Gout: Could You Recognize This Complex Form Of Arthritis?

Terry, a 59 year old man, started experiencing pain so excruciating that he could hardly walk around a year ago. He went to see his family doctor, who suggested that he was suffering from arthritis. He had blood work done, but remained without a clear diagnosis and without a treatment plan. The pain seemed to fade away after a while, and he hoped that it was nothing more than a freak episode. Unfortunately, he was wrong: six months later, the pain returned with a vengeance. 

By this time, some joints on his right foot were so swollen that he wasn't able to wear his shoes any more. This, it was obvious, was a sign that it was time to see the doctor again. After further blood tests, it turned out that Terry had gout. 

What Is Gout?

Terry's doctor had initially been right: gout is indeed a form of arthritis, but a complex form. Repeated attacks of excruciating pain, redness, swelling, and tenderness in joints are the tell-tale signs of this condition. Though it can strike anyone of any age, gout is more common in men. It's cause? Too much uric acid in the patient's blood. This excess alone isn't a guarantee that someone will end up with gout, though. Uric acid is formed from purine, a substance that's naturally present in the body as well as in some foods. The body normally dissolves purine, after which it is eliminated by the kidneys. When that doesn't happen, the uric acid can cause urate crystals, which accumulate in the joints and cause gout.

The fact that Terry is a man put him at a higher risk of gout, but his other risk factors could have been taken out of a textbook as well: he's overweight, he used to be a fishmonger and still loves eating fish, drinks beer almost every night, and he's on diuretics for his high blood pressure. 

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Could You Have Gout?

The onset of symptoms is almost always very sudden, and may occur at night. Severe joint pain is a big one, and though it often affects the joint of the big toe, it can also strike other parts of the foot, the hands, the knees, or the wrists. A gout-stricken joint will be red, warm, swollen, and tender, and discomfort can persist for weeks — even when an attack subsides. Subsequent attacks are likely to last longer and leave worse and longer lingering consequences. As the condition progresses, patients will see a decreased mobility of the affected joints. 

Gout: Treatment Options And Lifestyle Changes

In the absence of medical treatment, gout attacks can strike over and over again, sometimes progressively worsening. Joints can be eroded and ultimately destroyed, and the build-up of urate crystals can lead to nodules around the affected joint, called tophi. During flare-ups, these tophi can be sore and painful, and during resting periods, they can simply get in the way. Because urate crystals can also biuld up in the kidneys, kidney stones are another complication of gout. 

Should you recognize the gout symptoms laid out above, it's important to make an appointment with your doctor even if symptoms subside, because they can return and cause damage that could have been prevented. Tell your doctor about your symptoms, and if you already suspect gout, say so. 

Blood tests, fluid samples from the affected joint(s) and a discussion about symptoms and medical history can all be part of the diagnostic process. X-rays and CT scans may also be employed.

Gout Treatment Options

Terry was told to go on a diet to ensure his purine intake was lowered, as well as to lose weight. Cutting out yeast, spinach, fish, and meat isn't easy for him, and he hasn't yet given up beer. At first he was determined to make the right lifestyle changes, but now that his gout has confined him to the house — it's winter where he lives, so too cold to go without shoes, and he's embarrassed too — he sees beer and fish as one of the remaining pleasures in life.

He is, however, trying to lose weight, and he has also increased his water intake in accordance with his doctor's advice. In addition, again as his doctor advised him, Terry has started drinking more coffee, "at least five a day", as his doctor said. Coffee lowers uric acid levels, and the ability to drink more coffee may just be one of the upsides of having gout.

Should he make the remaining necessary lifestyle changes successfully, he will contribute to reduced symptoms. The same applies to you, if you have gout. 

These include Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation, and a pain medication called Colchicine for acute attacks. Colchicine is very effective at treating pain resulting from gout, but it can also cause side effects such as nausea, vomiting, and diarrhea that makes some patients unwilling to take it. In this case, higher doses of NSAIDs can come to the rescue as well.

Corticosteroids are another much-relied upon form of medication for gout patients. These medications, such as Prednisone, can reduce both inflammation and pain. When injected, corticosteroids can bring near-instant relief, but they can also be taken orally. Corticosteroids do, also, come with side effects such as mood swings, an increased blood pressure, and increased blood sugar levels. That is why Terry, who already has high blood pressure and depression, was not prescribed corticosteroids. 

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Medications called xanthine oxidase inhibitors, meanwhile, can help people who have suffered repeated gout attacks by blocking the production of uric acid in the body. Probenecid, meanwhile, doesn't block uric acid production but does help the kidneys remove it from the body. 

Before deciding on medication together with your doctor, be sure to discuss the benefits and side effects in detail. When you take the right medications before any joint damage occurs, and make the advised lifestyle changes alongside taking your medications, gout can often be treated very well.