Be Aware of the Common Signs and Symptoms of Gout
Gout, a form of inflammatory arthritis, is a particularly painful condition that affects millions of Americans. The pain is caused by inflammation in the joint induced by the deposition of sharp uric acid crystals. Uric acid is created when purines are metabolized or broken down by the body. Uric acid in and of itself is not harmful; it only becomes worrisome when the body is unable to properly process the acid or if the body is experiencing unusually high levels of the acid.
One of the most distinguishing signs of gout is its sudden onset in the middle of the night in the large joint of the big toe. Although, much less commonly, gout can occur at any time during the day and in a variety of other joints such as the ankles, knees, and wrists. Gouty arthritis is unique in that it primarily only affects a single joint at a time. However, if left untreated for long periods of time, multiple joints will likely begin to be implicated.
Gout symptoms include intense joint pain, redness, swelling, warmth, and a limited range of motion at the affected site. Gout often causes the joint to become so sensitive that it is difficult to walk, wear shoes, or even have a sheet resting against it. Read on to learn more about gout signs and symptoms.
What are the Symptoms of Gout?
- Sudden onset of intense pain in a single joint, usually in the lower body and most commonly in the big toe, as well as joints in the mid-foot and ankles
- Localized swelling and inflammation caused by the needle-like uric acid crystals
- Redness and a feeling of being warm to the touch
- Decreased joint mobility
Gout usually appears in a single joint at a time, but it can spread to multiple joints if it is left untreated and cause additional health complications. It is also more likely for multiple joints to be affected in recurrent gout attacks. It is important to take action at the first signs of gout.
Complications of Gout and its Symptoms
If gout is left untreated, tophaceous gout can occur. Tophi are large clumps of uric acid crystals that have grown together under the skin. Tophi are particularly harmful because they cause disfigurement through the destruction of bone and cartilage. There are two stages, or severities, of tophaceous gout:
Mild chronic tophaceous gouty arthopathy (CTGA), considered a stable or simple disease, is characterized by:
- A lack of drainage or ulceration of the overlying skin
- Slow growth, otherwise known as size stability, of the tophi – usually smaller in size
- Low risk of infection due to the lack of open wounds
- Lack of severe chronic joint inflammation
Moderate CTGA is characterized by the same symptoms as mild CTGA, however 2-4 joints are affected.
Severe CTGA, considered an unstable or complicated disease, is characterized by:
- Affecting more than 4 joints OR
- Any number of joints have:
- Drainage, most often caused by ulceration of the overlying skin
- Very rapid growth which puts the patient at a high risk for damage to the bone
- Damage to connective tissue and/or surrounding nerves
- High risk of infection due to the ulceration of the overlying skin
- Severe chronic joint inflammation
Untreated gout can also lead to kidney stones, which is known in the medical field as nephrolithiasis. Kidney stones are hard deposits that form in the kidneys and are ultimately excreted through the urinary tract. While kidney stones are unlikely to cause permanent damage, they can be very painful to pass.
With proper treatment, most often prescription medication, the tophi can be completely dissolved. Only in the most severe, refractory cases is surgery considered.
Gout Symptom Management
In order to prevent the progression to chronic, tophaceous gout, and to lessen the likelihood of damage to the surrounding tissue and bone, early treatment of gout is crucial. Currently, there are no cures for gout, so treatment primarily revolves around managing the symptoms of gout. Of primary concern is decreasing inflammation and lowering uric acid levels.
Decreasing inflammation helps by both decreasing pain and preventing damage to the joint and surrounding bone and tissue. NSAIDS, or nonsteroidal anti-inflammatory drugs, are the first line of defense when it comes to lowering the level of inflammation in the body. These drugs (e.g. ibuprofen, naproxen) are offered over the counter in relatively low doses, or your doctor can prescribe prescription strength NSAIDs (e.g. celecoxib, meloxicam). Since deposits of uric acid are the primary factor of gout, decreasing uric acid in the body is highly effective in controlling gout attacks symptoms. Prescriptions, such as allopurinol, colchicine, and febuxostat, are also available to help control the levels of uric acid in the blood.
In addition to the medicinal treatments that are available to manage the symptoms of gout, simple diet changes can also help lower the levels of uric acid. Purines are broken down into uric acid by the kidneys, so food that is high in purines should be avoided, including alcohol, red meat, organ meat, drinks and foods high in fructose, oily fish, and shellfish. Foods that may provide a beneficial anti-inflammatory effect and/or can help reduce the levels of uric acid in the body include cherries, bananas, apples, lemons, and baking soda.
Signs of An Impending Gout Attack
Many individuals learn to recognize when a gout flare up is imminent. The intense pain that is experienced in the midst of an attack is often preceded by burning, itching, or tingling in the affected joint. These signs can begin one to two hours before an attack. Once you have experienced these symptoms once, you can begin to predict recurrent attacks and start treatment as soon as the signs appear. However, it is not uncommon to have no precursor signs and some individuals are struck with an attack seemingly out of the blue, especially when attacks are infrequent.
Conditions Similar to Gout
Gout shares similarities with several other conditions, including but not limited to:
- Psuedogout. Psuedogout, calcic gout, or calcium pyrophosphate dihydrate (CPPD) deposition disease is a condition that mimics gout but is caused by a buildup of calcium pyrophosphate dihydrate rather than uric acid crystals. Rather than the big toe, pseudogout most often begins in the knee joint. It is also commonly found in the shoulders and wrists. Most cases of psuedogout affect more than one joint at a time. Also in contrast to common gout, psuedogout takes days to develop rather than hours. A simple blood test can confirm the presence calcium deposits and confirm a diagnosis of psuedogout.
- Rheumatoid arthritis. Rheumatoid arthritis is caused by an error within the body’s immune system that causes it to attack the membrane that lines your joints. Rheumatoid arthritis mimics the symptoms of gout quite closely, with similar swelling, redness, warmth, and pain around the joint. However, rheumatoid arthritis almost always affects multiple joints, often in the same joints on both sides of the body, where gout tends to only affect multiple joints in severe cases or when left untreated. Additionally, rheumatoid arthritis tends to have a more gradual onset than the sudden, intense pain caused by gout, and is most bothersome within the first hour of waking.
- Septic arthritis. Septic arthritis, or infectious arthritis, is caused by a bacterial infection in the joint cavity. The most common bacteria culprit is Staphylococcus aureus, with the infection commonly known as staph infection. The knee is most often implicated with septic arthritis, making up about 50% of cases. The wrists, ankles, and hips are also commonly affected. Septic arthritis is most common in individuals who have prior joint damage, such as in the case of rheumatoid arthritis. Analysis of the synovial fluid is the most effective diagnostic tool; a high presence of leukocytes (a type of white blood cell) and a lack of uric acid crystals indicate a high likelihood of septic arthritis.
- Osteoarthritis. Osteoarthritis is often referred to as “wear and tear” arthritis or degenerative arthritis because it is caused by the cartilage in between joints being worn down. This primarily occurs in old age, and is seen earlier in individuals that are overweight and therefore carry a more intense load on their joints. The symptoms of osteoarthritis present similarly to gout, with pain and stiffness in a joint or joints. However, similar to rheumatoid arthritis, osteoarthritis occurs gradually over time and is most bothersome first thing in the morning. Osteoarthritis symptoms can also rear their head after extended activity that causes the joints to become swollen. A physical examination and medical history are taken in order to come to a diagnosis, and a sample of the synovial joint fluid may be taken in order to rule out gout, psuedogout, and septic arthritis.
- Bunions. Bunions develop over time, most commonly as a result of too much pressure on the base of the big toe. This can be caused by a combination of factors, including foot structure and wearing high heels. Bunions have some similar symptoms to gout, but they tend to be much less severe and do not have a sudden onset. Symptoms include: displacement or bending of the big toe toward the other toes, skin irritation over the bunion, redness, swelling, and joint pain or stiffness.
When to Contact a Doctor
You should contact your doctor at the first sign of a gout attack because leaving the condition untreated will only prolong symptoms and increase the risk of irreversible damage to the joint, bone, and/or surrounding tissue. The longer that gout goes untreated, the higher your risk of developing chronic, tophaceous gout, also known as severe CTGA.
If you are having repeated attacks that respond poorly to treatment, you should ask your primary care physician to refer you to a rheumatologist – a doctor that specializes in diseases of the joints and muscles.
If the affected joint becomes hot to the touch and you develop a fever, this may be a sign that the joint has become infected, such as in the case of septic arthritis, and you should seek medical care immediately.
Should any of these signs and symptoms arise, consider making an appointment with your primary care physician or booking online with PlushCare in order to confirm the diagnosis and discuss a treatment plan.