Gout
Gout arthropathy / Gout arthritis

Gout is a condition where uric acid crystals accumulate in one or more joints. This provokes an inflammatory response and causes severe pain. Gout usually occurs in the big toe or foot.

Gout exists in an acute and a chronic form. The condition is particularly common in men aged 40 and over. However, this does not mean that women and young people cannot get gout.

Description of the condition

Gout is one of the rheumatic conditions that cause inflammation of the joints. In this respect, the surrounding tendons and bursas can also be affected.

In the acute form, a highly painful joint inflammation occurs suddenly. This, especially in the larger joints, is sometimes accompanied by fever. In this respect, the big toe is usually the first to be affected, but in principle it can occur in any joint. An acute gout attack may remain a one-time event, or it may recur more frequently or develop into chronic gout. The latter is the case for about two out of three people.

It is also possible for chronic gout to develop without having been preceded by one or more acute gout attacks. The symptoms then resemble rheumatoid arthritis or arthrosis, persist for a long(er) time and possibly spread to other joints. A clear sign that this is gout after all is the presence of tiny white lumps (tophi). These tophi occur in about 5-10% of the people with gout and are filled with a thick, chalk-like substance that bursts when the skin of a tophi ruptures. Tophi can often be found in the following areas:

• Fingers and toes.
  
• Auricles.
  
• Forearm.
  
• Achilles tendon.
  
• Back of the elbow.
  
• Front of the knee.

Cause and origin

Uric acid occurs in every body as a waste product of metabolism. When the body does not absorb uric acid properly or produces too much of it, problems arise. The uric acid is then not sufficiently excreted causing so-called uric acid crystals to accumulate in the joints, bursas or along tendons. The body reacts to this with an inflammatory response. It is then very painful to strain the red and swollen body part.

An exact cause for the development of gout is not known yet. There is a relationship between the use of certain medication (diuretics), cardiovascular conditions, and reduced kidney function. Genetics and an advancing age also play a role.
In addition, there appear to be a number of lifestyle factors that increase the risk of developing gout or triggering a gout attack. But this cannot be said with certainty. Think about, among other things:

• (Excessive) consumption of alcohol.
  
• Foods high in purine (some meats and fish).
  
• Excess weight.
  
• Prolonged increased stress.

Signs & symptoms

Typical symptoms that occur in case of gout are:

• It usually comes on quickly in one or more joints.
  
• Often the big toe is the first to be affected.
  
• Painful and inflamed (swollen, red, warm) joints, tendons and/or bursas.
  
• Pain when moving and straining the affected joint.
  
• Presence of tophi.

Diagnosis

When visiting a physician, they will initiate a conversation to find out what the problem is. A physical examination follows that looks for inflammatory signs of the affected joint and the presence of tophi.

Blood tests and a joint puncture can detect gout. In a joint puncture, the physician sucks a small amount of fluid from the inflamed joint with a needle. Under a microscope, a laboratory technician then looks for uric acid crystals.

Treatment

Gout affects everyone differently. A single gout attack usually recovers completely without permanent damage within 1 to 3 weeks. If the gout recurs more frequently or develops into a chronic form then the risk of permanent joint damage also increases.

Medication helps to treat gout and to prevent (further) joint damage. This fights the inflammation, prevents new inflammations and/or lowers the level of uric acid. Lifestyle modifications with adequate exercise and a healthy eating and drinking pattern help prevent new gout attacks.

Exercises

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your area.

References
Janssens, H.J.E.M., Lopuhaä, D.E., Schaafstra, A., Shackleton, D.P., Van der Helm-Van Mil, A.H.M., Van der Spruit, R., Van Peet, P.G., Wiersma, Tj. & Woutersen-Koch, H. (2017). NHG-Standaard. Artritis (M90). Nederlands Huisartsen Genootschap. Versie 2.0, november 2017.