When the joints are swollen and painful, how can you tell if it is gout? Gout is a condition caused by elevated blood uric acid levels and urate crystal deposition, and there are specific attack sites and symptom stages, and understanding the symptoms and stages of gout is of great help to control gout!
Do you know the symptoms and progression of gout?
(1) How to distinguish gout? There are three main characteristics of an acute gout attack
We know that gout often begins with an acute attack, which is actually caused by urate crystals in the joint, which is manifested as sudden redness, swelling, fever and pain in the joint. Compared with other arthritises, acute gouty arthritis has three typical features:
- (1) The onset of illness is abrupt, often in the middle of the night or early morning;
- (2) The symptoms are severe, which can lead to severe joint redness, swelling, heat and pain, and severe pain, which some people describe as comparable to a woman giving birth, the affected area cannot be touched, and it is difficult to sleep all night;
- (3) Preferred site, most gout patients have the first attack in the first metatarsophalangeal joint, followed by the toes, fingers, wrists and other four finger end joints.
Combining the above three points, gout can be distinguished from most other joint diseases, but this is only applicable to the typical gout attack, and it is not excluded that some patients have no significant symptoms at the onset of the disease, so it needs to be combined with uric acid test report for further diagnosis.
Compared with rheumatoid and osteoarthritis, acute attacks of gout are more asymptomatic, more rapid, and more intense
The reason why gout is more common in the distal joints of the extremities and in the early hours of the night is related to the fact that urate crystals are more easily deposited in areas with slow blood flow and low temperatures. However, if gout is poorly controlled and uric acid is high for a long time, gout may progress to multiple joints, including fingers, toes, instep, heel, ankle, knee, wrist, elbow, and other joints.
(2) To prevent and treat gout, it is necessary to understand the four stages of gout
The reason why it is important to understand the four stages of gout is that the treatment of gout pays attention to the principle of staging, and the focus of treatment is different in different periods. The four stages of gout are: asymptomatic hyperuricemia, acute gout attack, intermittent gout and chronic tophi arthritis.
The progression of gout
01 / Hyperuricemia - It seems to be asymptomatic, but in fact it is not small
This is also the early stage of gout, and the patient has no obvious symptoms, only a high blood uric acid level is found on the blood test. For hyperuricemia, the current international consensus is not to rush to use drug treatment, first start with changing diet and lifestyle habits, maintain ideal weight, if you can restore blood uric acid to normal, it is better to recover less than 420μmol/L, and there is no rush to use drugs, because most patients with hyperuricemia do not cause gout.
Although the joints are not painful during the period of hyperuricemia, urate crystals have been deposited in many parts of the joints and kidneys, and tophi and kidney damage are in progress
However, for patients with serum uric acid levels higher than 540 μmol/L or higher than 480 μmol/L but comorbidities such as dyslipidemia, hypertension, and diabetes, pharmacological intervention is recommended. This is when the patient's asymptomatic serum uric acid level is too high, which significantly increases the risk of gout attacks and worsens comorbidities. In fact, the harm of high uric acid is far more than joint pain, any part of urate deposit can be damaged, long-term high uric acid can lead to kidney damage, diabetes, cardiovascular disease and so on.
02 / Acute attack of gout - gout is not a disease, it hurts to kill
Acute attack of gout, as mentioned in the first part of the article, can cause strong symptoms in the joints, some people describe gout pain relief as comparable to giving birth, I think there may still be no pain in giving birth, but in severe cases it should be comparable to kidney colic, in short, it can make you restless. Acute attacks of gout are self-limiting and may recover within a week or two, even if ignored, but we should be aggressive with pharmacological interventions. If the inflammation continues, on the one hand, it will make the patient's joint movement always limited, affecting work and life; On the other hand, continuous inflammation will cause urate crystals to "fight" immune cells, causing more damage to joint structures and promoting the production of tophi.
In the acute phase, the joints are typically red, swollen, hot, and painful
Therefore, in an acute gout attack, anti-inflammatory analgesics such as non-steroidal anti-inflammatory drugs, colchicine or glucocorticoids should be used as soon as possible to eliminate the symptoms as soon as possible. For acute attacks of gout in the process of uric acid lowering, there is no need to stop the use of uric acid-lowering drugs, and for the first gout attack, it is generally not recommended to start urate-lowering therapy in the acute phase, and it is recommended to start it again after joint swelling and pain have been relieved.
03 / Intermittent period of gout - no pain in the joints does not mean that uric acid is normal
During the intermittent period of a gout attack, people with gout are no different from normal people. There are very few people with gout who don't have a second attack for 10 years after their first gout attack, and that's great if you're like that, but only a very small number of patients do. The vast majority of gout patients will have another attack within 1~2 years after the first attack, and if the uric acid is not well controlled, it may become more and more frequent after that, and more and more joints will have gout.
Although the joints are not painful during the intermittent period, urate crystals continue to be deposited, which can promote the occurrence of tophi and kidney damage
In the absence of gout, gout patients must not think that they have been cured, the main uric acid control is not up to standard, under the stimulation of poor diet, drinking, strenuous exercise, fatigue, psychological pressure and other factors, gout may kill at any time. In order to prevent gout, controlling uric acid levels is the key, and in the intermittent period, gout patients should combine urate-lowering drug treatment and life management to control uric acid at the standard level as much as possible.
04 / Tophi period - if you don't control it, it's really too late
When hyperuricemia gout has not been improved for a long time, and the body has had multiple acute gout attacks, it is necessary to be alert to the appearance of tophi. Tophi can occur in the joint cavity, subcutaneous around the joint, auricle, kidney and other parts, which can lead to soft tissue damage, skin lesions, joint structure damage, in severe cases, ulceration and infection can cause sepsis, structural damage can lead to joint disability, tophi is one of the biggest hazards of gout.
If you don't pay attention to tophi, then you will have deformation and disability of crystal joints
The appearance of tophi in gout patients indicates that the blood uric acid level is not well controlled for a long time, and the appearance of tophi will make it more difficult to lower uric acid, because the uric acid accumulated in the stone greatly increases the total amount of uric acid in the human body. For tophi patients, it is necessary to immediately standardize their own uric acid-lowering treatment, take medication on time according to the doctor's instructions, lower the blood uric acid to promote the dissolution of tophi, and actively consider surgical intervention for large, tissue-compressing, bone-eroding, ulcerative, and insoluble tophi to remove tophi as soon as possible!