A 68-Year-Old Postmenopausal Woman Experienced A Fall 4 Weeks Ago Gout – Causes, Stages and Treatment For This Inflammatory Arthritis

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Gout – Causes, Stages and Treatment For This Inflammatory Arthritis

What is gout?

Gout is an inflammatory arthritis that occurs when crystals deposit in joints, soft tissue, or bones. These crystals are a byproduct of the breakdown of purines that occur naturally in the body. Gout affects approximately 5.1 million Americans. It affects men over the age of 40 more than women, although postmenopausal men and women are equally affected.

What is the cause of gout?

Uric acid is a natural by-product of the breakdown of purines, which are then eliminated by our kidneys. However, our bodies are not very effective at eliminating uric acid, so it builds up, which is known as hyperuricemia. Hyperuricemia is a precursor to gout, but not everyone with hyperuricemia develops gout for reasons that are unclear. This uric acid causes crystals to form, which are deposited in joints, bones, and soft tissues. These needle-like crystals cause excruciating pain and are often likened to breaking a bone.

4 stages of gout

1. Asymptomatic hyperuricemia

During this time, the person has no symptoms of gout, but despite this, crystals deposit and accumulate, which then lead to gout attacks. Again, why this occurs in some patients with hyperuricemia and not others is unclear.

2. Acute attack of gout

Without treatment, acute attacks resolve spontaneously within 3 to 10 days. It is believed that the inflammation and lower pH that occurs during an attack eventually causes the crystals to dissolve. In addition, some crystals become enclosed in tissues, and other types of cells called macrophages may trigger an anti-inflammatory response. Finally, specific proteins are thought to coat crystals that also suppress inflammation. These procedures resolve symptoms within 3-10 days.

3. Critical period

This is the time between attacks. In general, about 68% of people will experience another gout attack or attack within the first year, 78% within 2 years, and 84% within 3 years. A small percentage of people never experience a gout attack again. During this critical period, the individual remains pain-free, although damage to the underlying structures can still occur.

4. Advanced gout

Over time, the persistence of crystals can lead to chronic low-level inflammation, which can lead to joint damage and the formation of crystal deposits called tophi. These deposits cause erosion and deformity of the joint, which is evident on x-rays or MRIs.

How is gout diagnosed?

The gold standard for diagnosis is to collect a sample of joint fluid during an acute attack and analyze it for the presence of monosodium urate crystals. However, this is not always possible during a physical exam. If the joint is not aspirated, a very detailed medical history is taken, the affected joint is carefully examined and blood tests are done because gout can mimic other diseases. This is why it is very important to see a doctor during an acute attack.

How is gout treated?

During an acute attack, treatment focuses on eliminating pain and disability as quickly as possible. For this, several types of medications are available. Because inflammation is an underlying disease, drugs that target inflammation are often used.

Treatment of advanced gout focuses on lowering uric acid levels, as gout does not occur without hyperuricemia. The goal is to prevent erosive changes in bone, soft tissue, and joint space that would otherwise occur. Talk to your provider about the best treatment options for you.

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