Gout is an inflammatory joint disease with sudden onset and very easy recurrence with severe pain, caused by high uric acid levels in the blood (hyperuricemia) and resulting in the deposition of monosodium urate crystals in the joints. Beijing Jishuitan Hospital Orthopedic Orthopedics Huang Ye joint inflammation can often become chronic and joint deformity occurs after repeated attacks of this disease. About 20% of patients with gout have kidney stones. Under normal circumstances, uric acid is a byproduct of cellular metabolism, and uric acid appears in the blood of normal people because food contains precursor substances for uric acid. Gout results when the kidneys become diseased or when certain medications impede the kidneys’ ability to remove uric acid, and when diseases such as hereditary diseases with abnormal enzymes or blood cancers speed up cell replication and destruction, resulting in abnormally high levels of uric acid in the blood. Symptoms Acute gouty arthritis attacks are usually unpredictable. They can be triggered by minor injuries, surgery, excessive alcohol consumption, excessive consumption of protein-rich foods, fatigue, emotional stress or various illnesses. The typical symptom is severe pain in one or more joints that occurs at night and becomes progressively worse and more unbearable, with symptoms such as redness, swelling, heat and tenderness. The disease most often involves the base of the toes, a condition known as foot gout. The arch, ankle, knee, wrist and elbow joints can also be involved. Crystals can be deposited around the joints in these areas because of poor circulation and the tendency for urates to crystallize at lower temperatures. Crystals can also be deposited in the outer ear or other areas of relatively low body temperature, but gout rarely affects the spine, hip, or shoulder. Symptoms of acute gouty arthritis also include chills, fever, general malaise, and a rapid heart rate. Gout occurs most often in middle-aged men and postmenopausal women, and it usually tends to worsen if symptoms appear before age 30. The first symptoms often appear in one joint and last for several days, then symptoms gradually disappear and joint function returns. There are usually no symptoms until the next gout attack. However, if the disease worsens and is not treated aggressively after an attack, it will lead to more frequent attacks and can affect multiple joints, resulting in permanent damage to the diseased joint. Severe chronic gout that causes deformities also worsens, with urate crystals deposited around joints and tendons causing damage and progressively limiting joint movement. Hard urate crystals (gout stones) often form under the skin around the joints. Gout stones can also occur in the kidneys and other organs, such as under the skin of the outer ear and near the elbow joint. If left untreated, gout stones in the hands and feet can break up and release lime like crystals. Diagnosis The diagnosis of gout can be determined by the obvious symptoms and examination of the joints, as well as hyperuricemia. Gout is diagnosed when pinpoint uric acid crystals are present in the joint puncture fluid using a polarized light microscope. Treatment The first step should be to control inflammation and relieve symptoms. Colchicine is a traditional therapeutic drug, which generally provides significant relief of joint pain symptoms after 12 to 24 hours of use, and the symptoms can disappear completely after 48 to 72 hours. Colchicine is mostly taken orally, but intravenous administration can be switched if gastrointestinal discomfort occurs. The drug often causes serious side effects such as diarrhea and even bone marrow damage. Non-steroidal anti-inflammatory drugs such as ibuprofen and anti-inflammatory pain are mostly used and are often more effective than colchicine in relieving joint swelling and pain. Sometimes hormones such as prednisone are also used. If only one or two joints are involved, injecting prednisone directly after a joint puncture and aspiration can effectively stop the inflammation caused by urate crystals deposited in the joint. In addition, analgesics such as codeine or pethidine hydrochloride are occasionally used to reduce joint pain. Proper braking and resting of inflamed joints can achieve pain relief. Secondly, recurrence of gout should be prevented. Patients should drink more water, avoid alcoholic beverages and eat less protein-rich foods. Patients with gout are usually overweight, and when their weight decreases, the uric acid level in the blood will automatically drop to normal or near normal. For patients with recurrent, severe gout attacks, medication should be continued after symptoms disappear or between attacks. A small daily oral dose of colchicine may prevent attacks or reduce their frequency. Routine use of non-steroidal anti-inflammatory drugs or in combination with colchicine can be effective in preventing gout flares, but this treatment does not prevent or cure progressive joint damage caused by crystalline buildup, and long-term use of such drugs can cause liver or kidney damage in patients. Drugs such as probenecid or benzosulfone can lower blood uric acid levels by increasing the excretion of uric acid. Aspirin interferes with the effects of both of these drugs, so they should not be used together. Acetaminophen or the non-steroidal anti-inflammatory drug ibuprofen may provide pain relief and is safe to use. Patients should drink plenty of fluids (at least 3L) daily to reduce the risk of joint and kidney damage. Allopurinol, which blocks the formation of uric acid in the body. The drug is especially helpful for patients with hyperuricemia and gout stones in the kidneys or who have kidney damage. However, the drug can also produce side effects such as gastrointestinal upset, rash, leukopenia and liver damage. Most gout stones in the outer ear, hand or foot will slowly shrink as blood uric acid levels fall, but very large gout stones must be surgically removed. For those patients who do not have gout symptoms but have hyperuricemia, medication can be used to lower the uric acid level in the blood. However, the medication itself and improper administration can produce various side effects. The use of colchicine can prevent the formation of kidney stones when the patient has a high uric acid excretion in the urine.