Although the disease is typically thought to occur in the feet or toes, gout can occur in any joint in the body. The condition is the result of a buildup of uric acid in the blood stream which crystallizes and accumulates in painful bunches in the joints, tendons, or cartilage. Since it affects the bone it is therefore known as an acute form of arthritis, although arthritis pain is typically the result of bone and joint swelling rather than from mineral crystallization. In the Western world today, “King’s Disease” or “Rich Man’s Disorder” affects about 2% of the population, most of the sufferers being older men.
Although it is seen all over the world, it is much more common today than it once was. The cause of gout is a selection of things, anything from genetics to diet, and research continues in a growing effort to find a cure to urate-buildup in the human body, the central cause of gout (though there are others).
In the Body
In gout, urate (uric acid) salts are deposited form the blood stream into the synovial fluid of the joints. Synovial fluid is an egg yolk-like fluid that acts as a cushion between ball joints, such as in the knees. When this liquid is tested in a lab and shown to contain a certain level of urate salts the patient is said to be at-risk for gout.
Once the condition sets in, these salts tend to gather in the phalangeal foot joints and big toe, a toe-swelling commonly known as podagra. The extremities (hands and feet) tend to be cooler than the core of the body and these cooler temperatures are an optimal environment for crystal formation. Gout has been known to show in other joints in the body; more than 20% of people diagnosed with gout will also develop kidney stones.
Did you know that you always have uric acid in your blood stream? Urate and the salts from uric acid are a result of the breakdown of cells in the body, the urate typically being disposed of in the urine. The human body is continually breaking down old cells and forming new ones in the growth process. This includes every cell in your body (there are over 100 trillion) and urate levels can grow exceedingly high if the patient is diagnosed with leukemia, or blood cancer, in which the cells of the body rapidly multiply and are rapidly destroyed. Daily food intake is also a source for the precursors of uric acid—everything we eat contains some amount of the waste—and the kidney is responsible for breaking it down. If the kidneys are not functioning properly, which is often the case with diabetics and those with leukemia, it is a strong sign that gout may be a future diagnosis.
Some kinds of kidney conditions impair the kidneys’ ability to breakdown urate and, in this case, dietetic measures are taken to reduce urate consumption.
Attacks of gout occur without warning and may be triggered by injury, stress, or diet, including alcohol consumption, which is a known contributor to gout. Bouts usually happen at night. Pain is felt in several joints and the skin over the joints becomes red or purple, tight, and feels warm to the touch.
Despite its unique name, pseudogout is not a “fake” or “pseudo” form of gout but a genuine condition much like normal monoarththritis or gout. The condition can occur in any joint, just like typical gout, but is on the whole much more likely to spread to other joints and far likelier to destroy sensitive cartilage. In some cases it has been known to destroy tendons and cartilage in under two days, which is why doctors urge those suffering joint pain to get a diagnosis and receive treatment as soon as possible.
The central difference between gout and pseudogout is the nature of the crystals that buildup in the joints. Chondrocalcinosis is the umbrella condition at the source of pseudogout and it is characterized by a buildup of calcium pyrophosphate crystals (rather than urate salts). These occur in the knees, wrists, and other large joints. Pain is felt largely in the arms and legs as well as a general stiffness and lingering chronic pain throughout.
Attacks of pseudogout are much less severe than urate gout. Many people feel no pain at all in between attacks, despite huge amounts of crystals and crystallization stored in the synovial fluid and joints.
In either case—both gout and pseudogout—there are a list of familiar symptoms. They include pain, stretched and shiny skin over the joints, fever, swelling, and infection. Infection of the joint called osteomyelitis is the result of opportunistic fungus or bacteria carried by the blood infecting fractures or tears in the damaged bone or cartilage. In this case gout and pseudogout may lead to early death if not treated properly with steroids, antibiotics, or emergency surgery.
One of the telltale symptoms of gout is the appearance of tophi. These are large yellow or white nodules occurring round the joints as a result of the buildup of monosodium urate crystals in joints and bone. Tophi are large and increasingly uncomfortable tumescent bumps extending from the damaged bone and if left untreated will eventually impair the mobility of the joint or limb. A tophus may also develop on the fingers, ears, or kidneys.
Refractory chronic gout (RCG) will result if either urate or calcium pyrophosphate levels cannot be controlled or if gout treatments are not working. This is especially the case for those with additional kidney disorders or diabetes; prolonged untreated gout as such will result in deformities and restricted or completely obstructed joint movement. Untreated tophi will erupt and release masses of chalky crystals.
There are no known permanent or effective experimental treatments for gout, although the treatments for gout pain are legion.
Treatment for gout is about controlling the inflamed contiguous bones and joints and therefore relieving the pain and swelling. Colchicine, a steroid which inhibits crystallization of the relevant minerals, is used most often. One milligram of colchicine, followed by 0.5 mg two hours later, results in a complete secession pain and swelling symptoms usually long before 72 hours have lapsed (usually between 12 and 48 hours).
Non-steroidal anti-inflammatory drugs (NSAIDs) are used as commonly as colchicine. These pharmaceuticals, such as allopurinol, febuxostat, and indomethacin, while they do relieve and halt crystallization, also tend to immobilize the joint for the beginning period of their effectiveness.
When these two treatments—NSAIDs and colchicine—are not effective, physicians generally turn to corticosteroids like prednisone. This is injected into the joint fluid and suspends the crystal within the joint, relieving pain and swelling. Reports of oral prednisone administration are generally positive, with no rebounds or bad side effects (colchicine can cause severe diarrhea). It may not get to this stage, since regular treatment with colchicine is effective and acceptable to the patient (with or without side effects) more than 82 per cent of the time.
Gout and Diet
Gout prophylaxis, or prevention, centers almost entirely around diet and improved lifestyle choices.
Reduced consumption of alcohol and meat will lower urate levels in the blood. This along with increasing the consumption of raw green vegetables was associated with a lowered risk of gout and a reduction in painful symptoms. In a recent study, consumption of high quantities of meat and seafood were both associated strongly with a risk of gout and urate buildup in the joints.
The findings from the above mentioned study from 2004, called “Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Goutin Men,” were critical for the dietetic treatment of gout. For a long time, purine-rich foods were thought to reduce gout and urate crystallization. When the Massachusetts General Hospital and the Harvard Medical School showed that consuming purine-rich foods like shellfish, fish, and red meat would actually cause or exacerbate gout, the nutritional treatment of the condition was rapidly altered.
It now focuses mainly in the consumption of vitamin C and dairy products. In the same 2004 study, regular doses of vitamin C reduced gout symptoms. Five-hundred milligrams per day for two months resulted in a lowered serum urate levels (less than 0.5 mg per deciliter). At the same time, the consumption of dairy products like milk or cottage cheese reduced urate in the blood by 10% within a 3-hour period.
A daily dose of milk products is therefore recommended by most physicians, as well as a diet high in vitamin C-rich foods. Dairy products would include reduced fat milk and cream, cottage cheese, yogurts, curd, lassi, and light cheeses. Vitmain C-rich foods include red and green chillis, red and green peppers, herbs, guava, kale, spinach, collard greens, broccoli, cauliflower, and citrus fruits.
The best way to treat gout is to never put yourself at risk for it by eating right. Maintaining a diet rich in the mentioned foods, light in the consumption of alcohol and fatty foods and red meats will not only reduce your chances of gout and pseudogout, but reduce your risk of diabetes and heart disease, extend your life expectancy, and improve your quality of life.