Gout: a joint condition caused by crystal buildup

For those who suffer from gout, the most commonly affected areas include the big toe, ankles, knees, wrists, elbows, and fingers. (Photo: Shutterstock)
For those who suffer from gout, the most commonly affected areas include the big toe, ankles, knees, wrists, elbows, and fingers. (Photo: Shutterstock)
While a healthy lifestyle is important for living a long life, there is no way to completely guarantee that you will never face health challenges. Statistically speaking, it is likely that you or someone you know is currently living with a chronic condition. Of the many chronic conditions that exist, diseases such as diabetes and heart conditions such as high blood pressure (hypertension) are the most common. While most such chronic illnesses are well-known, gout receives little attention in Jordan and abroad.اضافة اعلان

When uric acid builds up
A normal diet includes many purine-rich foods. When these foods break down in our bodies, they form a chemical known as uric acid. Uric acid is considered a waste product, and our body normally excretes it through urination. However, some people suffer from a dysfunction that results in the accumulation of uric acid in the body, known as hyperuricemia. The buildup of uric acid is not directly lethal, but it can lead to several diseases, gout being the most common.

When uric acid levels are normal, it remains dissolved in the blood. However, when concentrations increase, the acid tends to form crystals, which then leave the blood and accumulate in the soft tissues, mainly consisting of joints. The accumulation of crystals in the joints causes inflammation, swelling, and pain. For this reason, gout is classified as the most common type of inflammatory arthritis. The most frequently affected area, interestingly enough, is the big toe. Other affected joints include the ankles, knees, wrists, elbows, and fingers.

Symptoms of gout
Although gout often involves painful inflammation, symptoms can sometimes be so slight as to go unnoticed. In these cases, the condition is known as asymptomatic hyperuricemia. Individuals with this condition live their lives normally, unaware of the gout unless lab work is done showing that they have high levels of uric acid.

Even without symptoms, crystals will likely still accumulate in the joints. You may experience a seemingly sudden, acute gout attack that could last for three to 10 days. During a gout attack, swelling is common, along with intense pain that is often described to as “burning”. After the pain has subsided, the joint will typically return to normal.

However, it is common to have another gout flare-up within two years of a previous attack. The time between gout flare-ups is known as the intercritical period, and if uric acid levels are not properly managed, this period can grow shorter and shorter. As attack occur more frequently, gout can develop into a chronic condition, producing hard lumps known as tophi. A tophus (the singular form of tophi) is a large accumulation of crystals that forms deposits on the joints and soft tissues. These lumps are not directly painful, but they are often associated with inflammation and could cause permanent joint damage

Causes, risk factors, and triggers

Gout is primarily caused by hyperuricemia. Your body could produce too much uric acid due to naturally making too many purines, or because of a cell breakdown caused by exercise and certain other conditions such as tumor lysis syndrome, associated with cancer. However, a purine-rich diet can also influence the development of gout. Purine-rich foods include red meats, organs such as livers, seafood, beer and other alcoholic beverages, and beans. For someone with gout, these foods should be avoided as they may trigger gout flare-ups. Cold weather may also act as a trigger for the attacks.
Even without symptoms, crystals will likely still accumulate in the joints. You may experience a seemingly sudden, acute gout attack that could last for three to 10 days.
Hyperuricemia can also occur when the body does not efficiently eliminate uric acid. Kidney impairment (chronic kidney disease) is one of the main causes of gout. Similarly, acid-base changes in the body can lead to inefficient elimination of uric acid. Other conditions such as Down syndrome and hypothyroidism are other possible causes.

Hyperuricemia and gout tends to occur much earlier in men than women. In men, hyperuricemia frequently begins at puberty and gout can become prevalent around the age of 30. In women, however, hyperuricemia does not typically occur until after menopause and as a result, gout is more common around the age of 50.

Associated conditions
Although research is still ongoing, hyperuricemia and gout have been found to be associated with many other diseases. One associated condition is metabolic syndrome, which is a combination of diabetes, hypertension, and obesity. Alternately, these three conditions can also occur individually. One study found that those with gout are four times as likely to also have hypertension. Similarly, a Jordanian study found that 28.1 percent of type two diabetics in Jordan also had hyperuricemia.

These interrelated conditions can also increase the risk of other, more severe conditions such as heart disease and stroke. Additionally, increased uric acid levels can result in the buildup of crystals in the kidneys, with kidney stones developing in up to 20 percent of individuals. It has been proposed that kidney stones can cause damage to the kidneys and result in chronic kidney disease, however, no causative relationship has been found yet.

Prevention and pain management
Preventing hyperuricemia in the first place is the best way to prevent gout. Although it may be unavoidable due to other conditions, there are still lifestyle changes that can help. Diet plays a significant role in hyperuricemia and heavy consumption of purine-rich foods should be avoided. (For those with hyperuricemia and gout, these foods should be avoided altogether.) Additionally, hyperuricemia is associated with metabolic syndrome. This means that taking measures to prevent obesity, hypertension, and diabetes reduce your risk of developing gout. Exercising regularly, consuming a healthy diet, and managing your body weight are all important ways to live a healthy life and prevent these conditions.

Those who already have gout should focus on lowering uric acid levels and managing flare-ups. Uric acid levels can be lowered via lifestyle changes as well as various medications. Additionally, applying an ice pack, avoiding pressure, and elevating the affected joint may help. During an attack, managing the pain is another good strategy. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) helps to reduce inflammation in the joints. NSAIDs are the easiest form of pain management, since they are effective and are often available over-the-counter. However, they may not be suitable for all people. Those older than 65 and those who have a history of kidney impairment, liver impairment, or bleeding issues should speak to their doctors first before taking these medications.

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