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The gout: recognize a crisis of gout causes symptoms and treatment

A gout attack, what is it?

The drop is a particular form of arthritis that causes recurrent attacks of acute pain in one or a few joints . Usually, the gout attacks last a few days, then the symptoms disappear for several weeks. All joints are likely to be affected, but most often, the disease begins in the one at the base of the big toe . The joint then becomes purple red and swollen.

An abnormally high level of uric acid in the blood , a condition called hyperuricemia , is the cause of gout. Uric acid is one of the wastes that the body’s metabolism normally produces. When there is a surplus, uric acid gradually deposits in the body as crystals , among other things in the joints. These deposits trigger inflammatory reactions.

Gout affects nearly 2% of adults, especially men. The first crisis usually occurs around the age of 30 to 45 years for men, and after menopause for women.

The symptoms of gout

  • A  pain  sudden, intense and throbbing in a  joint . Seizures occur mostly  at night . The joints located at the extremities of the limbs are more sensitive than the others, in particular because they are colder. Cold can cause the transformation of liquid uric acid into uric acid crystals.
  • A  swelling  and  redness  of the affected area.
  • A great  feeling of cold  at the affected joint.
  • Rarely, generalized joint pain, accompanied by general discomfort, fever (up to 39 ° C) and chills. In this case, go to the hospital urgently.

Causes of gout

Funny names! 
The word “drop” was chosen for the image of the “drip” flow of a harmful liquid in the joints and organs. This disease was also called “podagre”, from the Greek podos (foot) and agra (taken), to signify that the pain “took the foot”. The term gout is still used in medicine, when the crisis affects the big toe.

The overeating , if they are frequent, and the abuse of alcohol (especially beer, whiskey, gin, vodka or rum), are the main risk factors.

Hippocrates, the “father” of medicine, who lived in Greece in the V century BC, had already noticed that the drop was concentrated among bon vivants . It was formerly called “the disease of kings” or “the disease of the rich”, because of the pantagruelian meals and well watered that only they could afford. As a result, it has long been known that the pleasures of the table are related to this disease.

More rarely, the disease may be hereditary or caused by a drug or other disease .

 

Risk factors

Here are some factors that contribute to increasing uric acid production or decreasing its excretion.

  • The  overeating , especially of  proteins  from offal, white and red meats, fish and seafood. Also, a calorie intake that consistently exceeds the needs of the body increases blood levels of uric acid.
  • The alcohol  : half the people who suffer from gout have bad drinking habits. Ethanol increases the production of uric acid (without having any effect on its excretion). Beer is the alcoholic beverage that raises uric acid levels the most.
  • The  stress  : it exhausts substances  antio xydantes  the body. The  radi free Caux  then attack more cells and precipitate cell death (resulting in the formation of uric acid).

People at risk for gout

  • The  men , probably because at puberty, their blood uric acid level is naturally higher than that of women. On the other hand, at  menopause , women have a uric acid level similar to that of men, and the gender gap is narrowing. Before menopause, the hormones  estrogen genes  activate the elimination of uric acid by the kidneys.
  • Individuals with any of the   following health conditions : kidney disease (kidney stones, kidney failure), high blood pressure, metabolic syndrome, diabetes, obesity, high cholesterol, narrowing of the opening of the arteries ( atherosclerosis ).
  • People taking certain  medications , such as  diurétiq ues  and regularly taking aspirin in low doses.
  • People who have a  family history  of gout. A hereditary metabolic problem could lead to excessive uric acid production in the body.

From good food to gout …

This is what happens in the body of an affected person. The uric acid is, in some way, waste that the body must eliminate. It is the end product of purine degradation . About two-thirds of purines eliminate daily from dead cells of the body, and a third of food ingested 2 . Red meat, game and seafood, for example, are very rich in purines.

It is normal for some uric acid to circulate in the blood. However, if uric acid is present in too large quantities and the kidneys fail to eliminate this excess, its blood concentration increases. The body is then hyperuricemic.

Over the years, excess uric acid is deposited in the tissues as sodium urate crystals . Deposits are formed in the joints or elsewhere in the body (under the skin, cartilage, kidneys, etc.). The white blood cells then try to get rid of them by “eating” them by phagocytosis . As a result, crystals damage the white blood cells, triggering a violent inflammation lasting up to 2 weeks, if left untreated.

For reasons unknown, hyperuricemia does not always cause symptoms. Indeed, only a third of people in a state of hyperuricemia have gout. It is estimated that 5% to 10% of the adult population is hyperuricemic.

Different from the pseudogout

The pseudogout is another arthritic disease that is very similar to gout (pseudo means similar). It also causes attacks of sharp joint pain and swelling in a joint. These seizures are also caused by the formation and deposition of crystals in the affected joint. However, the crystals are different: they are crystals of calcium pyrophosphate. Pseudogout affects about 3% of people in their sixties. With age, articular cartilage can calcify in some places. It seems that in some people, calcium crystals break off cartilage, cause inflammation and destroy joint structures. The analysis of a sample of synovial fluid (in which the joint is bathed) helps the doctor to distinguish these two types of arthritis.

Evolution of gout

Since gout is better known today and there are many ways to control it, the quality of life of people who suffer from it has greatly improved. Early diagnosis and treatment can reduce the number of seizuresand prevent permanent damage to the joints.

In the absence of treatment, the first crisis disappears spontaneously in 1 to 2 weeks. During the first 24 to 36 hours, the pains are intense. The slightest pressure on the joint is unbearable, and it may even be impossible to put on a stocking. On the other hand, if the crisis is treated quickly, it lasts from 1 to 2 days. Often, a new crisis is triggered from 6 months to 2 years later. Only a small proportion of sufferers will have a gout attack in their lifetime.

Possible complications

This is rare nowadays, but if gout is not treated properly, the frequency of attacks and the number of joints reached tend to increase over time. The arthritis can then settle so chronic in several joints (knees, ankles, wrists, elbows, etc.).

The deposits of crystals can be created under the skin  : they are called tophi (or tophi, in the singular). They appear on the outer edge of the ear, on the elbows, on the fingers, on the toes and near the Achilles tendon. They can damage the tendons.

In case of neglect of the treatments, the excess of uric acid can also be deposited in the kidneys , block its fine channels and cause kidney stones or kidney failure.

Diagnostic of gout

Depending on the case, the doctor will use one or another of the following types of samples.

– Blood test  : measurement of the level of uric acid in the blood (uricemia).
– Urine sample  : evaluation of the amount of uric acid excreted by the kidneys.
– Puncture of the synovial fluid of the affected joint  : search for crystals of uric acid, to confirm the diagnosis. Uric acid crystals are not detectable by radiology (X-ray or other), but are visible under a microscope in a sample of synovial fluid.

People at risk

  • The  men , probably because at puberty, their blood uric acid level is naturally higher than that of women. On the other hand, at  menopause , women have a uric acid level similar to that of men, and the gender gap is narrowing. Before menopause, hormones  oest geneous  activate the elimination of uric acid by the kidneys.
  • Individuals with any of the   following health problems :
    – kidney disease (kidney stones, kidney failure);
    – hypertension;
    – the metabolic syndrome;
    – diabetes;
    – obesity;
    – hypercholesterolemia;
    – a narrowing of the opening of the arteries ( atherosclerosis ).
  • People taking certain  medications , such as  diurétiq ues  and regularly taking aspirin in low doses.
  • People who have a  family history  of gout. A hereditary metabolic problem could lead to excessive uric acid production in the body.

Prevention of gout

Measures to reduce the risks of recurrence and complications

Food

In the past, monitoring your diet was the main way to treat gout. Nowadays, as some drugs can reduce the uric acid concentration in the blood, doctors do not necessarily restrict their patients to a strict diet.

However, purine-rich foods raise blood uric acid levels, and some should be banned during a gout attack (see Medical Treatments section ).

Here are the tips offered by the Professional Order of Dietitians of Quebec in terms of diet, which is good to follow between crises or in case of chronic gout .

  • Adjust the energy intake according to your needs. If weight loss is indicated, make sure it occurs slowly and gradually. Rapid weight loss (or fasting) reduces the excretion of uric acid by the kidneys. You can use our test to calculate your body mass index (BMI) or to know your healthy weight .
  • Properly distribute your protein , fat and carbohydrate intake . Follow the recommendations in Canada’s Food Guide . (The recommendations may vary, for example in the case of diabetes, consult a nutritionist if necessary.)
  • Have a sufficient intake of fruits and vegetables , which have a protective effect against gout (8 to 10 servings a day for men, and 7 to 8 servings a day for women).
  • Avoid or limit the ingestion of alcohol . Drink at most 1 drink a day, and no more than 3 times a week.
    Note . Recommendations vary from one source to another. Some suggest reducing the consumption of beer and spirits (eg, gin and vodka). Drinking wine moderately (up to 1 or 2 glasses of 5 oz or 150 ml per day) would not increase the risk of gout . The amount of alcohol well tolerated by people with gout can vary.
  • Drink at least 2 liters of water or drinks (soups, juice, tea, etc.) a day. Water is preferred.

What about coffee? 
Coffee is not to be avoided in case of gout, because it contains negligible amounts of purines. According to epidemiological studies , it appears that regular coffee consumption would even exert a slight protective effect against this disease. This should not be seen as an incentive to drink more. To find out more, check out our Café page.

A diet rich in vitamin C: beneficial? 
The link between vitamin C intake provided by food and uric acid levels in the blood was studied in a group of 1387 men, under the Health Professional Follow-up Study. The higher the vitamin C intake, the lower the level of uric acid. This discovery will however have to be verified by other studies.

Warning. The ketogenic diets are not recommended for people with gout. This type of diet is particularly low in carbohydrates and high in fat. Ketogenic diets reduce the excretion of uric acid by the kidneys. This is the case of the Atkins diet, for example.

pharmaceuticals

Respect the dosage prescribed by the doctor. Some medications reduce the likelihood of other seizures (see Medical Treatments section). Revisit your doctor as needed in case of adverse effects or ineffective treatment.

Medical treatment of gout

No cure for gout exists for now. The therapeutic approach acts on two levels. She aims :

  • to relieve the symptoms (pain and inflammation) of an acute attack and to stop the crisis with anti-inflammatory agents;
  • to prevent recurrences and complications , in the long term, with the help of drugs that reduces blood uric acid levels.

Medications to relieve pain and counter inflammation

In the event of a seizure, oral nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed, such as ibuprofen (Advil, Motrin) or naproxen (Naprosyn, Aleve, Anaprox). These act quickly.

If nonsteroidal anti-inflammatory drugs are ineffective, oral therapy with Colchicine (Colchimax) may help. This medicine has an anti-inflammatory and pain-relieving effect. He was the first to be used to relieve gout. Taken for a long time, it also reduces the frequency of seizures. On the other hand, it does not prevent the formation of uric acid crystals in the joints. The majority of users have nausea, vomiting, diarrhea and abdominal cramps. These important side effects explain why colchicine is no longer the first drug proposed to relieve pain.

If the patient is not relieved by previous treatments, steroidal anti-inflammatory drugs, or corticosteroids , may be prescribed (eg, prednisone). They are taken either orally, in tablet form, or by injection into the diseased joint.

Warning. The aspirin , a popular anti-inflammatory, is cons-indicated in cases of gout, because it raises the level of uric acid.

Medications to prevent recurrence and complications

The medication is intended to lower serum uric acid to prevent seizures and reduce the risk of kidney problems and permanent damage to the joints. It acts in 2 ways and gives interesting results.

Increase the excretion of uric acid . Some drugs work on the kidneys so the body removes more uric acid. In addition to lowering the level of uric acid in the blood, they prevent the deposition of crystals in the joints. The most effective drug is probenecid (Benemide in France, Benuryl in Canada). It is contraindicated for people with kidney failure or kidney stones.

Decrease uric acid production . Allopurinol (Zyloric  in France, Zyloprim  in Canada) effectively limits joint damage that can occur in the long term. A significant decrease in uric acid level is observed 24 hours after the start of treatment. It continues and results in a satisfactory rate after 2 weeks of treatment. Allopurinol works by inhibiting an enzyme that participates in the synthesis of uric acid.
Warning . Do not start allopurinol before the complete end of an acute attack of gout. Otherwise, the crisis may resurface.

Food during a crisis

Here are a few tips :

  • Avoid alcohol or limit yourself to 1 drink in a day, and do not exceed 3 drinks per week .
  • It is good to restrict the consumption of game, seafood and fish, which are high-purine foods, especially if it has been noticed that any of these foods triggered the crisis.
  • Do not eat foods high in fat.
  • Drink 2 to 3 liters of fluid a day, at least half of which must be water.

Other changes in diet, which vary from one person to another depending on the state of health, may be beneficial. It is better to consult a nutritionist for personalized advice.

To find other ways to relieve arthritis pain (application of heat or cold on the joint, exercises, relaxation, etc.), see Arthritis sheet (overview).

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