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Gout Diagnosis

The 4 Stages of Gout & Effective Treatment

By August 9, 2022No Comments11 min read

Here’s what to expect at each of the four stages of gout, as well as how to treat it & prevent further progression of the gout attack. 

Gout is a kind of inflammatory arthritis that occurs when uric acid levels in your body get too high. Uric acid is a normal consequence of metabolic events in your body. When uric acid levels become so high that your body cannot easily dissolve and expel it (through urine), uric acid begins to crystallize. Uric acid crystals accumulate in the joints, causing acute irritation. The big toe is a well-known site of gout attacks, but gout can affect every joint in the body.

Gout is one of the oldest diseases known, with records reaching back to ancient Egypt. This excruciatingly painful arthritis affects millions of adults in the United States today, just as it did in the 17th century, as described brilliantly by Dr. Thomas Sydenham:

“The victim goes to bed and sleeps in good health. About two o’clock in the morning he is awakened by a severe pain in the great toe; more rarely in the heel, ankle or instep…The pain, which was at first moderate, becomes more intense…So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of bedclothes nor the jar of a person walking in the room.”

Fortunately, gout is now one of the most treatable kinds of arthritis, with some rheumatologists even claiming that it can be cured. However, far too many gout sufferers go untreated or undertreated. In one recent study, for example, just 37% of gout patients were taking the uric acid-lowering medicine allopurinol; barely half of gout patients with regular flares were using it.

Incorrect gout treatment might speed up the disease’s progression. Gout can affect additional joints throughout the body over time, causing complications such as gout tophi and chronic bone damage.

Let’s find out more about how gout starts, how it progresses through the stages, and how to treat gout to prevent symptoms, lower uric acid levels, and avoid long-term gout consequences.

 

Stage 1: High Uric Acid Levels

In this early stage of gout, also known as asymptomatic hyperuricemia, uric acid builds up in the blood and begins to form crystals around joints, most commonly in the foot.

Uric acid is formed when your body breaks down purines, which are naturally produced in your body and can also be found in some foods and beverages. While eating high-purine foods can raise uric acid levels, many experts believe that the importance of diet in the development of gout is overstated. Chronically high uric acid levels occur when your kidneys are unable to adequately eliminate uric acid, which can occur for a variety of causes, including:

  • Overweight
  • Kidney disease
  • Taking diuretics
  • Drinking alcohol in excess
  • Diabetes
  • Underactive thyroid
  • Genes/family history
  • Eating a high-purine diet

The person has no joint pain, no red or swollen joints, simply an elevated uric acid blood test at this first stage of gout & at this point, uric acid, or urate crystals start forming in the joints and can cause inflammation later on.

High uric acid levels, however, are insufficient to diagnose gout. According to some rheumatologists most people with hyperuricemia never get clinical gout.

 

Stage 2: Acute Gout

A rapid, unexpected midnight onset of gout symptoms may develop at this stage.

“This is when a person experiences pain, redness, and swelling in a joint, most usually in the big toe, foot, ankle, or knee, although gout can begin in other joints as well,” explains Dr. Fields. “This occurs when urate crystals are released into the joint fluid and induce an inflammatory reaction, drawing in a large number of white blood cells and releasing inflammatory chemicals that cause pain, redness, and swelling.”

If you believe you are having a gout attack, consult your general care physician or a rheumatologist to begin treatment. Seeing a doctor during a gout flare is critical because your doctor may want to extract fluid from the affected joint and examine it under a microscope for the presence of uric acid crystals. The presence of uric acid crystals in joint fluid aids in the diagnosis of gout.

 

Stage 3: Intercritical Gout

According to Dr. Fields, 75 percent of patients who have their first gout episode will have another within a year, although some people can go years without another attack. “Where a person has already had a gout flare but is currently not feeling any joint pain or edema,” he defines the in-between stage. “Almost all gout sufferers will go through this phase because it is the nature of gout to flare up and then settle down for a period of time before the next flare.”

Even if nothing appears to be happening, this is the stage at which patients should begin long-term treatment. Supplements that lowers uric acid levels like Gout Care GC®  can help avoid future gout flare-ups and the long-term consequences that come with them.

 

Stage 4: Chronic Gout

This stage is also known as “tophaceous gout” because the uric acid deposits can develop nodules known as “tophi,” which are commonly located at the bunion point of the big toe or at the elbow. Tophi, on the other hand, can occur anywhere in the body. “At this stage, a person can experience joint discomfort from gout almost all of the time. This stage is frequently reached after many years of uncontrolled gout.

Progressive joint damage develops during this stage, hence people with gout should be treated before this occurs. Treatment delays can aggravate gout.

 

How to Tell If Your Gout Is Getting Worse?

As you get more familiar with gout symptoms, you may be able to detect the onset of a gout attack. “Worsening of pain, swelling, redness, and warmth of the affected joint during the assault is a symptom of attack progression. Furthermore, the disease may worsen with recurrent or more frequent gout attacks of longer duration, involvement of additional joints, and the presence of tophi.

What Causes Gout to Worsen?

Gout can and will most likely worsen without therapy. Furthermore, there are a few factors such as diet, obesity, stress and injury that can cause gout flares. Anything that causes urate levels to quickly rise or fall can result in a gout attack. Lets look at some of the main factors that main contribute to gout & high uric acid. 

Diet and how it may effect gout.

Consuming meals heavy in purines, which are broken down into urate, such as red meat and shellfish, may help. Foods high in fructose can also enhance the body’s urate production. Because alcohol reduces the excretion of uric acid in urine, uric acid levels can rise. Dr. Fields explains that “beer not only has the effect of alcohol on uric acid in the urine, but it also has protein that breaks down to purine and subsequently urate, so it increases urate in two ways.”

Although you should limit purine-rich foods to avoid flare-ups, both experts we spoke with agreed that diet alone isn’t adequate to control gout. “Strict dietary purine restriction is rarely indicated because it only lowers mean serum [blood] urate levels by about 1 mg/dl, which is insufficient for most patients,” adds Dr. Meysemi.

Gout was originally known as the “King’s Disease,” yet it was widely assumed to be caused solely by rich food and wine. “Gout is a hereditary condition, not a nutritional disorder, in which your body either excretes or produces too much urate.”

Although diet can aid with gout flares, medication is nearly always required to combat a genetic proclivity for gout. ”
“Avoid certain meals if you discover that they cause gout symptoms.” Consumption of alcoholic beverages or rich foods may cause gout episodes in some individuals, and the individual patient should avoid recognized triggers.

 

The effect of obesity on gout.

Obesity, on the other hand, is one of the risk factors for gout. In fact, gout has recently become increasingly common, presumably as a result of rising obesity rates. “Weight loss in an obese person has a stronger urate-lowering effect than a purine-free diet.” To that end, a nutritious diet and regular exercise can help you lose weight and lower your risk of disease progression.

Injury and Stress

Gout attacks can also be triggered by emotional stress. Physical damage to the foot (such as during running) can also cause crystals to be released and an inflammatory reaction.

“We don’t dissuade individuals with gout from exercising,” Dr. Fields explains. “However, if someone has a gout flare in the foot, ankle, or knee, we recommend they keep off their feet as much as possible, because further damage to a gout flared joint might prolong the flare.”

Starting a treatment program may unintentionally cause a flare; however, other medications can be administered to assist mitigate this risk.

 

How Gout Treatment Prevents Disease Progression

Gout is one of the most well-understood and therapeutically curable kinds of arthritis, thanks in part to its long history. “The advancement of gout can be avoided by initiating adequate treatment as soon as feasible,” says Dr. Meysami. “Uric acid-lowering medications, such as allopurinol [a 1960s pharmaceutical], can lower uric acid levels and prevent gout attacks.”
NSAIDs (nonsteroidal anti-inflammatory medications) or corticosteroids can be used to treat gout flare-ups. Local steroid injections may be administered as well. Colchicine (Colcrys) is another medicine that is frequently used to terminate acute attacks, however it is currently given at a much lower dose to reduce adverse effects such as stomach distress.

Long-term treatment can begin after a flare has ended. “Almost all gout patients will require medication to regulate their urate,” Dr. Fields explains. “To have a positive outcome, persons with gout must keep their blood urate level below 6.0 mg/dl.” The body will eventually draw the urate crystals out of their joints as a result, and the flares will end.” Tophi will likewise fade away with time.

 

Xanthine oxidase inhibitors are medications that reduce the quantity of uric acid produced by your body. Allopurinol (Zyloprim and Aloprim) and febuxostat are two examples (Uloric). Colchicine, which reduces the inflammatory response to gout, may also be used in conjunction with allopurinol at the beginning of long-term treatment after a flare has subsided.

Another class of medications known as uricosurics aid in the removal of uric acid from the body. Probenecid (Probalan) and lesinurad are two examples (Zurampic). In those whose gout has not been successfully controlled with conventional medications, an infused medicine called pegloticase (Krystexxa) can help the body remove uric acid. New drugs, including a biologic presently approved by the FDA for rheumatoid arthritis, are also on the horizon for gout treatment.

Your doctor will look over your medical history to see if there are any contraindications to gout drugs. You may be advised to discontinue the use of diuretics (water tablets), as these can lead to uric acid accumulation.

Talk to your doctor about any additional home treatments for gout outside weight loss, diet, and exercise – Or Try Gout Care GC® our signature blend of natural herbal ingredients which have assisted people with fast and effective relief of gout symptoms for over 20 years.