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Gout - Symptoms & Causes

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Gout Causes and Risk Factors

Arthritis refers to the inflammation of one or more joints. In the case of gout, that inflammation is caused by the build-up of uric acid crystals in joints.

Uric acid, or urate, is a by-product created when your body breaks down organic chemicals called purines. Purines are naturally produced in the body or introduced through purine-rich foods, drinks, or medications. While uric acid plays vital roles in the body—stimulating the immune system, tissue healing, facilitating nervous functions, etc.—too much of it (a condition known as hyperuricemia) is toxic.

For the most part, the kidneys keep the urate levels in check by excreting the excess through urine. But sometimes, there’s too much uric acid in the blood for the kidneys to handle. Or the kidneys themselves have a problem filtering out waste uric acid. Either way, the excess uric acid winds up accumulating in joints. The urate condenses into tiny sharp crystals that cause inflammation and pain in the affected joint.

Uric acid affects the big toe first in more than half of all gout cases. This is because urate tends to crystalise at low temperatures. The big toe, being the coolest and most extreme appendage, is often the first and sometimes the only joint to develop gout.

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Anything that spikes uric acid levels in the body is a potential cause or contributor to developing gout. Here are the known risk factors linked to hyperuricemia and gout:

Obesity

Being overweight promotes hyperuricemia through increased urate production and decreased renal clearance.


Purine-rich diet

Some foods and drinks, such as meat, seafood, and alcohol, contain high levels of purine. Having too much of these in your diet can elevate uric acid production.


Underlying health problems

Conditions such as chronic kidney disease, type II diabetes, osteoarthritis, and hypertension can lead to gout.

Old age

Arthritis, in general, tends to affect the older population (50 years and over).


Genetics

If your family has a history of hyperuricemia and gout, you’re more likely to develop the same. Also, certain genetic disorders can elevate the risk of developing gout.


Certain medications

Continued or excessive use of drugs such as low-dose aspirin, diuretics, and ciclosporin can raise urate concentrations in your body.


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Common Gout Symptoms

A joint affected by gout may exhibit the following symptoms:

Sharp, intense pain

Usually, the pain flares up in what’s known as a “gout attack.” These flare-ups usually happen at night and can be intense enough to wake you.


Stiff joint

Gout may limit the joint’s natural range of motion. It becomes difficult or painful to move the affected joint in certain ways.


Inflammation

The joint swells, reddens/discolours, and feels warm.


Tenderness

The joint becomes hypersensitive to touch. The lightest touch, even a sheet brushing over the joint, can feel unbearable. 


Hard lumps around the joint

As the uric acid crystals accumulate around the joint, they form hard bumps or growths resembling swollen nodules protruding from under the skin. These are called tophus.


Tight skin over the joint

The skin covering the affected joint appears stretched, thin, and shiny.


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Other joint conditions sometimes exhibit symptoms similar to gout. For certainty, clinical tests are used to diagnose the disease. Gout diagnosis involves the following tests:

  • Uric acid tests.

The doctor checks for abnormally high levels of uric acid in the blood and/or urine.  

  • Synovial fluid test.

This test looks for urate crystals in the synovial fluid drawn from the joint suspected to have gout. Most joints in your body are bathed in synovial fluid, a viscous non-Newtonian fluid used to lubricate joints during movements.

  • Imaging tests.

X-ray images, ultrasound scans, and dual-energy CT (DECT) scans can detect signs of gout in joints.


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