When uric acid levels in the blood become too high, crystals form in the joints and soft tissues. The immune system perceives the crystals as invaders, triggering an attack that leads to inflammation in the joints and surrounding areas. This is the primary cause of gout.
Q2. How is gout diagnosed?
It is often perceived that sudden pain and redness in the big toe joint indicate a gout attack. In fact, many early symptoms of arthritis are quite similar to a gout attack. How do doctors diagnose gout? The most definitive method is to extract joint fluid for testing. If uric acid crystals are found in the inflamed joints, it confirms a diagnosis of gout. However, gout often occurs in small joints, making it difficult to extract joint fluid for testing. In such cases, doctors will assess whether the inflamed joints are caused by gout, based on the symptoms from past episodes, and uric acid levels in the blood.
Q3. How is gout treated?
Medications for treating gout are often confused with those for lowering uric acid levels. The treatment for gout focuses on controlling inflammation to effectively manage its symptoms. Commonly used medications include non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and biologics in severe cases.
However, controlling inflammation is not a cure for gout. High uric acid levels can cause not only gout but also cardiovascular disease and kidney failure. Therefore, addressing the root cause by controlling uric acid levels is essential to reduce the risk of gout attacks and other complications.
Q4. Why does gout keep recurring even with dietary restrictions?
In our diet, we may consume foods high in purines. Purines are converted into uric acid in the body, which may trigger gout attacks. However, it is a misconception that diet restrictions alone, like avoiding high-purine foods, can lower uric acid levels and prevent gout. It is not the consumption of high-purine foods that directly leads to high uric acid levels. Instead, it is the declining function of the kidneys in excreting uric acid that causes these levels to increase in the blood.
Monitoring one's diet can help reduce the chance of gout attacks, such as by reducing the intake of high-fat foods and alcohol. The metabolites from these foods can put the body in an inflammatory state, leading to gout attacks in joints and soft tissues with uric acid crystals. However, when the content of uric acid crystals gradually increases, gout attacks become more frequent, even without other influencing factors.
Therefore, the most effective method is to take medication that lowers uric acid levels in the blood, dissolving accumulated uric acid crystals, which can cure gout.
Q5. Why does gout worsen after taking uric acid medication?
Patients often experience more severe and frequent gout attacks after starting uric acid-lowering medications. This common phenomenon occurs because, as uric acid dissolves, the crystal structure changes significantly, prompting the immune system to recognise these uric acid crystals as new threats and attack them accordingly. However, as the uric acid crystals gradually decrease in quantity, the chances of triggering attacks will also reduce. Therefore, doctors prescribe medications to prevent gout attacks during the initial stages of uric acid-lowering treatment.
Q6. Can gout be completely cured? How can recurrences be avoided?
Gout is often seen as an intermittent issue. However, if left unattended, it can worsen and potentially lead to chronic arthritis. With appropriate treatment, uric acid levels can be effectively managed, making it possible to cure gout. As uric acid-lowering medication is administered, uric acid crystals gradually dissolve, resolving gout problems completely. Controlling uric acid levels is an ongoing and long-term process, which can also lower the risks of cardiovascular disease and deterioration in kidney function. Therefore, treating gout not only addresses joint issues but also helps enhance overall health.
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