อาการ สาเหตุ และวิธีรักษาโรคเกาต์ (Gout)

Gout

A pervasive and complex type of arthritis that may affect anybody. It is characterized by sudden, acute pain, swelling, redness, and tenderness in one or more joints, most commonly the big toe.

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Gout is a pervasive and complex type of arthritis that may affect anybody. It is characterized by sudden, acute pain, swelling, redness, and tenderness in one or more joints, most commonly the big toe. The ankles, knees, elbows, wrists, and finger joints can also be involved.

A gout attack can develop without warning signs, frequently waking you up in the middle of the night with a burning feeling in a big toe.  Gout symptoms may fluctuate, but there are ways to manage symptoms and prevent their recurrence.

Symptoms of gout
The affected joint feels hot and is exquisitely tender, to the point it cannot bear even the weight of a bed sheet. The pain is most intense in the first four to twelve hours after it begins, limiting joint motion as gouty attack progresses. The skin over the joint is red and shiny, with soft tissue swelling in and around the affected joint. Some joint soreness may persist from a few days to 1-2 weeks after the most intense pain has subsided. Subsequent episodes are likely to be more severe and impact more joints.

When to see a doctor
Whenever you experience sudden, severe pain in a joint, seek medical attention immediately. Untreated gout can lead to increased discomfort and joint damage. If you have a fever and a hot, swollen joint, this may indicate an infection that requires prompt medical attention to limit joint damage.

Causes
The buildup of uric acid in the bloodstream is what usually causes gout. The human body makes uric acid as a breakdown product of purine-containing foods and beverages and from endogenous sources. High purines foods are red meat, organ meat, such as liver, and sea foods such as anchovies, sardines, mussels, scallops, trout, and tuna. Alcoholic beverages, mainly beers and sweetened drinks containing cane sugar or fruit sugar (fructose), all increase uric acid levels.

Uric acid is normally eliminated from the body through the kidneys and urine. When the body makes too much uric acid or the kidneys don't filter out enough; in that case, uric acid can accumulate and form microscopic, sharp crystals around your joints, precipitating a gouty attack. However, many people with elevated uric acid levels never develop gout.

Risk Factors
People with elevated blood uric acid are more prone to develop gout; they should avoid high purines containing foods and alcoholic or sugar-sweetened beverages. Men are 4 to 10 times more likely to have gout than women. Overweight people produce more uric acid. They are also more likely to develop gout at a younger age. Gout is made more likely by several disorders and circumstances. Untreated high blood pressure and chronic disorders such as diabetes, metabolic syndrome, and heart and kidney disease are examples of these. You are more prone to gout if other family members have had the condition.

Complications
Patients with gout may develop more severe problems, such as recurrent gouty arthritis, which medications can prevent. Untreated gout can cause joint erosion, damage, and tophi formation from urate crystal deposits under the skin, which may appear in various places, including your fingers, hands, feet, elbows, and the Achilles tendons at the back of your ankles. Tophi are typically not painful, although they can swell and become tender during gout attacks.

Diagnosis

  • A needle might be placed to aspirate fluid from the affected joint. Urate crystals may be observed when the fluid samples are examined under a microscope,
  • A lab test can determine the concentration of uric acid in the blood.
  • X-rays of the joints can rule out other causes of joint inflammation.
  • Ultrasonography detects urate crystals in joints using sound waves.
  • Dual-energy computed tomography (DECT) examination combines X-ray pictures taken from various angles to detect joint urate crystals.

Treatment
Two classes of medications are available for gout treatment, each of which targets different mechanisms.

  1. The first class reduces the inflammation and discomfort that accompany gout episodes.
  2. The second kind prevents gout complications by decreasing uric acid levels in the blood.

The medication you should take depends on the frequency and severity of your symptoms.

Lifestyle modification and home remedies
Medications are the most efficacious method of treating gout episodes and preventing gout flares. However, lifestyle modifications are essential as well, and you may wish to avoid problematic drinks and limit your alcoholic and sugar-sweetened beverages intake. Instead, consume lots of nonalcoholic drinks, particularly water.

Preparing for Doctors appointment
Your doctor may ask you a series of questions:

  • What are your signs and symptoms?
  • When did you notice these symptoms for the first time?
  • Do your symptoms appear and disappear? How frequently?
  • Does anything, such as certain meals or physical or mental stress, appear to aggravate your symptoms?
  • Do you have any additional medical issues that require treatment?
  • Do you have any first-degree relatives with gout, such as a parent or sibling?
  • Do you consume alcoholic beverages? If so, how much and how often?

Article by

Published: 20 Jul 2022

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