gout Gout is a disease caused by elevated levels of uric acid in the blood, leading to the deposition of uric acid crystals in the joints, resulting in painful inflammatory attacks within and around the joints. Tophi, characteristic clinical manifestations of gout, are commonly found in joints such as the ears, toes, fingertips, hands, elbows, Achilles tendons, and patellar bursae.

Gout is a disease caused by the deposition of uric acid crystals in the joints due to elevated levels of uric acid in the blood. The deposition of these crystals leads to painful inflammation within and around the joints. Tophi, which are characteristic clinical manifestations of gout, are commonly found in joints such as the earlobes, toes, fingertips, knuckles, elbows, Achilles tendons, and patellar bursae. This condition is directly related to disorders in purine metabolism and/or decreased excretion of uric acid, with its main clinical features being elevated blood uric acid levels, recurrent acute arthritis, and the presence of tophi. It can lead to complications such as renal disease, and in severe cases, joint damage and renal impairment can occur. It is often associated with conditions such as hyperlipidemia, hypertension, diabetes, arteriosclerosis, and coronary heart disease.

Understanding the triggering factors of gout is crucial for disease control and reducing acute pain.

Drug-induced factors

Certain medications that can affect the kidney's ability to excrete uric acid, leading to elevated blood uric acid levels, include thiazide diuretics, cyclosporine, pyrazinamide, ethambutol, niacin, warfarin, low-dose aspirin, and others.

High purine food intake

Consumption of high-purine foods such as meat, animal organs, and certain seafood (such as shellfish) can lead to increased blood uric acid levels as these foods are broken down into uric acid by the body.

Alcohol consumption

Excessive alcohol intake is an independent risk factor for gout attacks. Beer, in particular, contains a high amount of purine components, posing the highest risk for triggering gout.

Other diseases

Conditions such as kidney disease, cardiovascular disease, metabolic syndrome, psoriasis, obesity, diabetes, hypothyroidism, insulin resistance, and others are all associated with hyperuricemia. When combined with other risk factors, they can more easily lead to gout attacks.

The symptoms of gout can be described based on the natural course of the disease in its three stages.

Asymptomatic phase

This phase is characterized by fluctuating or sustained hyperuricemia without the manifestation of gout (such as arthritis, tophi, and uric acid kidney stones). The time from elevated blood uric acid to the appearance of symptoms can be several years, and in some cases, symptoms may never appear throughout a person's lifetime.

Acute arthritis phase and intercritical period

Gout typically starts suddenly, often at midnight or in the early morning, with severe joint pain that peaks within a few hours. The affected joint becomes red, swollen, hot, painful, and experiences functional impairment.

The initial attack usually affects a single joint, with the first metatarsophalangeal joint being the most commonly affected.

The attack is self-limiting, with symptoms resolving within two weeks, after which the redness and swelling subside, followed by peeling of the skin at the affected joint.

High blood uric acid levels may be present, but in some acute attacks, blood uric acid levels may be normal.

Uric acid salt crystals can be found in joint fluid or tophi.

Fever may be present.

Tophi and chronic arthritis phase

Tophi are characteristic clinical manifestations of gout, commonly found on the earlobes and around the joints, as well as at the olecranon, Achilles tendon, and patellar bursa.

Tophi appear as varying-sized, elevated, yellowish-white growths with thin surfaces, which discharge white powdery or pasty material upon rupture.

Chronic arthritis is commonly seen in patients who have not received standardized treatment, with asymmetric irregular swelling and pain in the affected joints. The extensive deposition of tophi in the joints can lead to bone damage, resulting in joint deformities, particularly in the hands and feet, and can cause disability.

Symptoms of renal disease

Patients with long-term gout may experience kidney damage, which presents with specific symptoms that require vigilance.

Uric acid nephropathy: Onset is insidious, with clinical manifestations such as increased nocturia, low specific gravity of urine, low-molecular-weight proteinuria, leukocyturia, mild hematuria, and urinary casts. In advanced stages, it can lead to renal insufficiency, hypertension, edema, anemia, and more.

Uric acid kidney stones: Symptoms can range from asymptomatic to renal colic, hematuria, difficulty in urination, hydronephrosis, pyelonephritis, or perinephric abscess.

Acute kidney failure: Obstruction of renal tubules, renal pelvis, and even ureters by a large number of uric acid salt crystals can lead to sudden oliguria or anuria, and can progress to acute renal failure.

Diet

Maintain adequate water intake and avoid consuming alcohol, sugary beverages, and high-purine animal foods such as animal organs and seafood.

Dietary recommendations

Consume ample water, with a daily intake of 2000 ml or more.

Increase intake of fresh vegetables.

Dietary restrictions

Limit alcohol intake, especially beer.

Reduce consumption of high-purine foods, including animal organs, pork, beef, lamb, shellfish, sardines, mackerel, and tuna.

Reduce consumption of fructose-containing beverages.

Lifestyle

Maintain a healthy weight and waist circumference, and engage in moderate physical activity.

Specifically, gout patients should adhere to the following principles:

Maintain a healthy weight.

Follow a regular diet and sleep schedule.

Engage in regular exercise.

Quit smoking.

Discontinue medications that can lead to elevated uric acid levels.

During gout attacks, it is important to rest and avoid fatigue, as well as to prevent vigorous exercise or sudden exposure to cold. According to a large data analysis in China, vigorous exercise is the third leading trigger for gout attacks in both men and women. Sudden exposure to cold is the second leading trigger for gout attacks in women and the fifth leading trigger in men.

Adjusting lifestyle can help prevent and treat gout. Refer to the section on daily life management for specific details.