(soft instrumental music)
- When people think of gout,
the thought of a hot painful and acutely
swollen joint come to mind.
However, that is only the tip of the iceberg.
And there is more to this disease than meets the eye.
If left untreated, gout can become a chronic disease
causing multiple complications.
The stages of gout.
Acute gout or a gout attack happens when
something causes the uric acid levels
to either go up or down abruptly.
For example, a large purine load like an alcohol binge.
This causes disturbance of the uric acid crystals
that have formed in the joint.
Uric acid is seen by the body as an outsider
and therefore, the body will try and attack this,
leading to inflammation.
This can be a highly inflammatory state
and therefore attacks could be excruciatingly painful
with redness, heat, and swelling.
Leading to inability to use the joint properly.
If untreated, these attacks are self-limiting
and will subside after a few days on it's own.
60% of people who have a gout attack
will have a second one within a year.
And overall 84% may have another attack
within three years if not controlled.
Interval gout or intercritical gout
is a time between these attacks.
There is no pain or joint swelling.
But this does not mean that the gout is gone.
If nothing is done to try and decrease
the uric acid levels during this time,
the uric acid crystals continue to deposit
in various joints and tissues and can lead to damage.
This is an opportunity to start management
via lifestyle changes and possibly medication
to prevent future attacks or chronic gout.
Chronic gout develops in patients with gout
whose uric acid levels remain high.
When uric acid levels in the bloodstream
remain too high, more and more crystals are deposited.
Acute attacks become more frequent and more severe.
Joint damage occurs which can lead to a loss of mobility.
Chronic gout can present with one more of the following.
Tophi, when uric acid crystals begin to
deposit in soft tissue they form
nodules called Tophi.
Tophi commonly appear in the hands,
fingers, elbows, and ears.
But they can appear almost anywhere in the body.
Which can be very disfiguring.
Progression of flares can also occur.
As chronic gout gets worse, flare ups occur more often
and last longer.
In about half of all patients with gout
the first attack occurs in the joint
at the base of the big toe.
When chronic gout occurs, other joints may be effected.
Including the ankle and the knee.
Over time the inflammation causes permanent damage
to bone and cartilage which we call erosions.
And these can lead to functional disability.
Uric acid is normally eliminated by the kidneys.
Kidney disease therefore can cause
uric acid to build up and lead to gout.
However, excess uric acid can also damage the kidneys.
And so kidney problems associated with
chronic gout include gout kidney,
kidney stones, and kidney failure.
Although one can easily forget they have gout
after an attack resolves, it is important
to realize that the problem can still persist
and move into a chronic phase with more complications
as we mentioned above.
Therefore, prevention and early treatment if indicated
are ways to get this disease under control.
(light music)