Gout is a serious systemic disease that has been known for generations, affects and destroys joints and skin, and has fortunately become very rare in this severe form nowadays thanks to early therapy. What is still common, however, is the acute attack of gout, often the first symptom of a disorder of the uric acid metabolism. It manifests itself with a painfully swollen toe, usually after barbecues with copious alcohol consumption.
What is an acute attack of gout?
Affected in a gout attack is in the vast majority of cases the metatarsophalangeal joint of the big toe, which is noticeable by sudden swelling, redness and severe pain. In an acute gout attack, a short-term overload of the body with uric acid causes uric acid crystals to break down in joint spaces. In the vast majority of cases, the metatarsophalangeal joint is affected, which becomes noticeable through sudden swelling, redness and severe pain. The gout attack is thus an expression of the derailment of an already elevated uric acid level, which should subsequently be treated permanently.
Causes
Uric acid is an end product from the metabolism of purines, components of our DNA. This also explains why the acute attack of gout often occurs after barbecues:
Above-average consumption of meat overloads the body with purines for a short time (after all, animal meat also consists of DNA), the consumption of alcohol with the barbecue meat also keeps the liver busy, and the uric acid level rises above the threshold. Mostly men are affected, who are then awakened early the next morning by pain in the big toe. Uric acid crystals have accumulated there overnight, because when the uric acid becomes crystals and disappears from the bloodstream, it can no longer cause any major damage in the rest of the body. Incidentally, the uric acid level in the blood was already too high in most of those affected beforehand, but was not noticed: The so-called Hyperurikämie makes also first long time no complaints. It can be the result of genetic predisposition, a deficiency in kidney function, or excessive uric acid production, the latter in tumor diseases with an increased cell division rate, among other things. Medications such as diuretics can also affect uric acid levels.
Symptoms, complaints, and signs
In the early stages of gout, there are often no symptoms at all. In some cases, this asymptomatic phase lasts for several years or even decades. Without the patient noticing, uric acid levels rise in the blood during this period, resulting in hyperuricemia. If the uric acid concentration exceeds a critical value, this leads to the occurrence of symptoms. This leads to the formation of uric acid crystals that are deposited within the joints, which in turn threatens an acute attack of gout. The base joint of the big toes is particularly affected. Typical of an acute gout attack is that it occurs abruptly and without any warning. In the middle of the night or early in the morning, sudden, severe attacks of pain appear. The affected joint reacts extremely sensitively to touch and movement. It also swells doughy and reddens. Furthermore, it suffers from overheating. It is not uncommon for an acute attack of gout to be accompanied by fever. The symptoms of an acute gout attack can last for several hours or even days. If no medical treatment is given, the attacks occur at increasingly shorter intervals. In addition, there is a risk that they will spread to other joints. Thus, it is not uncommon for the knee joint, the ankle joint, the thumb joints or the metatarsal joints to be affected by the pain. As it progresses, gout can take on chronic proportions.
Diagnosis and course
Thus, from complete health, the acute attack of gout suddenly results in inflammation of the metatarsophalangeal joint of the big toe, and more rarely of the ankle, knee or metatarsophalangeal joint of the thumb. The bed cover is often not endured in this case. Other symptoms besides the swelling, redness and pain generally do not exist, after a few days to three weeks the symptoms subside on their own.
Complications
An acute attack of gout requires medical attention. If the symptoms are treated incorrectly or ignored, far-reaching complications are the result. Gout affects the joints. The affected area swells severely and severe episodes of pain occur.Depending on the advanced stage, other symptoms include various inflammatory reactions such as overheating and reddening of the joint as well as fever. Soft tissue nodules as well as visible joint deformities appear, which can increase to the point of immobility. The disease is based on a purine metabolism disorder, which negatively affects the uric acid level and can affect people of any age. It is usually only discovered and treated in the later years of life. If the gout is then already too advanced, the X-ray image shows crystal deposits that can affect the entire body as well as the organs. This type of gouty tophi is rather rare. As a very serious complication of untreated gout attacks, the uric acid level can rise so high that the kidney is permanently impaired in its function. Uric acid crystals are deposited in the kidneys and there is a risk of kidney stones. In the worst case, functional failure. If the patient is under medical treatment, the acute gout attack can subside relatively problem-free. However, there is always the risk of a new outbreak. With a healthy lifestyle and proper medication, most complications and pain can be circumvented.
When should you see a doctor?
If symptoms such as high fever, severe feeling of illness and vomiting occur during an acute gout attack, in addition to the typical joint pain and hyperthermia, a doctor should be consulted. In a severe attack of gout, uric acid levels may be greatly elevated, causing uric acid to crystallize in the joints, bursae, subcutaneous fat tissue and renal medulla. This is the case when a concentration of more than eight milligrams per deciliter of blood is detected. The uric acid stones that form damage the kidneys if gout attacks are untreated and recur frequently; in rare cases, this can lead to kidney failure. After checking the uric acid level, the doctor prescribes anti-inflammatory painkillers as well as uricostatic drugs to inhibit the formation of uric acid and uricosuric drugs to promote the excretion of uric acid. Medical treatment of gout by the general practitioner is sufficient for diagnosis and therapy. If the symptoms persist or the uric acid level cannot be permanently reduced, it may be advisable to consult a nutritionist. This person helps to put together a low-purine diet, which is essential for the prevention of gout attacks.
Treatment and therapy
If one does not want to wait that long, one should consult a physician. This can determine the uric acid value of the blood (which is paradoxically often not even increased in the acute attack, however) and then treat solely on the basis of the very typical symptoms with suitable pain medication such as Diclofenac. Colchicine is another possible drug that usually works excellently in the case of a gout attack and thus virtually “after the fact” secures the diagnosis. Due to possible side effects, however, it is only a second-choice drug. Glucocorticoids such as prednisone are also possible variants in the therapy of the acute attack.
Outlook and prognosis
Those who suffer from acute gout attacks can expect that the severe sensitivity to touch but also fever and general feeling of illness will continue to increase. Therefore, increasing headaches, elevated pulse rates, and vomiting are not uncommon in people with acute gout attacks. Despite dietary changes and drug treatment, kidney stones can occur. Especially if the uric acid level is above 9mg/dl. If there are already bony changes (deformations or stiffening) at the joints, movement restrictions up to invalidity and kidney damage (gout kidney), which in the worst case must be treated by dialysis, cannot be ruled out. Damage to the skin increases the more frequently the gout attacks occur. The prognosis also includes that high blood pressure and elevated blood sugar levels may occur. This addresses the metabolic syndrome, in the context of which an acute gout attack may occur frequently. The prognosis depends on the time of diagnosis, as well as the course of the disease, therapy, and also strongly on the patient’s cooperation – especially in terms of dietary changes, abstaining from alcohol, and increased exercise.
Prevention
However, to prevent an acute attack of gout from becoming chronic gout in the long term, preventive measures and long-term drug therapy are the most important measures.First of all, the focus is on a diet, with weight normalization and sufficient drinking, a low-meat diet (to minimize the purines absorbed) and abstention from alcohol. Tough diet for a man/woman – but chronic gout with permanent joint and bone destruction and the breaking through of the uric acid crystals through the skin can and should only be prevented in this way. Regular monitoring of the uric acid level by the family doctor is essential for monitoring the therapy. Only when the level rises above 9 mg/dl should medication also be taken: Allopurinol is one of the most commonly prescribed drugs in family practice and can reduce the attack of uric acid in the metabolism. However, like any other drug, it has potential side effects and should therefore only be started when conservative measures (i.e. the tiresome diet) have failed. But then it can still contribute to a drop in uric acid levels and prevent the progression of gout and further painful attacks.
Here’s what you can do yourself
To be able to respond in an emergency, sufferers should always carry their prescribed painkillers (e.g., diclofenac or colchicine). If the first symptoms appear, a doctor should be consulted immediately. To prevent an acute attack of gout from developing into chronic gout in the long term, there are a number of preventive measures in addition to long-term treatment with medication. The main focus is on a balanced diet. If necessary, a diet must be considered in order to return to a normal weight. The diet should therefore be as healthy as possible. It is advisable to eat plenty of fresh fruit and vegetables. On the other hand, convenience products and fast food should be avoided. Furthermore, care should be taken to ensure that sufficient fluids (ideally water) are consumed in order to stimulate kidney activity. This accelerates the elimination of excess uric acid. In any case, the affected person should eat a diet as low in meat and fat as possible. Due to the relatively high purine content of meat, its consumption contributes to an increase in uric acid levels. This should be taken into account especially in the case of a hereditary predisposition. Various foods, such as lemon juice, apple cider vinegar, olive oil, and also baking soda or wheatgrass juice, can be beneficial in lowering uric acid levels. Plenty of exercise can help optimize body weight. Excess fat tissue can also increase uric acid production. In addition, abstaining from alcohol is inevitable.
