Gout

Overview

In gout, excess uric acid in the bloodstream leads to the formation of uric acid crystals in the joints (among other things). This is mostly caused by impaired uric acid excretion (i.e. removal from the body), combined with overeating/malnutrition and high alcohol consumption. A healthy lifestyle and modest consumption of alcohol can help prevent this disorder. An acute attack of gout leads to very painful joint swelling, often in the big toe.

Symptoms

Acute (acute gout)

• Sudden onset of severe pain (typically during the night)
• Joint is swollen, overheated, red or reddish-blue
• Joint is too painful to be moved
• Joint is extremely sensitive to touch
• Typically, just one joint is affected (for 60% of patients this is the joint of the big toe, more rarely the hindfoot, ankle, knee or finger)
• Sometimes fever

Chronic

• Kidneys
  • Kidney stones and colic (in 50% of patients)
  • Deposit of uric acid crystals in kidney tissue (impairment of kidney function)
  • High blood pressure (caused by kidney damage)
• Joints
  • After many years, the structure of many joints is destroyed by the uric acid deposits
• Body surface:
  • Deposit of uric acid crystals
  • Visible and tangible bulges and lumps that sometimes break open

Causes and treatment

Causes

Excess uric acid in the bloodstream (waste product of purine) and deposits of uric acid crystals (in cartilage and bone of joints, kidneys, skin, bursa, etc.).

• Reduced excretion of uric acid by the kidneys
  • Genetic predisposition (primary hyperuricaemia)
  • Renal insufficiency, e.g. caused by diabetes
  • Certain medication
• Promoting factors
  • Overeating and malnutrition (food rich in purine)
  • Overweight and lack of exercise
  • Chronic alcohol abuse
• Destroyed cells release more uric acid
  • Infectious diseases
  • Injuries, operations
  • Blood diseases, in particular leukaemia
  • Psoriasis
  • Malignant tumours

Further treatment by your doctor / in hospital

Possible tests

• As a rule, a physical examination is sufficient
• Possible procedures
  • Joint puncture (analysis of synovial fluid)
  • X-ray
  • Testing of blood uric acid levels

Possible therapies

• Acute attack
  • Treat joint inflammation and pain
  • Medication: Primarily NSAIDs (no acetylsylicylic acid) and/or cortisone
  • Topical cold treatment
• Long-term treatment
  • Medication that lowers uric acid production
  • Medication that promotes uric acid excretion

What can I do myself?

• During an attack: Immobilise, cool and elevate the affected joint
• Regularly drink plenty of fluids
• Avoid excessive alcohol consumption
• Aim for a normal weight
• Take regular exercise
• Diet: Low-purine foods, i.e. less meat, tripe, pulses, fish and seafood
• Dairy products are preferred as main protein suppliers for gout sufferers

When to see a doctor?

• Generally recommended for a gout attack
• Sudden onset of severe pain in the big toe (or another joint)
• Discoloured, swollen and overheated joint
• Severe psychological strain
• Changes to urine colour and output
• Colic (stomach cramps)

Further information

Rheumaliga Schweiz (Swiss League against Rheumatism)
www.rheumaliga.ch
Brochure on gout

Synonyms

gout, arthritis urica, gout attack, hyperuricaemia