This article is all about Gout. It looks at what the condition is, what the symptoms are, why people get it and how we treat it. The information is also presented in video format below.
What exactly is Gout ?
Gout is caused due to a build up a chemical found in the blood, called uric acid. We all have uric acid in our blood. It’s produced when our body breaks down chemicals called purines which are found in certain food and drinks, particularly red meat, oily fish, yeast products and alcohol especially beer but also spirits.
If the uric acid in our blood reaches a certain concentration it can start to crystalise and form tiny sharp crystals that that have a tendency to become concentrated in the joints.
The crystals form more easily in colder temperatures and they also need a roughed surface to crystalise on. And the coldest, roughest joint we have in our bodies is the MTP joint of the Big toe. It’s cold, because it’s far from the warmth of the body and it’s rough because it’s one of earliest joints to succumb to osteoarthritis.
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| Gout affecting the Big Toe MTP joint |
Gout can theoretically affect any synovial joint in the body but it’s the colder joints that are most commonly affected; the Toes, the Foot & Ankle Joints, the Finger Joints, the Wrists and Elbows.
When gout affects the joints, it tends come in episodes called gout attacks. And the symptoms of a gout attack are pain, redness and swelling around the joint. As I mentioned earlier, the big toe MTP joint is the most common joint affected by gout, and the pain can be really severe.
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| MTP joint Redness & Swelling |
The picture below, by British artist James Gillray in 1799 is called ‘The Gout’ and is his interpretation of what a big toe feels like during a gout attack.
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| 'The Gout' - James Gillray, 1799 |
The other common symptom that you see with gout are soft tissue swellings called bursitis. This time the uric acid crystallises in tissue’s called bursa’s, which we have around many different joints. Ive done another article/video all about bursitis which you can see here. The bursa over the tip of the elbow is most commonly affected in gout because it’s a fairly cold area of the body. This is called an olecranon bursitis and they can get quite large. The other area that we tend to see gout related bursitis is around the front on the knee.
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| An Olecranon Bursitis |
In late stage gout uric acid crystals can also build up under the skin and around the internal organs. These are called gouty tophi and you can see an example of them around the end joints of the fingers below. They have pasty whiteish appearance and they can cause further damage to the underlying joints and any body organs that they’ve build up on, particularly the kidneys, and so kidney failure is another symptom of late stage gout.
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| Gouty Tophi in Finger Joints |
Why do people get Gout ?
Centuries ago, gout used to be called the disease of the rich, because of its association with diets high in red meat and alcohol. These days however, we find that anyone can get gout. It is more common in men and particularly in men who drink too much beer. So if you are a drinker with gout then do take this seriously as a warning sign that you really need to be reducing your alcohol levels. But then again you could live a perfectly healthy lifestyle and still have gout. It just might be that your body isn’t very good at clearing uric acid from your system compared to other people.
What is the treatment ?
If you think you might have gout then you do need to see a health care professional. Because untreated gout can be a serious problem not only to the joints where it can cause considerable damage and arthritis but as we’ve discussed, it can also damage the internal organs, particularly the kidneys.
Also, the symptoms of a gout attack can be very similar to a severe joint infection. A blood test can check for infection and also test the uric acid levels in your blood. Testing a sample of joint fluid is the most accurate way of diagnosing gout as you can see the tiny uric acid crystals through a microscope. Also, Imaging the joint with X-ray, ultrasound or MRI can look at the joint surfaces and see if there is any underlying damage or inflammation.
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| Taking a sample of joint fluid |
If gout is confirmed and it’s your first episode of pain then it is usually treated with anti-inflammatories and sometimes steroids. A drug called Colchicine is often used for a few days to settle down an acute gout attack. You will also need to look carefully at your diet and try to cut down on any of the foods we mentioned before, and significantly reduce your alcohol intake if thats an issue for you.
If further attacks continue to occur and your uric acid levels continue to be raised then you might need to use a uric acid lowering drug which is then usually taken for life. The 2 main drugs used in the UK are Allopurinol and Febuxostat. And these drugs are usually very effective at keeping symptoms under control for the long term.
In most cases gout is managed by your family doctor or other community MSK professional but if you have more severe symptoms or the usual treatments aren’t working then you might need to see a Rheumatologist who are the specialist doctors who treat gout which hasn’t responded to the usual treatments. And if you have significant joint arthritis as a result of gout then you might need to see an Orthopaedic Surgeon about the option of joint replacement or other surgical treatments.
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This article provides general information related to various medical conditions and their treatment. It is intended for informational purposes only and not a substitute for professional advice, diagnosis or treatment provided by a doctor or other qualified health care professional. The information provided does not constitute personal advice or guarantee of outcome and should not be used to diagnose yourself or others. You should never ignore advice provided by a health care professional because of something you have seen or read on this website. You should always consult a doctor or other qualified health care professional for personal medical advice.