What is Gout | Sudden & Severe Episodes of Pain

Gout - What it is

Gout is a condition that causes sudden, excruciating pain and swelling in the affected joints, particularly in the big toe. It is a metabolic disorder caused by an excessive amount of uric acid in the blood.

Gout can also arise from a high protein and fat diet and also alcohol. When the kidneys are unable to excrete the excess uric acid, it may end up being deposited as crystals in the joints. If left untreated, the joints may be damaged resulting in deformity and restricted mobility even after an acute attack has subsided.

What happens when you have Gout?

In some people, there is an abnormality in the metabolism of purine, a chemical compound found in many foods, leading to high levels of uric acid in the blood, far more than what the kidneys can excrete into the urine.

The excess uric acid in the blood is deposited as uric acid crystals in the joint cartilage, tendons and other surrounding tissues. The uric acid crystals irritate the synovial membrane that covers the joints, resulting in redness, pain and swelling. The joints commonly affected by gout are the big toe, foot, ankle, knee, elbow and wrist.

Stages of Gout

Patients with gout do not suffer from continuous pain all the time. They experience sudden joint pains from “acute attacks”. When the acute attacks subside, they may feel well for months or even years, but the attacks may recur and become more frequent.

From a medical point of view, there are 4 stages of gout:

1. Asymptomatic phase

Patients have elevated levels of uric acid in the blood, but do not experience any pain or swelling. Not all patients with high uric acid will have an acute attack.

2. Acute gout

At this stage, uric acid crystals are deposited around the joint, causing sudden swelling and intense pain. This is commonly referred to as gout attack.

3. “Interval” gout

In between gout attacks, patients may not experience any symptoms and will have normal joint function. The uric acid level remains high.

4. Chronic gout

If treatment is not sought, years of gout attacks will cause damage to the affected joints, leading to deformity, chronic pain, and immobility.

Elevated levels of uric acid may be deposited as crystals in the kidney forming uric acid kidney stones. These uric acid kidney stones, like the regular ones, may cause pain, obstruction to the flow of urine and infection. Clumps of uric acid crystals called tophi, can form around joints, tendon, ligaments and even in ear lobes of patients with chronic gout.