Gout: Causes, Symptoms, and Risk Fcator, diagnosis
Learn what gout is, its symptoms, and formation of gout crystal, gout and pseudogout and diagnosis
What Is Gout?
Gout is a type of arthritis that causes sudden attacks of severe pain, swelling, and redness in the joints or soft tissues.
Gout develops when excess uric acid accumulates in the bloodstream.
This uric acid crystal deposited in the joints, leading to inflammation, intense pain, swelling, and redness.
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Common Symptoms of Gout
Early signs of gout
- In the joints slight discomfort, tingling, or stiffness
- Redness or warmth in the affected area
- Gradual swelling that worsens over time
Sign of acute gout
- Acute gout attacks cause sudden, sevee pain, swelling, and redness in the joints.
- These attacks last from a few days up to a week.
- It generally affects only one joint. You will only feel symptoms during the attack, not before or after.
- Gout commonly affects the big toe, but it can also affect other joints such as the wrist, ankle, elbow, shoulder, knee, and hip.
- These attacks often begin at night and typically involve a single joint.
- The affected joint usually feels warm to touch.
- It may also be painful or difficult to move the joint.
Chronic gout symptoms
- Chronic gout occurs when you have 2 or more gout attack in a year.
- Multiple joints are normally affected and symptoms can appear even between attacks.
- It can cause permanent joint stiffness, damage and deformities over time.
- Tophi (These are hard, lumps deposits of uric acid crystals) may form under the skin around joints.
- Flares become more frequent and may involve several joints.
- Kidney problems such as kidney stones can develop in some cases.
What are the risk factors for gout?
Gout can affect anyone, even people without a family history of it. Some groups are more likely to develop gout because of certain biological and lifestyle factor.
Family history: Having close relatives with gout increases your risk.
Gender and age: Gout is more common in men and in older adults, especially postmenopausal women.
Obesity: Being overweight can lead to higher uric acid levels.
Medical conditions: Diseases such as high blood pressure, diabetes, and kidney disease can contribute to gout.
Medications: Certain drugs, like diuretics and low-dose aspirin, can raise uric acid levels.
High blood pressure, heart failure, diabetes, and metabolic syndrome are strongly linked to gout.
Chronic kidney disease impairs the body’s ability to remove uric acid, increasing the risk.
Diet: Diet high in purine-rich foods, excess alcohol consumption increases the risk of gout.
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The Science Behind Gout: Uric Acid and Crystals
1. Uric acid formation
Purines are natural chemicals found in all body tissues and many foods.
The body constantly breaks down purines, and one of the byproducts of this process is uric acid.
Normally, extra uric acid is removed through urine. However, when the body produces too much uric acid or the kidneys cannot remove it efficiently, urate (uric acid) builds up in the blood.
This excess uric acid can form urate crystals, which may collect in the joints and cause gout.
Uric acid can build up due to:
- The kidneys not excreting it fast enough
- The body producing too much uric acid
2. Crystal formation
When there is excess uric acid in the blood, it can form sharp, needle-like crystals called sodium urate crystals.
These crystals gradually build up in the joints over months or years, often without causing symptoms at first.
When the blood becomes supersaturated with uric acid, the excess starts to crystallize, leading to joint pain.
3. Inflammation in Joints
When uric acid crystals form in the joints, the immune system treats them as foreign substances. This triggers a sudden and painful inflammatory reaction, known as a gout flare.
The inflammation causes severe pain, redness, swelling, and warmth in the affected joint — the typical symptoms of a gout attack.
Why Some People Do Not Develop Gout
Many people with high uric acid levels (hyperuricemia) never develop gout. Even when gout does occur, it often happens after years of having high uric acid without any symptoms.
This is because not everyone’s body reacts to uric acid crystals in the same way — some people can have crystals without inflammation or pain.
People with asymptomatic hyperuricemia (high uric acid but no symptoms) are usually advised to make lifestyle changes, such as losing weight, eating a balanced diet, and reducing alcohol intake, but medical treatment is not usually needed unless symptoms appear.
How Gout and Kidney Disease Are Related
Gout happens when there is too much uric acid in the blood, which forms crystals in the joints.
If you have kidney disease, your kidneys may not remove uric acid properly. This causes uric acid to build up, leading to gout.
If gout is not treated, it can also harm the kidneys over time and may cause kidney stones.
Gout and Pseudogout
Difference between Gout and Pseudogout
Gout
Gout happens when uric acid (monosodium urate) builds up and forms crystals in the joints.
Uric acid comes from the breakdown of purines, found in the body and in foods like red meat, seafood, and organ meats.
Too much uric acid causes these crystals to deposit in the joint lining (synovium), leading to inflammation, pain, and swelling.
Pseudogout (CPPD)
Pseudogout occurs when calcium pyrophosphate crystals form in the cartilage.
A painful attack happens when these crystals move (shed) from the cartilage into the joint.
The crystals can irritate the joint, causing pain, redness, and swelling, similar to gout.
Unlike gout crystals, CPPD crystals are rhomboid-shaped with blunt ends.
Sometimes, these crystals stay in the cartilage for years without causing symptoms.
Similarity Between Gout and Pseudogout
Both gout and pseudogout are types of inflammatory arthritis.
In both conditions, tiny crystals form in the joints and nearby tissues, sometimes even in other parts of the body.
Both cause joint pain, swelling, inflammation, and stiffness.
The symptoms of gout and pseudogout can look similar to those of osteoarthritis or rheumatoid arthritis.
Different Stages of Gout
Stage 1: Asymptomatic Gout
In this early stage, uric acid starts to build up in the blood, but there are no symptoms yet.
Uric acid crystals may begin to form in the joints silently.
Stage 2: Acute Gout
When uric acid levels become too high, crystals form around the joints.
This causes sudden and severe pain, swelling, redness, and warmth in the affected joint.
The pain may last from a few days to a few weeks and often happens unexpectedly.
The first attack usually makes people realize they may have gout.
Stage 3: Intercritical (Interval) Gout
After an attack, there may be a pain-free period that can last months or even years before the next flare.
This stage is known as “intercritical” or interval joints.
Even though symptoms disappear, uric acid continues to build up in the blood and joints during this stage.
Stage 4: Chronic Tophaceous Gout
If uric acid levels remain high and untreated, gout can progress to this chronic stage.
Tophi (hard lumps of urate crystals) may form under the skin, in joints, bones, cartilage, or around tendons.
Tophi can cause joint deformities, stiffness, and limited movement.
They can also become painful, infected, or unsightly.
Other issues like persistent joint pain and kidney stones may also develop at this stage.
Diagnosis for Gout
To diagnose gout, your doctor will ask about your symptoms, medical history, and lifestyle. They may also perform a few tests to confirm the diagnosis.
Blood Test
A blood test measures the amount of uric acid in your blood.
A high uric acid level suggests gout, but sometimes levels can be normal during an attack because uric acid moves from the blood into the inflamed joint.
If your level is high during an attack, it was likely even higher before the flare started.
Synovial Fluid Test
This is the most accurate test for gout.
The doctor takes a small sample of joint fluid (synovial fluid) and examines it under a microscope.
The presence of urate crystals in the fluid confirms gout.
Imaging Tests
Tests like X-rays or ultrasounds help rule out other causes of joint pain and check for joint damage or crystal deposits caused by gout.
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