Uric acid gout

Uric acid gout

Gout is a joint inflammation caused by the precipitation of uric acid crystals. Most often, it is the big toe joint that is affected, and the condition is then called gout. Gout causes severe pain, but can be treated with drugs.

What is gout?

During the body's breakdown of nutrients, uric acid is formed as a waste product. The uric acid is excreted through the kidneys together with the urine. Normally, there is a balance between the formation and excretion of uric acid. Gout usually occurs because the amount of uric acid in the blood is too large, either due to reduced excretion of uric acid through the kidneys or because the formation is greater than the excretion. The excess of uric acid precipitates as crystals that accumulate in certain joints. In over 50% of cases, the big toe joint is attacked, and is then called gout. Other joints, such as fingers, ankles, elbows, knees and wrists, can also be affected.

Women are rarely affected until after menopause. The number of new cases is constantly increasing and it is believed that this is due to the lifestyle we live, where the incidence of obesity is constantly increasing and, in addition, the proportion of elderly people is increasing.

Causes of gout

There is often no good explanation as to why gout occurs, but possible causes are:

Heritage

• Congenital defect in uric acid metabolism (rare)

• Side effect from other medicines, for example some diuretic medicines and some blood-thinning medicines (acetylsalicylic acid)

• Other diseases such as kidney disease, cancer and psoriasis

Symptoms of gout

Gout usually occurs in acute attacks that develop in a short time, and the attacks often occur at night. This causes symptoms such as:

• Severe gout-like pain

• Reduced mobility in the joint

• Some also get a fever

A seizure lasts for 3-10 days without treatment, while the duration is reduced to 1-2 days with seizure treatment. Gout can over time lead to, among other things, kidney stones and should therefore always be treated. Repeated attacks over several years can make the condition more chronic, with inflammation in several joints.

Good advice for gout attacks

• Keep the joint still and avoid stress

• Cooling down with cold water or an ice pack can reduce the pain somewhat

• If you have had gout attacks in the past, it may be a good idea to have any medication available, so that you can start treatment as soon as possible when the attack starts

Diet in gout

A diet with the lowest possible content of so-called purines is recommended to prevent seizures. Purines are substances found in all cells' genetic material, and when cells die, purines are released and broken down into uric acid. Examples of foods that contain a lot of purines and which you should therefore be careful with are:

• Meat and seafood (shellfish, anchovies, sardines)

• Alcoholic beverages, especially beer and spirits. Wine is recommended if you are going to drink alcohol. Alcohol also inhibits the excretion of uric acid from the kidneys

• Soft drinks and sweet fruit drinks

• High-fat products

• Peas, lentils, asparagus, spinach and mushrooms

• Oatmeal

A diet rich in fruit, vegetables (NOTE! some exceptions - see above) and low-fat dairy products is recommended. In addition, it is important to drink plenty of water. Weight reduction is recommended for overweight people, but avoid rapid weight loss as it will increase the amount of uric acid in the blood and thus could trigger seizures.

Seizure medications

Gout is treated with anti-seizure drugs that make the attack go away faster. NSAIDs are a group of pain-relieving and anti-inflammatory medicines that are commonly used for this purpose. Several types of NSAIDs can be used, but salicylates (acetylsalicylic acid) should be avoided as they can increase the concentration of uric acid.

Colchicine has an anti-inflammatory effect and is an alternative to NSAIDs in acute attacks of gout, but is also used preventively in lower doses. Treatment with colchicine must be started within 24 hours after you notice the first symptom to have an optimal effect. Injections with glucocorticoid into the joint are also used in some cases.

Preventive medications

If you have more than 1-2 attacks a year, the doctor often finds it necessary to use a preventive medicine that is taken regularly every day. Medicines used are so-called uricosurics or enzyme inhibitors.

Uricosurics (probenecid) work by increasing excretion and reducing the reabsorption of uric acid through the kidneys so that more uric acid is excreted. The medicine should not be used by people who have had kidney stones.

Enzyme inhibitors (allopurinol) work by reducing the formation of uric acid in the body and reduce the amount of uric acid in both blood and urine. Allopurinol normally has few side effects, but some may be sensitive to the active ingredient and develop a skin rash. A doctor should then be contacted. The medicines can cause nausea and it can therefore be an advantage to take the tablets in connection with a meal.

The preventive medicines can briefly increase the concentration of uric acid in the blood and thus trigger gout attacks in the start-up period. It is therefore common to use seizure medication in parallel at the start of treatment. For the same reason, preventive treatment should also not be started during an attack.

Sources: Norwegian drug handbook for healthcare personnel, Norwegian health informatics for healthcare personnel, Norwegian Rheumatism Association, Felleskatalogen, Helse Bergen