Gout

Medicine 3

Head of Department:
Prof. Dr. med. univ. Georg Schett

Understanding causes

Dual Energy CT image of a foot affected by gout with inflammatory knot formation

Gout (urikopathy) is a metabolic disease in which uric acid accumulates in the body and is deposited in the form of tiny needle-tipped crystals in joints and tissue. The immune system tries to combat these crystals. Recent scientific studies have shown that certain immune cells (neutrophil granulocytes) burst when fighting gout crystals, with the cell contents forming dense networks around the critals. Thus, messenger substances of inflammation get caught and are deactivated there (published in Nature Medicine 2014 Apr 28).

A frequent cause is usually a genetic excretory disorder, so that it leads to an increased uric acid level in the blood. However, various triggers promote the outbreak of gout, including diseases (e.g. diabetes mellitus), medication, but also an unhealthy diet, lack of exercise and obesity.

Facts and figures around the disease

About 80 percent of gout patients are men, mostly between the ages of 40 and 60, rarely in younger years. Women usually do not get gout before the onset of menopause.

Typical symptoms and course of the disease at a glance

The disease usually occurs suddenly with severe pain in a joint or in the whole finger or toe. The region is then red, swollen and hot.

In addition, general signs of inflammation such as fever, increased white blood cells (leukocytes) and an elevated uric acid level can occur. Interestingly, in mild cases, the attack of gout subsides after a few hours to 2 days. In more severe cases the acute condition can last up to 14 days, in advanced stages up to several weeks.

How does the physician make the diagnosis?

  • Clinical examination of joints for pain and swelling
  • Measurement of ignition values
  • Determination of the uric acid level in the blood
  • Use of imaging techniques: X-ray, sonography or dual-energy computer tomography (DECT)
  • Puncture of synovial fluid if necessary

How is gout treated?

In case of seizure:

  • Anti-rheumatic inflammation inhibitors (e.g. Diclophenac, Indometacin)
  • Glucocorticoids, such as prednisolone
  • Colchicine
  • Physical therapy: short-term immobilization of the affected joints

After the seizure, the goal is to lower the uric acid level in the blood serum using medication.

Practical tips for everyday life

Today, gout is almost always curable under the condition that the patients adhere to the therapy and eat a balanced and low meat diet.

 
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