What is gout?
Gout is a painful form of arthritis caused by uric acid crystals that form in and around the joints.
It’s the most common type of inflammatory arthritis.
It’s more common in men and you’re more likely to get it as you get older. gout occurs in people who have high levels of uric acid, also known as urate, in their blood.
Urate is created every day when our bodies break down purines. Purines are chemicals that are naturally created in our body, but they are also present in certain foods.
We all have urate in our blood: this is normal and healthy. But if levels become too high it may cause gout.
Tophi
Urate crystals can also collect outside of the joints and can be seen under the skin, forming small, firm lumps called tophi. You can sometimes see the white colour of the urate crystals under the skin.
The most common areas for tophi are:
- over the top of the toes
- back of the heel
- front of the knee
- backs of the fingers and wrists
- around the elbow
- the ears.
Tophi aren’t usually painful, but they can get in the way of normal daily activities. They can sometimes become inflamed, break down and leak fluid with gritty white material - these are the urate crystals.
Tophi can also grow within your joints and cause damage to your cartilage and bone. This can lead to more regular, daily pain when you use the affected joints.
If urate levels stay too high, urate crystals can slowly form. They mainly occur in and around firm joint tissues, such as the cartilage. But crystals can also appear under your skin and may even occur in your internal organs, such as the kidneys.
What are the symptoms of gout?
An episode of gout is called a gout attack. Gout attacks are very painful and can happen quite suddenly, often overnight. During a gout attack, symptoms in the affected joint(s) may include:
- Intense pain.
- Redness.
- Stiffness.
- Swelling.
- Tenderness, even to light touch, such as from a bedsheet.
- Warmth, or a feeling like the joint is “on fire.”
A gout attack can last a week or two. Between gout attacks, you may have no symptoms at all.
Some people have gout attacks frequently, while others go years between episodes.
If gout isn’t treated, attacks may become more frequent and last longer.
Gout attacks can happen over and over again in the same joint or affect different joints.
What causes gout?
The human body makes uric acid during the breakdown of chemicals called purines found in certain food and drinks.
This normal byproduct goes through the kidneys and exits the body when you pee.
Sometimes the body produces too much uric acid.
Or the kidneys can’t do a good job handling it. When the body has high levels of uric acid, or hyperuricemia, uric acid crystals can concentrate in the joints.
The sharp, needle-like crystals cause gout.
What can trigger an attack?
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that gives you a fever
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- dehydration
starting urate lowering therapy (ULT), especially at a high dose, or not taking your ULT regularly each day.