What is Gout?
Gout has a strong correlation with hyperuricemia (high levels of uric acid in the blood). Asymptomatic hyperuricemia (the state of elevated levels of uric acid in the blood without symptoms) is considered a precursor state to the development of gout, though not all hyperuricemia patients will develop gout. Gout is caused by buildup of uric acid and marked by painful inflammation of the joint. Uric acid is the final product of purines (substances that are found naturally in your body, as well as in certain foods) metabolism in human beings. In normal condition, uric acid dissolves in your blood or excreted in the urine. But sometimes the body produces more uric acid than it is able to excrete, which causes increased uric acid levels in the blood.
Gout occurs when excess uric acid triggers the formation of tiny crystals of urate (a salt derived from uric acid) that deposit in tissues of the body, especially the joints. When crystals form in the joints, it causes recurring attacks of joint inflammation. In chronic gout, hard lumps of uric acid may develop in the tissues, particularly in and around the joints. Without proper treatments, gout can lead to worsening pain, joint damage, decreased kidney function, and kidney stones.
Who gets gout? More than one million people in the United States suffer from gout. It is nine times more common in men than in women. Men in their 40s and 50s are most likely to develop gout. It predominantly attacks males after puberty, with a peak age of 75. In women, gout attacks usually occur after menopause. But after age 80 more women than men have gout.
The Signs/ Symptoms of Gout
Unlike rheumatoid arthritis or systemic lupus that can attack multiple joints simultaneously, gout usually only attacks a single joint at a time. Acute gout attacks often happen in the big toe, but sometimes also in the ankle, knee, shoulder, hip, wrist, or elbow. The attacks are often unpredictable and intense, causing severe pain in the affected joints followed by swelling, warmth, reddish discoloration, and tenderness. If you have a fever during the gout attacks, you should seek medical care immediately because it might be a sign of infection. Though the severe pain has subsided, joint discomfort may last from a few days to a few weeks. A patient with gout usually has less flexibility, because it is harder to move or use the affected joints. Gout attacks may occur more frequently and last longer as the disease progresses. Multiple joints can be involved simultaneously over time. In rare instances, gout may lead to a more chronic type of joint inflammation that mimics rheumatoid arthritis.
Gouty arthritis is typically an extremely painful attack with a rapid onset of joint inflammation. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid (synovial fluid) and joint lining (synovial lining). Intense joint inflammation occurs as the immune system reacts, causing white blood cells to engulf the uric acid crystals and chemical messengers of inflammation to be released, leading to pain, heat, and redness of the joint tissues. (Source: medicinenet.com)
In chronic tophaceous gout, uric acid crystals lodge as white, chalky material in soft body tissues and in and about the joints, where they may cause bursitis and destruction of bone. Collections of these crystals (also known as tophi nodules) can appear in the elbow, earlobe, and Achilles tendon (back of the ankle). These tophi usually do not cause any pain, and can be a valuable clue in gout diagnosis. It is an indicator that shows a substantial overload of uric acid within the body. Microscopic evaluation of a tophus reveals a nest-like accumulation of uric acid crystals embedded with white blood cells of inflammation.