Sudden, severe pain and swelling in the joints, especially in the big toe? What’s perplexing is that there is no injury or trauma either? Well, it could be a gout attack.
“One in 25 people suffers from gout,” says Dr Sajal Ajmani, consultant, rheumatology, BLK-Max Super Specialty Hospital, Pusa Road, Delhi. “It happens in people who have too much uric acid in their blood. Gout is a form of arthritis. It can cause pain and swelling in joints. Initially, it usually affects only one joint — most frequently the big toe. Other commonly affected joints are the ankle and knee.”
Put simply, gout is inflammatory arthritis. Though it can affect anyone, it is more common (and occurs earlier) in men, since they have higher levels of uric acid almost their entire life. Most women are found to suffer from gout after menopause when their uric acid levels tend to rise.
What causes gout?
The uric acid the body makes usually goes through the kidneys and exits with urine. When there is too much uric acid produced by the body, the kidneys will struggle to filter it. This leads to hyperuricemia where sharp uric acid crystals are formed, which then concentrates in the joints, causing gout.
The obese and those with diabetes and hypertension are particularly prone to gout. People with kidney disease, congestive heart failure and those who consume too much animal protein, alcohol and are on water pills (diuretics) are also susceptible to gout.
Gout attacks could be sudden, and symptoms include intense pain, swelling, sensitivity to light touches, warmth, redness and stiffness in the specific area. They can last a week or two and sometimes stretch on for years, with periodic attacks in the same joint or can affect different joints as well. If untreated, they can cause permanent joint damage. Some people with gout can also develop other health problems such as arthritis, kidney stones and heart disease.
Tests and treatment for gout
The pain and swelling are worst at the beginning but get better within a few days to weeks. Such attacks will become frequent if not treated. The damage done to the joint adds up over time and eventually multiple joints get affected.
The diagnosis is made by confirming the presence of uric acid crystals in the joint fluid or high levels of uric acid in blood. It is important to note that the uric acid level in the blood may be falsely normal during the attack, so the blood test should be done when the pain has subsided. Blood tests to check uric acid level, X-rays, ultrasound, MRI or even aspiration (where a needle is used to pull fluid from the joint and medics look for uric acid crystals) are usually employed.
“Gout is easily treatable by dietary changes and medicines,” says Dr Ajmani. “At the time of attack painkillers or steroids or [other medicines] can help relieve the symptoms. To prevent further attacks, uric-acid-lowering medicines need to be started. The uric-acid-lowering medicine is to be taken regularly rather than just during the attacks.”
Alcohol should be avoided along with dietary changes. The person should not consume sugary drinks and high-purine-content food such as red meat.
“One should follow a healthy diet which includes fruits, vegetables, whole grains and low-fat dairy products,” says Dr Ajmani. “If you are overweight, then weight loss will also help. Your doctor will check your uric acid levels regularly to make sure the medicines are working, and you are taking the right dose.”
Tips to prevent/manage gout
- Hydrate yourself so that the kidneys can work better.
- Exercise and maintain a healthy weight.
- Limit purines in body since they trigger uric acid. Purines are found in red meat, liver meat, shellfish, animal protein, alcohol, fruit sugar (fructose), medicines like diuretics, immunosuppressants or drugs used to slow the immune system (common in organ transplants, for example).
- Manage gout attacks by elevating the joint, putting ice, limiting stress and being on rest.
Takeaways
- Sudden and severe pain accompanied by swelling in the joints, especially the big toe, is one of the primary symptoms of gout.
- The obese and those with diabetes and hypertension are particularly prone to gout.
- Maintaining bodyweight with exercise and a healthy diet incorporating low-fat dairy products, whole grains, fruits and vegetables, avoiding alcohol and limiting intake of animal protein is key in managing gout.
