The disease occurs more frequently in men and at an advanced age. The cause is a permanently elevated uric acid level in the blood, which results in the formation and deposition of uric acid crystals in the joints. These deposits can lead to the typical, painful inflammatory reactions.
Although gout is a chronic disease, it can usually be treated well. A combination of medication that regulates uric acid levels and lifestyle adjustments can alleviate symptoms and reduce the frequency of gout attacks.
What is gout?
Alongside diabetes, gout is one of the most common diseases of affluence. Gout leads to an increased concentration of uric acid in the blood (technical term: hyperuricemia). If the uric acid in the blood exceeds a certain concentration, our body can no longer excrete it completely. Tiny, needle-shaped crystals form and are deposited in various places in the body. These crystals are also known as urates. Urates can be deposited in the joints (arthritis urica), in soft tissue (gouty tophi) and in internal organs such as the kidneys (renal gravel, kidney stones).
The deposition of uric acid crystals in the joints triggers an inflammatory reaction, which is accompanied by the painful symptoms of a gout attack. If acute attacks of gout remain untreated or occur repeatedly, the disease can develop into a chronic form, which is associated with long-term joint damage and other health complications.
What forms of gout are there?
A distinction is made between two forms of gout: primary and secondary gout. Both have different causes, but are similar.
- Primary hyperuricemia (congenital gout)
Primary hyperuricemia refers to an increased concentration of uric acid in the blood caused by genetic factors or a disorder in purine metabolism. The body either produces too much uric acid or cannot excrete it sufficiently. Primary hyperuricemia is more often hereditary and is the main cause of gout.
- Secondary hyperuricemia (gout as a result of a disease)
Secondary hyperuricemia occurs when an increased uric acid level in the blood is caused by other diseases or external factors. Causes can include kidney disease, certain medications (such as diuretics), chemotherapy or excessive alcohol consumption.
How long does a gout attack last?
An attack of gout usually lasts between 3 and 14 days without treatment. The pain is particularly severe in the first few days before gradually improving. Even if the symptoms subside, the uric acid level often remains elevated, which can lead to further attacks. Early treatment can significantly reduce the duration and intensity of the seizure.
Gout: causes and risk factors
Gout is often caused by a genetic predisposition that leads to reduced excretion of uric acid.
Unhealthy lifestyle habits such as being overweight, lack of exercise, a diet too heavy in meat and excessive alcohol consumption increase the risk of a gout attack.
Diseases such as high blood pressure, renal insufficiency or poorly controlled diabetes can also increase the risk. Acute illnesses (such as pneumonia), operations or trauma can also trigger an attack of gout.
Other diseases such as leukemia, psoriasis or kidney disease can increase uric acid production or reduce its excretion and thus increase the risk of gout. In rare cases, gout can be caused by a genetic overproduction of uric acid, as in Lesch-Nyhan syndrome.
Certain medications, such as cytostatics, can also promote an attack of gout.
Another risk factor is gender: men are more frequently affected and often experience their first attack of gout between the ages of 40 and 45. Women are generally only at risk after the menopause, which indicates the protective influence of the female sex hormones up to this point.
Symptoms of gout: recognizing signs and warning signals
Gout usually develops gradually over many years. Until the first attack of gout, sufferers usually do not notice they have the disease. Typical symptoms of a first acute attack of gout are very severe pain in the affected joint. In 60 percent of cases, gout first becomes noticeable on the big toe. In an acute attack of gout, the affected joint is severely inflamed, swollen, reddened and sensitive to touch. Even the weight of a light comforter or sock can be too much. It is possible that the inflammation may also spread to the tendon sheaths and bursae. Rare side effects of a gout attack can include headaches, fever, nausea and palpitations.
Gout: diagnosis and examinations
The diagnosis of gout is usually based on a combination of clinical symptoms, laboratory values and imaging procedures. The gold standard for diagnosing gout is to obtain joint fluid and examine it under the microscope for the presence of uric acid crystals. The blood test sometimes (but not always) shows elevated uric acid levels and increased inflammatory parameters. Imaging procedures such as ultrasound, X-rays or special computer tomography scans can provide additional indications of the presence of gout.
If gout is suspected, it is advisable to consult a general practitioner or a rheumatologist to confirm the diagnosis and initiate appropriate treatment.
Preventing gout with the right diet and exercise
Everyone has uric acid in their blood. It is produced in the body during the breakdown of purines – substances that our body needs for cell development. On the one hand, it forms them in the metabolism itself and on the other hand, we take in purines with our food.
An elevated uric acid level in the blood does not necessarily mean that you will develop gout. However, there is a risk that the saturation limit for uric acid in the blood will be exceeded, leading to deposits of uric acid crystals and thus to (acute) gout.
Uric acid levels can be influenced to a certain extent by lifestyle and diet.
The consumption of purine-rich foods such as red meat, offal and seafood should be reduced, as purines are broken down into uric acid in the body. It is also recommended to drink enough water to promote the excretion of uric acid. Drinks and foods containing fructose (especially soft drinks) should be avoided. Regular exercise, avoiding obesity and moderate consumption of alcohol, especially beer, can also contribute to prevention.
Early detection of gout: How do I recognize gout?
Gout usually manifests as sudden, intense pain in one or more joints, often accompanied by redness, swelling and warmth. The big toe joint is most commonly affected, but knees, ankle joints or fingers can also be affected. The pain usually occurs at night and can last for several days. In many cases, these attacks are the first signs of gout. In the long term, repeated seizures can occur in the absence of or inadequate therapy.
Gout prognosis: good chances with timely treatment
Both an acute attack of gout and chronic gout can be treated well with targeted medication, which can prevent possible long-term consequences (joint or kidney damage, gout tophi).
In addition to drug therapy, a healthy diet and sufficient exercise also play a role.
Gout treatment: What helps with gout?
An acute attack of gout should be treated by a doctor. The earlier targeted treatment is started, the better. If left untreated, gout can become chronic and cause permanent damage to the joints, skin and kidneys.
Which medications help against gout?
The treatment of gout follows a clearly structured approach that is tailored to the respective condition and severity of the disease.
First, the acute inflammatory reaction is treated in order to relieve the pain quickly. This is done by administering anti-inflammatory medication such as non-steroidal anti-inflammatory drugs (NSAIDs), cortisone or colchicine. These medications work quickly and effectively to relieve the symptoms.
If gout becomes chronic or if gout attacks occur repeatedly, a long-term therapy aimed at lowering the uric acid level in the blood comes into play. This is crucial to prevent future relapses and avoid the development of gout tophi (uric acid deposits in tissues) or kidney damage. To this end, drugs are used that inhibit uric acid production or promote its excretion via the kidneys.
An important aspect is prophylaxis at the start of uric acid-lowering therapy. The rapid drop in uric acid levels can lead to an increase in gout attacks in the first few months. To prevent these, it is recommended to start preventive therapy at the same time as anti-inflammatory medication to minimize the risk of additional flare-ups.
Overview of medications:
- NSAIDs for gout: High doses of anti-inflammatory painkillers help with an acute attack of gout. Non-steroidal anti-inflammatory drugs (NSAIDs for short), e.g. with the active ingredient diclofenac or ibuprofen, achieve good results.
- Cortisone: Cortisone can be used in cases of impaired kidney function or contraindications for NSAIDs. Either in tablet form or directly into the affected joint with an injection.
- Colchicine: Colchicine is an alkaloid of the autumn crocus. It has an anti-inflammatory effect at low doses and can also be prescribed for an acute attack of gout.
- Interleukin-1 inhibitors: Interleukin-1 is an important messenger substance in the inflammatory reaction of gout and can be specifically blocked. Treatment with Anakinra or Canakinumab is cost-intensive and requires a cost approval from the health insurance company.
- Urostatic drugs: Urostatic drugs are primarily used to permanently reduce uric acid levels. Urostatic drugs such as allopurinol and febuxostat increase uric acid excretion via the kidneys and thus lower the uric acid level in the blood.
- Uricosurics: Uricosurics with the active ingredients benzbromarone, probenecid or lesinurad reduce uric acid production and thus lead to a reduction in the uric acid level in the blood.
Gout: surgery for deformities and gout nodules
In severe cases, deformities and gouty nodules can be treated surgically.
Details of the treatments