Gout or hyperuricemia is a well-known metabolic disease. In this case, there is an increase and concentration of uric acid in the blood, which in its Auswrikung mainly leads to severe joint inflammation and joint pain. It is mainly divided into acute gout attack and chronic gout.
What is gout?
Gout or hyperuricemia, which was formerly also known as nipper, is a metabolic disease. Typical of gout is primarily the accumulation of uric acid in the blood, from which uric acid crystals form over time. These are then deposited in the joints, tendons and bursae. In the course of this, there is then severe pain in the area of the joints (joint inflammation), whereby mostly irreversible joint damage is the result. Furthermore, gout can be divided into two forms:
1. primary gout: the body produces more uric acid than it excretes through the kidneys and bladder. Secondary gout: In this form, lasting damage has already been caused by the production of uric acid and its accumulation in the body. For example, kidney failure may be responsible for cell death in this case. Gout often occurs in people with a high standard of living. Mostly, it affects men at a more mature age (between the ages of 40 and 60).
Causes
The causes of gout are not yet fully understood. However, it is assumed that genetic causes trigger gout in most cases. Hereditary predisposition may be responsible for the production of too much uric acid in this case. A genetic defect can also be the cause that not enough urea is excreted. In the course of this, the urea crystals are deposited in the blood and migrate into the joints, tendons and bursae of the joints. This leads to joint inflammation, which can be very painful. Other causes can be a metabolic disorder in which purines, which are found primarily in meat and offal, cause an overproduction of urea. People who consume a lot of meat and alcohol in particular can develop gout. Likewise, acute gout attacks are possible in these sufferers.
Symptoms, complaints and signs
Gout is often initially noticeable in only one joint. In the first stage, there is only an elevated uric acid level, which does not yet cause any clear symptoms. The first signs may be kidney stones or an acute attack of gout. In the second stage, severe pain occurs in individual joints. In most cases, the joints of the feet and toes are affected; in about eight percent of cases, the symptoms affect the joints of both feet. Usually, the first gout attack occurs at night and can last for several days. Signs of inflammation are often noticed at the affected joint. The joints then take on a noticeable redness, are sensitive to touch and overheated. The skin over the affected joint may peel or itch. Occasionally, an attack of gout is associated with other symptoms. Typically, there is fever, headache or palpitations, for example. Some sufferers also experience gastrointestinal complaints. Sufferers also feel weak and their performance is restricted. After several gout attacks, the mobility of the joints also decreases, associated with further pain and swelling. Between attacks, those affected are symptom-free. Chronic gout is manifested by the fact that the symptoms persist permanently and increase in intensity as they progress.
Course
The course of gout can be without further complications if the disease is recognized in time by the doctor. Especially the uric acid level should be examined particularly in the context of a diagnosis. If, on the other hand, no treatment is given, gout can develop into chronic gout. The course of untreated gout is as follows: 1. acute gout attack, 2. intercritical gout phase, 3. chronic gout.
Complications
Without proper treatment of gout, affected individuals are at risk of various sequelae. Typical complications of gout include deformities of the joints and soft tissue nodules. If an acute attack of gout occurs, it usually results in severe pain. In addition, fever may occur due to the inflammatory reaction. Usually, the gout attack heals without additional effects. However, further attacks are not uncommon.If no professional treatment is given to lower the body’s uric acid level, the gout attacks appear at increasingly shorter intervals. This increases the risk of permanent damage to joints and bones. As a result, the patient continually suffers from swollen, painful and immobile joints. In addition, the affected joint appears reddened and overheated. In the case of chronic gout, crystal deposits can form in various parts of the body, which can be seen on an X-ray. Physicians refer to these deposits as gouty tophi. However, they occur only rarely. Another negative effect of gout is the increase in uric acid levels, which sometimes leads to kidney impairment. This includes the formation of kidney stones, which arise from uric acid deposits. They in turn pose the risk of painful renal colic. They also promote kidney inflammation and urinary tract infections. Sometimes uric acid levels in the kidney increase to such an extreme that acute failure of the organ occurs.
When should you see a doctor?
People who have unusually pale or white skin should consult a doctor to be on the safe side. If there is swelling of the joints, pain of the bones as well as restricted movement, a doctor is needed. Before taking any pain medication, it is always necessary to consult a medical professional to avoid further illnesses. If the pain spreads or the swelling increases in size, a doctor should be consulted immediately. If several joints are affected in the further course of the disease, the change should also be presented to a physician. If the motor restrictions lead to one-sided strain on the body or poor posture, a doctor is needed. If there is redness of the skin, increased body temperature, and hot joints, there is cause for concern. A visit to the doctor is required so that treatment can be initiated. If dizziness, nausea or vomiting occurs repeatedly, a doctor should be contacted. If there is inner restlessness, irritability, as well as an increased experience of stress, consultation with a physician is necessary. If daily obligations at work or in private life can no longer be performed as usual, a doctor should be consulted. If psychological problems occur, a doctor is also needed. Help should be sought for emotional or mental impairment as well as behavioral problems.
Treatment and therapy
A gout disease should definitely be examined and treated by a doctor, otherwise life-threatening complications or kidney failure can set in. Therapy for gout mainly focuses on lowering the uric acid level in the blood. Furthermore, the unpleasant accompanying symptoms are to be alleviated. Above all, joint pain, swelling and pain in the limbs are the focus of gout therapy. In addition, a medical treatment should prevent a chronic gout disease. The following medications can be considered: anti-inflammatory antirheumatic drugs for severe gout, cortisol-containing glucocorticoids as painkillers and anti-inflammatories, and/or colchicine for acute gout attacks to relieve joint pain. However, colchicine does not lower uric acid levels and is thus intended only for symptom relief. In self-treatment, cold compresses of the affected joints are useful. These extremities should also be kept still. In addition, it is advisable to drink plenty of fluids in order to reduce the concentration of Hanrstoff. Alcohol and fatty meat dishes should be avoided in any case.
Outlook and prognosis
Although gout is not curable, it responds very well to drug treatment. Disciplined patients who adhere to a low-purine diet can positively influence the prognosis. The first attack usually subsides on its own after one to two weeks. Many of those affected are pain-free for a long time afterwards, but it is still advisable to start taking uric acid-lowering medication immediately. This can prevent the occurrence of further attacks. Uricopathy patients have a significantly increased risk of cardiovascular disease and diabetes mellitus. Avoiding meat, alcohol and excess sugar reduces the threat of these secondary diseases. Male patients benefit particularly from changing their dietary habits.If left untreated, the disease progresses in relapses that become more frequent and eventually turn into a chronic condition. The joint surfaces are destroyed, and irreversible thickening and deformation of the joints occur. Typical consequences of chronic gout are also so-called tophi. These are painless deposits of urate directly under the skin. They are usually found on the auricle and near the joints. In the most unfavorable case, arthritis urica leads to damage to the kidney, which can manifest itself in kidney inflammation and even acute kidney failure.
Prevention
Gout can be prevented relatively well. This includes avoiding a diet high in fat and meat. Likewise, do not drink alcohol, as this can lead to an increase in uric acid concentration. Drink plenty of fluids to dilute the urea and flush it out more quickly.
Follow-up
As part of gout follow-up, uric acid levels are checked regularly to check the medication regimen. Depending on the results of the examination, medication may be adjusted or maintained. If necessary, diet, physical exercise and other components of the therapy are also checked. Progress checks initially take place several times a year and can be reduced if the disease progresses positively. If the symptoms do not decrease or even become more severe, permanent therapy is indicated. The purine metabolism must be regulated in order to alleviate the typical symptoms and achieve long-term recovery. After an acute attack of gout, the patient must take it easy and continue to cool the affected area. During follow-up care, the causes of the disease are determined to enable an optimally adapted therapy. Likewise, possible triggers such as alcohol or a purine-rich diet must be avoided, since in most cases these aggravate the symptoms. After an operation, as is necessary in the case of arthritically destroyed joints, rest and recuperation are again the order of the day. The patient must undergo a follow-up after one to two weeks and visit the responsible internist and, depending on the symptoms, other specialists at regular intervals for medical check-ups.
What you can do yourself
With a gout should be consulted in any case a doctor. The medical professional will prescribe appropriate medicines and conventional medical measures depending on the cause. To support the initial treatment, affected individuals can take some self-help measures. In an acute attack, the inflamed joints should be cooled with compresses or compresses. The affected limbs should be elevated and moved as little as possible. This should be accompanied by drinking plenty of water or tea so that the crystals are quickly eliminated. Alcohol should be avoided. The same applies to purine-rich foods such as offal, roasts, seafood, foods containing yeast, spinach and cauliflower. An effective home remedy for gout is cherries. The fruit contains anti-inflammatory substances, which at the same time neutralize uric acid in the blood and relieve pain. Other foods that help to eliminate uric acid (such as celery or radishes) may also be eaten more frequently during a gout attack. Apart from this, those affected should tackle the causes of gout. Those suffering from obesity should strive to lose weight, while alcoholics should seek therapeutic help. If kidney disease or type 2 diabetes is present, long-term therapy with professional support may be necessary.
