the duration of symptoms. The aim of treatment is to control symptoms and reduce the frequency of attacks. As is widely known among the public, changing dietary habits is primarily important in the treatment of gout. In fact, by changing dietary habits, the goal is to lower the uric acid level in the body. Especially limiting foods and drinks that can raise uric acid levels can help reduce attacks.
Changes made in diet are not sufficient alone in every patient. When necessary, specialist doctors may apply medication therapy both to relieve complaints during an attack and to lower uric acid levels. The main gout treatment methods are as follows:

• Medications that reduce inflammation in the joint can be used during an acute gout attack. These medications can help relieve pain, swelling, and tenderness.
• Depending on the patient's condition, oral medications may be preferred, and in some cases, injection directly into the joint may also be performed.
• Long-term medication therapy may be necessary in patients who have frequent attacks, have tophi, or develop gout-related joint damage. For this purpose, medictions that reduce uric acid formation in the body or make it easier for the kidneys to remove uric acid can be used. In some patients who do not benefit sufficiently from other treatments, treatments that break down uric acid may be considered.
• During uric acid-lowering treatment, blood values are checked at regular intervals. Generally, the goal is to keep the uric acid level below 6 mg/dL. In patients with tophi or ongoing attacks, doctors may aim for the uric acid level to be even below this value. Even if pain and swelling subside, it is important not to discontinue long-term treatment without a doctor's recommendation.
• Avoiding organ meats such as liver and kidney and limiting the consumption of red meat and some seafood can help control uric acid levels. Instead, vegetables, whole grains, low-fat dairy products, and appropriate amounts of legumes can be included in meals. In addition, reducing sugary drinks and alcohol consumption is important.

Attacks may temporarily occur in the initial period of starting uric acid-lowering treatment. This does not mean that the treatment is not working. The specialist doctor may prescribe additional medications for a while to reduce the risk of attacks. It is important for patients to share their complaints with their doctors during this period and to continue using their medications as recommended.

What Is Good for Gout?

In addition to the treatment recommended by doctors in gout, some measures that can be taken in daily life can also help relieve symptoms. Especially during an attack, resting the painful joint and applying cold compresses to the area can reduce pain and swelling. The main methods that may be good for gout are as follows:

• Resting the affected joint: Putting weight on the painful joint during a gout attack can increase the severity of symptoms. For example, patients with affected foot joints avoiding standing for long periods and movements that strain the foot can help them feel relief.
• Applying cold compresses: Holding an ice pack wrapped in a towel over the painful joint can help relieve pain and swelling. To prevent skin damage, it is important that the ice does not come into direct contact with the skin and that the application does not exceed 20 minutes at a time.
• Keeping the affected area elevated: Especially patients with swelling in the foot and ankle can place a pillow under their legs while resting. Keeping the affected area elevated can help reduce swelling.
• Drinking enough water: Dehydration can trigger a gout attack. Therefore, it is important to drink water regularly throughout the day. However, patients whose fluid intake is limited by a doctor due to a reason such as kidney disease must comply with the recommended amount.
• Paying attention to movement: Although it is necessary to rest the joint during an attack, regular exercise is recommended between attacks. However, it is important to avoid exercises that put too much load on the joints or cause excessive strain.

Recurrent attacks in gout can over time cause damage to the joints and movement restriction. Therefore, if you notice sudden-onset pain, redness, or swelling in your joints, you can apply to the specialist doctors of Yeditepe University Hospitals and have the necessary checks done.