How Uric Acid Crystals Form
Infographic
The build-up of uric acid crystals begins with purines, a chemical compound found in many foods.
- When the body metabolizes purines, it produces a substance called uric acid.
- The uric acid enters the bloodstream.
- The kidneys filter the blood and normally filter out excess uric acid. This uric acid is then excreted via urine or stool .10
- If the kidneys cannot adequately filter out excess uric acid, or if the body produces too much uric acid, there will be too much uric acid in the bloodstream.
- Too much uric acid in the bloodstream is called hyperuricemia.
- In some people, hyperuricemia leads to the formation of uric acid crystals that collect in joint tissue, leading to painful symptoms.
An inability to adequately process and excrete uric acid accounts for an estimated 90% of gout cases.9 Other cases occur because a body produces too much uric acid.
Can I Have Surgery To Fix My Gout
In the worst cases of chronic gout, you may need surgery to fix joint damage, or replace joints. You are at risk for getting kidney stones when you have gout, since urate crystals can build up in your urinary tract and form stones. Kidney stones made from urate crystals can build up in your kidneys, and can cause damage and scars.
Can Gout Be Cured
Cure is a very strong word, but we can certainly treat the gout and put it in remission by giving the treatment as mentioned, Dr. Meysami says.
Whether to use the word cure may be a matter of semantics: A patients gout tendency may never go away but can be well-controlled. Treatments for gout are extremely good, and the vast majority of gout patients can expect to be cured, Dr. Fields says. Cured is in quotes since it means that gout flares can completely disappear, but the person would need to stay on their medicine.
Gout progression, though, certainly isnt inevitable, which is close to the best news any gout patient can hear.
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Warning Signs Of A Gout Flare
Some people with gout, also known as gouty arthritis, say an attack begins with a burning, itching, or tingling feeling in a joint maybe an hour or two before the flare-up starts. The joint may feel a little stiff or a bit sore. Not long after, the telltale signs of gout begin. If you get repeated attacks, youll learn your bodys signals that one is about to begin.
Sometimes, people with gout have no early signs that a flare is about to start. They may just wake up in the middle of the night with a very painful joint.
When the flare starts, most people have redness, swelling, and severe pain, usually in one joint. The most common place for gout is the base of the big toe, but it can happen in other joints such as the elbow, knee, wrist, ankle, and instep.
The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
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How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
Preventing And Treating Gout
When you first come to AllCare Foot & Ankle Center with gout symptoms, we conduct a thorough examination to determine the best course of treatment. We typically prescribe nonsteroidal anti-inflammatory medications to help control symptoms and prevent further joint damage.
If youve already had or continue to have multiple gout attacks, it can lead to a variety of health complications, including the erosion and destruction of your toe joint and the development of kidney stones. This is why preventing future gout attacks is essential for your overall health and wellness, not just for relieving the pain in your toe.
We recommend the following to help prevent future gout flare ups:
- Drink plenty of fluids
- Limit or avoid alcoholic drinks
- Reduce meat, poultry, and seafood in your diet
- Consume more low-fat dairy products for protein
- Lose weight, if necessary
The common symptoms of gout arent something you should ignore, and we can help you get it under control. Give us a call at our Arlington or Dallas offices, or request an appointment online today.
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How Gout Treatment Prevents Disease Progression
Fortunately, in part because of its long history, gout is one of the most well-understood and most medically treatable forms of arthritis. The progression of gout is preventable by starting appropriate treatment as soon as possible, Dr. Meysami says. Uric acid-lowering agents, such as allopurinol , can decrease uric acid levels and prevent gout attacks.
During flares, gout patients can take NSAIDs or corticosteroids to calm the attack. Local steroid injections may also be given. A medication called colchicine is also often used to stop acute attacks, but its given now at a much lower dose in order to avoid side effects, including stomach upset.
After a flare ends, long-term treatment can begin. Almost all people with gout will need medication to control their urate, Dr. Fields says. To get a good outcome, people with gout need to get their blood urate level below 6.0 mg/dl and keep it there. By doing that, the body will gradually pull the urate crystals out of their joints, and the flares can stop. Tophi will also gradually disappear.
Medications called xanthine oxidase inhibitors limit the amount of uric acid your body produces. These include allopurinol and febuxostat . Colchicine, which decreases the inflammatory response to gout, may also be given along with allopurinol at the start of long-term treatment after a flare subsides.
How Do You Get Gout
So, how do you get gout after all? Having lots of beer and purine rich foods might be the most popular issue. But then, there are people who never bother about what they eat or drink and they never experience gout. This is because there are a few risk factors to take in consideration and each of them could increase the risk of developing the affection.
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Why Do I Get Gout
You might think that gout is caused by drinking too much beer and fizzy drinks and eating too much meat and shellfish. In fact, gout is caused by having too much of a chemical called uric acid in your blood.
Your body makes uric acid when you eat food. It is normal and healthy to have some uric acid in your body. Most people get rid of uric acid through their urine.
The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)
Figure 3: Progression of Gout
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Gout In Big Toe: Can You Get Gout In Any Toe
Most common place for gout is the big toe because uric acid is supposed to be sensitive of temperature changes.
At cooler temperatures, uric acid turns into crystals. Since the toe is the body part that is farthest from the heart, it is also the coolest part of the body and, thus, the most likely target for gout attack. However, gout can affect any joint in the body.
Who Is At Risk Of Gout
Gout is sometimes called the disease of kings because of a false link to overindulgence in food and alcohol. Anyone can get the condition, but certain factors can increase your risk:
- Gender: Males are more likely to get gout than females.
- Age: Middle-aged and older men and women after menopause are more at risk for gout.
- Obesity
- Family history
- Diet: A diet high in purines, which are broken down into uric acid, can lead to gout. High purine foods include meats like bacon, turkey, veal, venison, and liver, and seafood like anchovies, sardines, mussels, codfish, scallops, trout, and haddock. High fructose foods and drinks such as soda pop also can increase your risk.
- Alcohol use
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What Causes Your Gout Attacks
If there is too much uric acid in your blood, the acid turns into crystals in your joints especially your toes, knees, elbows, wrists and fingers.
The crystals are very sharp, like needles, and your joint gets very sore and painful. This is called a gout attack.
Crystals can cause damage to your joints.
The crystals cause lumps which are called tophi . If tophi get too big they can make it hard for you to wear shoes, use a knife and fork, write and walk easily.
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Can Gout Be Prevented
Some people with gout experience recurrent attacks, which may be prevented by using prescription medications. These medicines work by lowering uric acid levels in the blood. The most commonly used is allopurinol. This helps to lower uric acid levels by reducing the body’s production of uric acid.
You can also reduce your chance of having further attacks of gout by adopting some sensible lifestyle changes, such as:
- reducing alcohol intake avoid binge drinking, in particular
- gradually losing weight if you are overweight, while avoiding fad diets
- eating a healthy, balanced diet
- drinking plenty of water, especially when at risk of dehydration
There is no scientific evidence that particular foods cause gout, but some studies have shown that people who are prone to gout are more likely to eat foods rich in purines a substance that’s converted into uric acid within the body.
Foods with high levels of purines include:
- red meat and offal such as liver, kidneys and heart
- seafood, especially shellfish, scallops, mussels, herring, mackerel, sardines and anchovies
- foods containing yeast such as Vegemite and beer
It’s best to seek the advice of your doctor or an accredited practising dietitian before making any changes to your diet. Most people with gout find that a healthy, balanced diet along with medication is enough to reduce their uric acid levels.
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What Are The Symptoms Of Gout
The most common symptom of gout is pain in the affected joint, such as the big toe. Gout flares often start suddenly at night, and the intense pain may wake you up. In addition, your joint may feel swollen, red, warm, and stiff.
Gout flares usually occur in one joint. They can be triggered by:
- Certain foods.
- Physical trauma.
- Certain illnesses.
Flares typically get better over a week or two. In between flares, you usually dont have symptoms. Some people may have frequent flares, while others may not have another flare for years. However, over time, if left untreated, your flares may last longer and happen more often.
Some people with gout may be more likely to develop other conditions or complications, especially with the heart and kidneys.
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How Are Gout Attacks Prevented
Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.
The Pathology Of Gout
Gout is primarily a metabolic disorder in which uric acid accumulates in blood and tissues. When tissue levels reach saturation, needle-like crystals form, causing inflammation. This occurs most commonly in the cooler joints, notably the metatarsophalangeal joint of the big toe.
Many people with hyperuricemia never develop gout, but those with the highest levels are most likely to suffer episodes. Hyperuricemia may also lead to kidney stones.
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Risk Factors For Gout
Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, diabetes, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels in patients with gout.
Southern Cross Medical Library
The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross. For more articles go to the Medical Library index page.
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Do Home Based Gout Remedies Actually Work
What do you think of when you hear someone talking about a home remedy theyve used to treat an illness?
Does it perk up your ears, or just make you suspicious and skeptical?
Remedies have been used by people for thousands of years with varying degrees of success. Some are based on folklore, while others continue the trend of following what works through trial and experimentation passed down the generational line.
Gout In Arm And Elbow: Can Gout Affect Your Elbow And Arm
The elbow is formed by three bones out of which two bones belong to the forearm and known as the radius and ulna. The third bone, which is also the largest and the only bone in the upper arm, is called the humerus. It is important because it helps in lifting, throwing and writing. Uric acid crystals will typically deposit in the middle section where are all three bones connect in the joint capsule of the elbow.
A gout attack in your elbow will also happen unexpectedly. You will wake up in the morning to find that your elbow is suddenly swollen and painful. You will experience severe pain and tenderness, just like the big toe, your elbow will be extremely sensitive to any pressure even to a bed sheet.
Your elbow will have red and swollen appearance as if its puffed up and you may feel warm. Your arm mobility will be limited. Due to the redness, the skin on your elbow may be peeling and flaking. You may feel itchy as well due to gout in elbow and arm.
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Gout Symptoms And Complications
Gout is not gout until symptoms occur. When they do, they usually come on suddenly and, at least initially, affect a single joint. Within hours, that joint becomes red, swollen, hot, and painful they’re called gout attacks for a reason. It’s easy to mistake a gout attack for a localized infection of a joint. The metatarsophalangeal joint at the base of the big toe is often the site of the first attack, but the knees, ankles, and joints between the many small bones that form the foot are also common sites. People who already have osteoarthritis the most common form of arthritis often experience their gout attacks in the joints of the finger
Stage : Intercritical Gout
After a first gout flare, 75 percent of people will have a second within a year but some people can go years before another attack, says Dr. Fields. The in-between stage is where a person has already had a gout flare but is presently not having any joint pain or swelling, he says. Almost all gout patients will go through this phase, since it is the nature of gout to have flares and then quiet down for a period of time before the next flare.
Even though it may seem like nothing is happening, this is the point in which patients should begin long-term treatment. Lowering uric acid levels with medication can prevent future gout flares and long-term complications that go with them.
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