"The most frequently affected joint is the first metatarsophalangeal of the foot".
DR. JAVIER NICOLÁS GARCÍA GONZÁLEZ
SPECIALIST. INTERNAL MEDICINE DEPARTMENT
Gout is a disease produced by the deposit of microscopic uric acid crystals in the joints, causing their painful inflammation.
Sometimes, these crystals form accumulations that can be felt -tophos-, or they are deposited in the kidneys, causing nephritic colics or alterations in their function.
In the vast majority of cases it can be prevented with adequate treatment.
It is necessary to make a diet poor in foods rich in purines (mainly viscera, seafood, red meat, asparagus and alcohol) and take a medication, allopurinol or febuxostat, to reduce the uric acid content of the body, sometimes for many years.
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What are the symptoms of gout?
It presents itself in the form of sudden episodes ("attacks") of intense pain and swelling of a joint, constituting one of the causes of acute arthritis. The acute episode, without treatment, lasts several days.
These episodes tend to repeat, being able to affect in the successive attacks to any articulation. The articulation more frequently affected is the first metatarsal-phalangeal of the foot, but also it can happen in other articulations of the feet, the ankles and, more rarely, in the knees or the wrists.
Sometimes, the synovial bags or the tendons can become inflamed, giving rise to bursitis or tenosynovitis, respectively. If the disease is allowed to evolve, the attacks may not be completely resolved, affecting several joints at once and significantly limiting the patient's quality of life.
Sometimes, in advanced stages, palpable accumulations appear in the form of hard nodules, called tophi. Sometimes, uric acid crystals are deposited in the kidneys, giving rise to episodes of nephritic colic.
The most common symptoms are:
- Pain and swelling of a joint.
- Functional incapacity.
- Nephritic colics.
Do you have any of these symptoms?
You may have gout
What are the causes of gout?
Under normal conditions, the amount of uric acid that enters the body with the diet, plus that produced through a series of biochemical reactions, is equal to the amount of uric acid that is eliminated, through the urine and, to a lesser extent, the feces.
When the amount of uric acid produced plus the amount ingested is greater than that which is eliminated, the body's uric acid increases, which translates into higher levels in the blood, until it precipitates in the form of crystals, mainly in the joints, giving rise to the symptoms and signs of the disease.
Who can suffer from gout?
It is 4 times more frequent in men than in women. It can occur from adolescence to senile age, although it preferably affects men between 35 and 50 and women over 50.
Besides the male sex and the intermediate age of life, the main risk factor is having elevated uric acid levels in the blood, the higher these are.
Other predisposing factors are obesity, high blood pressure, taking certain drugs and a diet rich in uric acid precursors.
How is gout diagnosed?
Generally, the diagnosis of gout is made on the basis of the symptoms and signs of the physical examination, and the determination of the uric acid figures in the blood.
It is considered hyperuricemia when uric acid values are greater than 7 mg/dl.
Sometimes it is necessary to extract fluid from the affected joint to confirm the diagnosis by observing the presence of uric acid crystals in the joint fluid.
It will be necessary to make a differential diagnosis with other rheumatological diseases such as chondrocalcinosis, spondyloarthropathy, psoriatic arthritis, etc.
How is gout treated?
Treatment is based on the administration of a non-steroidal anti-inflammatory, colchicine or both, at decreasing doses for several days until the total cessation of symptoms. It is more effective the sooner it is started.
What to do if the uric acid in the blood is high and no symptoms have appeared?
It is necessary to limit the taking of foods rich in purines and to correct the obesity and the hypertension if they are present.
Only when the uric acid figures in the blood are very high is treatment with drugs recommended.
Where do we treat it?
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