KATHMANDU: Gout is a form of inflammatory arthritis caused by high levels of uric acid in the blood. These elevated levels can lead to the formation of uric acid crystals, which accumulate in the joints, causing intense pain, swelling, and stiffness.

The most common area affected by gout is the big toe, although other joints such as the knees, ankles, and fingers can also be involved.

When an attack occurs, it can feel as if the affected joint is on fire, making it difficult to walk and perform everyday activities.

Types and Stages of Gout

Gout presents itself in different stages, each with unique characteristics:

1. Asymptomatic Hyperuricemia – In this early stage, individuals may have high uric acid levels but experience no symptoms. Though there is no immediate need for treatment, this stage can lead to silent tissue damage.
2. Acute Gout – Sudden and severe joint pain caused by uric acid crystals in the joint. Acute gout attacks typically last from 3 days to 2 weeks. Triggers such as alcohol and stress can worsen flare-ups.
3. Chronic Tophaceous Gout – This is the most debilitating form of gout, often leading to permanent damage in joints and kidneys. Chronic gout results in frequent flare-ups and the formation of tophi, lumps of uric acid crystals under the skin.
4. Pseudogout – Often confused with gout, pseudogout is caused by calcium pyrophosphate crystals in the joint, rather than uric acid. Although symptoms are similar, pseudogout flare-ups tend to be less severe and require different treatment.
5. Interval or Intercritical Gout – The period between acute gout attacks when symptoms subside. However, uric acid crystals can continue to accumulate during this phase.

Causes and Risk Factors

Several factors can increase the risk of developing gout, including obesity, genetics, high uric acid levels, and aging.

Lifestyle choices such as excessive alcohol consumption, a diet high in purine-rich foods, and certain medications like diuretics can also contribute to the onset of gout.

Other health conditions, including high blood pressure, diabetes, and kidney disease, can further heighten the risk.

Symptoms and Diagnosis

The hallmark symptoms of gout include redness, warmth, and swelling in the affected joint, accompanied by sudden, intense pain, often beginning at night.

Diagnosis typically involves a combination of medical history, physical examination, joint fluid tests, and imaging techniques like X-rays or ultrasound to detect the presence of uric acid crystals.

Treatment and Prevention

While there is no cure for gout, effective management involves a combination of lifestyle changes and medications.

Self-care includes maintaining a healthy weight, staying active, avoiding alcohol, and modifying dietary habits to reduce purine intake.

Medications like corticosteroids, colchicine, and NSAIDs are used to relieve pain during flare-ups, while drugs like allopurinol and probenecid help to lower uric acid levels and prevent future attacks.

Preventative measures include staying hydrated, eating a balanced diet, exercising regularly, and avoiding stress and alcohol.

People with gout should also avoid smoking and manage their weight to reduce the risk of flare-ups.

Foods to Avoid

Certain foods can trigger gout attacks by raising uric acid levels in the blood. These include alcohol, red meat, organ meats, and certain seafood, all of which are high in purines. Additionally, sugar-sweetened beverages and foods containing fructose should also be avoided.

Conclusion

Gout is a painful and often debilitating condition caused by an accumulation of uric acid in the joints.

Although it can be triggered by dietary choices, alcohol, and other health conditions, gout can be managed with early diagnosis, lifestyle changes, and medication.

By making the necessary adjustments to diet and physical activity, individuals can reduce the frequency and severity of gout attacks, preventing long-term damage to the joints and improving overall quality of life. Early intervention and proper management are crucial to controlling gout effectively.