Gout pain can be intense and feel like fire in the joints. Gout is a type of inflammatory arthritis that causes severe pain, swelling, and redness in the joints. While it can affect any joint, it most commonly affects joints in the toes (usually the big toe), feet, knees, and elbows.
Symptoms of a gout attack generally reach their maximum intensity 12-24 hours after they start and then slowly subside on their own. Without treatment, you can expect to recover within 7-14 days.
What is chronic tophaceous gout?
Some people experience gout only in the form of attacks or episodes. These attacks can occur 1-2 times a year or throughout their entire lifetime. In between the attacks, they may have no symptoms at all.
Chronic gout is characterized by recurrent attacks that are accompanied by mild symptoms even between attacks. During the interval between attacks, you may experience pain and other symptoms that are then exacerbated during an attack.
Chronic gout often results in hard deposits or bumps of uric acid crystals under the skin. These hard deposits are referred to as tophi, which are painless but cause inflammation that contributes to bone and cartilage destruction. The condition is called chronic tophaceous gout.
Tophi typically occur around joints in the olecranon bursa, hands, feet, or at the pinna of the ear. Tophi are not always permanent and can be dissolved with treatment.
Can you have high blood uric acid levels but no gout symptoms?
Gout typically causes high uric acid levels in your blood, a condition called hyperuricemia. However, in some cases you may have high uric acid levels in your blood without developing symptoms of gout. This is called asymptomatic hyperuricemia.
Even if you have asymptomatic hyperuricemia and are at increased risk of developing gout, doctors typically do not recommend treatment during this period. They may, however, suggest lifestyle changes such as exercise, a healthy diet, and limiting alcohol to help lower uric acid levels. If you have asymptomatic hyperuricemia, your doctor will conduct tests to rule out other causes.
Hyperuricemia does not always lead to gout attacks. You may have normal uric acid levels in your blood during an attack.
How is gout diagnosed?
If you are experiencing gout pain, seek medical attention. Early diagnosis and treatment are crucial to avoid worsening the condition.
Your doctor will ask about your symptoms and other relevant medical history and perform a physical examination. To confirm a diagnosis, they will order blood tests, including a serum uric acid test that measures your uric acid level. Other tests include:
- Rheumatoid arthritis (RA) factor test: RA factor test is a blood test that is used to confirm a diagnosis of rheumatoid arthritis. Many times, gout symptoms resemble RA symptoms, especially during the interval between the attacks of chronic gout. Therefore, your doctor may order this test to determine whether the symptoms are due to RA.
- X-ray: Your doctor will order an X-ray to rule out other conditions that resemble gout, such as chondrocalcinosis (a buildup of calcium crystals in the joints) or other forms of arthritis. If you have chronic gout, your doctor may order an X-ray to check whether the condition has damaged joint cartilage and bones.
- Ultrasound scan: An ultrasound scan of an affected joint can detect uric acid crystals, which may not be detected by physical examination.
- Joint fluid analysis or test: If your doctor wants to rule out septic arthritis, which is an infection of the joints, they may draw fluid from the affected joint and send it for lab analysis.
How is gout treated?
Your doctor may suggest dietary changes that involve avoiding foods that contain purines, which are naturally occurring substances that form uric acid in the body.
Medications may be prescribed, which you can take during gout attacks to alleviate the inflammation and pain:
Can lifestyle changes help relieve gout pain?
Certain lifestyle changes can help reduce the recurrence of gout attacks:
- Avoiding foods with high levels of purines
- Red meat
- Organ meat
- Fatty fish, such as cod and salmon
- Foods containing yeast extract
- Avoiding sugary drinks, such as sodas and sweetened fruit juices
- Avoiding or limiting alcohol intake (beer and spirits)
- Drinking enough water to prevent dehydration, which promotes tophi formation
- Keeping weight under control
- Staying away from crash diets or high-protein low-carb diets
- Staying physically active and performing exercises that avoid strain on the joints
Rothschild BM. Gout and Pseudogout. Medscape. https://emedicine.medscape.com/article/329958-overview
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