The main cause of gout (gouty arthritis) is deposition of uric acid crystals in the tissues. People with higher levels of uric acid, obesity, high intake of food containing purines, high alcohol intake and abnormal kidney function are at higher risk of this disease. The symptoms of gout (gouty arthritis) are acute and often occur at night. It can affect the joints of ankles, knees, feet, wrists, hands and toe.
Inflammation, swelling, redness and tenderness of affected joints are the most common symptoms of gout (gouty arthritis). Generally, gout develops in the joints of big toe or hallux. Moving or touching affected toe may be extremely painful. Onset of symptoms is usually rapid and occurs in one joint at a time. Very rarely, two or three joints are involved simultaneously. The pain of gout continues for 5-10 days and then stops. Discomfort by gout reduces gradually over 1-2 weeks and the joint becomes pain-free and normal.
As the disease progresses, there may be deposition of uric acid crystals in bursae (small fluid-filled sacs) around the joints which may result in bursitis. It causes swelling and pain around the joints. In some rare cases of gouty arthritis, there may be more chronic type of joint inflammation resembling rheumatoid arthritis.
Formation of tophi (uric acid crystals) nodules is one of the significant symptoms of gout (gouty arthritis). In the chronic condition of gouty arthritis, there may be deposition of nodular masses of uric acid crystals in various soft tissue areas. They are most frequently found as hard nodules around the fingers, around the big toe and at the tips of elbows. Tophi nodules may be seen anywhere in the body such as vocal cords, ears and rarely around the spinal cord. If lodged in the spine, tophi can give rise to serious damage such as compression. Tophi may grow to the size of handballs which can destroy cartilage in the joints and bone.
In addition to these symptoms, there may be some other complications such as kidney stone formation and impaired kidney function. About 40% of patients with gout may suffer from kidney stones due to hyperuricemia. Approximately 25% of patients having chronic gouty arthritis develop progressive kidney disease which may result in kidney failure. Besides this, gout may accompany some heart related problems such as coronary artery disease, high blood pressure and congestive heart failure. The combination of high blood pressure and hyperuricaemia may result in kidney damage.
Diagnosis of gout includes physical examination, laboratory investigations such as analysis of synovial fluid and imaging tests like x-ray. Various treatment options for gouty arthritis are medications, physiotherapy, exercise and dietary changes.