Gout

Gout is a joint inflammation that comes in attacks and hurts a lot. Inflammation comes quickly, is very powerful and then usually heals completely within one to three weeks. You can get medications that prevent gout if you often get problems.

When you get gout, the inner toe of the big toe is usually inflamed, but other joints can also become inflamed. The reason is that crystals of uric acid have formed in the joint. The crystals can be likened to small sharp needles and cause pain and inflammation in the joint where they are formed.

Gout attacks can be more easily triggered in conjunction with high stress on the body, for example during surgery or a severe infection. A gout attack can also be triggered by eating a lot, especially protein-rich foods while drinking alcohol. The fact that the inner toe of the big toe becomes inflamed is sometimes referred to as a gate winch or page.

Symptoms of gout

In the case of a gout attack, the problems usually come on suddenly and often start at night. A joint, often the base of the big toe, quickly becomes sore, red and swollen. The pain increases for a few hours and the joint becomes very sensitive to touch. A light print from a sheet, for example, can hurt a lot. It is common to get a little fever and feel sick and frozen.

When the inflammation begins to recede, usually after days to a week, the skin over the joint can begin to peel.

Several joints can be inflamed

It is most common with gout in the big toe, but any joint can be attacked. You can get gout in late skis or mucus bags, for example around the heel or in a mucus bag on the outside of the elbow.

When and where should I seek care?

Contact a  health care provider if you suspect you have gout.

You can seek care at any healthcare center you want throughout the country. You also have the opportunity to have a regular doctor’s contact at the health center.

Seek treatment directly at an emergency room or emergency room if you have severe problems or if this is your first time having a seizure and do not know for sure that it is gout.

Most cases of gout are treated by doctors at the health care center, but sometimes you get a  referral to the hospital’s emergency room. If the doctor has difficulty diagnosing or if there is a problem with the treatment, you can get a referral to a rheumatologist.

How can I reduce the risk of gout?

Here are some things you can do yourself to relieve gout problems:

  • Avoid alcohol.
  • Avoid beer, both with and without alcohol.
  • Avoid high purine foods.
  • Touch you regularly.
  • Lose weight if you are overweight.

Investigations

It is usually quite easy for a doctor to diagnose gout by examining, for example, the base of the big toe. Rapid joint pain along with the joint being sore, swollen and blue red are typical symptoms. Sometimes the doctor may need to supplement the examination with a joint puncture or X-ray examination, in order for the diagnosis to be completely safe.

Blood and joint fluid control

You are given a blood test, called urate, to check the level of uric acid in the blood. It can vary for different reasons and is not enough for the doctor to diagnose gout. This is because uric acid levels may be normal in some people despite an ongoing gout attack. Also, high uric acid levels in the blood do not automatically mean you have or will get gout. If there is uncertainty about the diagnosis, you may undergo sampling of the joint fluid. It is examined under a microscope and if you have gout it is clearly visible, as crystals shaped like small needles.

Radiographic examination

The joints can be examined with ultrasound and advanced x-ray technique, so-called dual-energy CT or dect. But access to these surveys varies depending on where you live. The joints can change in a typical way eventually if you have had gout for several years. This is evident in a regular x-ray examination of the joints.

Treatment

It is common for you to receive only medicines that relieve inflammation and relieve pain if you have only a single gout attack. But you should get preventative treatment if you have recurring attacks. There are preventative prescription drugs that lower the level of uric acid. Read more about medicines for gout.

Prevention treatment for gout is goal controlled. This means that treatment is given with the aim of lowering the level of uric acid in the blood so that crystals cannot be formed in the joint. This is achieved by giving preventive drugs, controlling the uric acid in the blood and increasing the dose of the drug until you reach a target level of urate 360 ​​µmol / liter or below. Thereafter, treatment continues at that dosage and the attacks disappear.

What is gout?

The inflammation is due to the formation of crystals of uric acid in the joint. Uric acid is formed when the body breaks down a group of substances called purines. These substances are included, among other things, in the hereditary mass in all the body’s cell nuclei and in other important functions in the cells. Purines are also found in protein-rich foods and beers.

Crystals can form especially in the joints if the level of uric acid becomes too high. The crystals can be likened to small sharp needles and cause inflammation in the joint where they are formed. It causes you sudden and severe pain, swelling and redness in the joint.

Another fairly commonplace in the body where crystals can be formed in the urinary tract, in the form of kidney stones.

How much uric acid is in the blood depends partly on how much is formed in the body and partly on how much of the uric acid disappears with the urine.

The risk of gout increases with age as the level of uric acid in the blood rises as you get older. Women have less uric acid than men up to menopause, then the level increases and gout then becomes more common in women as well.

Much uric acid does not need to cause gout

It is quite common to have too much uric acid in the blood and that does not mean that you will get gout. Of all those who have elevated uric acid levels, about 15 percent develop gout. It is only if you have any problems that you need treatment.

Heredity matters

More recently, it has been found that our genes have a major impact on the risk of gout. If you have genes that cause poor urinary acid excretion through the kidneys, you will have a higher level of uric acid and an increased risk of gout. This is an explanation that the prevalence of gout varies widely across the world.

Alcohol increases the risk of gout attacks

Alcohol is a major cause of high levels of uric acid in the blood. Alcoholic beverages, especially beer, contain purines that cause more uric acid to form. Alcohol also makes you urinate for less uric acid.

Alcohol-free beer also contains purines.

Purine rich foods and increased weight

The more you weigh, the more uric acid is formed in the blood. Therefore, it is good to lose weight if you have gout. A diet that contains a lot of purines can help raise the level of uric acid. There are many purines in red meat, intestinal food, seafood, beer and beverages with fructose and such diet increases the level of uric acid and the risk of gout. Peas, beans, spinach, and corn are high purine vegetables, but they do not increase the level of uric acid in the blood or the risk of gout.

Other diseases can be a contributing cause

It is more common for you to get gout if you have any other illness, such as high blood pressure or high levels of blood fats.  Then you often have a lot of uric acids, which makes crystals easier to form in the joints.

Also, diseases that cause the body’s cells to react faster than usual affect the level of uric acid. Some examples are psoriasis and various types of blood cancer.

Drugs can increase uric acid levels in the blood

Some medicines may increase the level of uric acid in the blood:

  • Liquid drugs that are used in particular with high blood pressure and heart failure are the most common type of drugs that increase the amount of uric acid. 
  • Acetylsalicylic acid, which is found in several medications, can raise uric acid levels at low doses.
  • Cytostatic drugs used to treat cancer of the blood can greatly increase the level of uric acid. To counteract this, you also receive medicines that lower uric acid.

Complications and sequelae

The uric acid can form nodules at various points in the body if you have had high levels of uric acid in your blood for many years. Then you have probably also had repeated gout attacks. It appears as small yellowish-white bumps, so-called tofi, on for example fingers, toes or outer ear. The tubers contain a large number of uric acid crystals. This type of gout, called chronic gout, takes many years to develop and can cause the joints to become deformed. The disease goes from attacks to more chronic disorders.

Cardiovascular disease and diabetes

It is very common to have cardiovascular disease and diabetes if you have gout. Therefore, screening for these conditions in gout is recommended.

Kidney disease

High levels of uric acid can also lead to kidney stone formation, kidney stones. Gout can also cause crystals of uric acid to form in the kidneys so that they function poorly. But the risk of kidney damage from gout alone is small. They also usually have other diseases that damage the kidneys at the same time, such as diabetes or high blood pressure.

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