Gout is a condition that results in crystallization of a salt uric acid (sodium-urate) in tissues, especially in the joints. We have provided a detailed explanation below that addresses the most common questions patients have about this condition.
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1.- Is it possible to have a gout attack with normal levels of uric acid?
Yes, it can happen in as many as 50% of patients. The amount of uric acid in blood at the time the inflammatory attack occurred is not always indicative of the amount of urate crystals that have accumulated in the joints. Patients with gouty symptoms may have normal levels of uric acids. However, there are cases where patients have no symptoms and those with severe gouty symptoms. Gout can be diagnosed even if a blood test shows a normal level of uric acid.
2. Is it gout if blood tests show high levels of uric acid?
Gout and hyperuricaemia are two distinct concepts. High levels of uric acids in the blood are called hyperuricaemia. It is defined as a level above 6.8 mg/dL (7mg/dL by convention) which is the point at which it crystallizes. Gout is when there are urate crystals within the tissues (joints and kidneys). Gout is a condition that affects one in ten people who have high levels of uric acid. However, chronic hyperuricaemia can often be accompanied by gout. High blood uric acid levels on a regular basis could indicate that we are not able to remove it properly, that our production is higher than normal, or both. Crystalline deposits can develop over time, which can cause various symptoms, such as joint, kidney, and other problems. or the formation of lesions beneath the skin called tophi (aggregates crystals).
3.- What are the symptoms of gout?
Most common is inflammation at the first metatarsophalangeal joints, i.e. The joint connecting the big toe to your foot. This is a very severe and painful condition that usually occurs at night. It can also cause erythema, or reddening of the skin around the joint. Although the initial symptoms may be mild and brief, gout attacks can become more severe and persistent if there is no treatment.
4.- Does gout attack only the big toe?
No. No. Gout can also cause inflammation of other joints, such as the knee and elbow (especially the olecranial Bursa which “cushions the back” of the elbow), wrist, and others.
5.- Can certain foods or drinks cause gout?
Gout can be caused by diet, even though it is important. More than 90% of cases are due to a problem with the kidneys eliminating uric acid. It is not recommended to consume foods high in purines, such as beer (with or without alcohol), high-proof alcoholic beverages and sweetened drinks (soft drink), etc. Red meat, game, seafood, and oily fish (sardines and anchovies) are all good options. Gout patients may experience joint pain from tomatoes, although a moderate intake of tomatoes is not likely to cause any problems. However, animal proteins can produce more purines than those made from vegetable proteins. Drinking 1-2 litres of water per day is recommended, especially if you have urate kidney stones. Skimmed milk products, cherries, and foods rich in vitamin C, as well as moderate coffee consumption, are also good options. However, obesity and overweight should be avoided.
6.- When should I visit the doctor?
Joint inflammation and recurrent pain, particularly in the big toe or instep, can be a sign of joint inflammation. If your uric acids levels have been rising over time or are exceptionally high (e.g. 9 or more), you may want to consult your doctor. If you have hyperuricaemia or a history of gout, it may be worth consulting your doctor.
7.- Can colchicine and traditional anti-inflammatory drugs be used to treat gout?
No. No. Gout treatment must be completed with the prescribed medication. This is not a quick fix. It takes months or years of work depending on each patient. Only constant medication under the supervision of a doctor and healthy lifestyle habits can eliminate the accumulation of uric acids crystals.
8.- Is it possible to cure gout by changing your diet and abstaining from alcohol?
The majority of cases, the answer is “no”. The majority of cases are not solved by reducing salt intake. However, patients with arterial hypertension will need to take daily antihypertensive medications. Gout patients often require the assistance of drugs. Gout sufferers have been accumulating urate in their bodies for many years, without even realizing it. Although diet can help, this is not enough to dissolve the uric acid. Gout can be treated with medication that reduces or increases the elimination of purines, such as allopurinol and febuxostat.
9.- Can there be inflammatory attacks with medication to dissolve urate crystallines?
It may seem odd and unexpected, but this can often happen in gout patients if drugs like allopurinol or febuxostat are not given the proper anti-inflammatory prophylaxis. Patients mistakenly believe they are more dangerous than beneficial. It is important to include a preventive treatment for gout attacks in the first month (or 6-12 months depending on your type of gout), when drugs such as allopurinol, febuxostat or benzbromarone are introduced. This includes a low-dose anti-inflammatory like naproxen (or corticoids in some cases), since there is a higher risk of joint problems in the first months as the crystal deposits begin to dissolve.
10.- Are high levels of uric acid and gout really dangerous?
Gout is more than just a painful joint that becomes inflamed or inflamed occasionally. Gout can cause systemic inflammation and not just joint inflammation. It can also affect vital organs like the kidney. Gout and hyperuricaemia are closely linked to the metabolic syndrome. It is common to see a variety of traditional risk factors for gout, including obesity, high cholesterol, triglyceride levels and insulin resistance. These factors can all be mutually reinforcing and put patients at high or moderate cardiovascular risk. It is important to pay the same attention to blood uric acids as to glucose and lipid levels.