When Gout Goes Out of Hand

(Photo Credit: En.wikipedia.org)
(Photo Credit: En.wikipedia.org)

Yesterday a childhood friend of mine succumbed to kidney failure and heart complications which resulted from Gout Stage 4.  He was diagnosed with gout just a month ago as told by his sister.  The symptoms he felt in recent months, probably years according to his children, he blamed on arthritis.  He would often complain of joint pains, sometimes even when he was asleep. 

Pain attacks on his ankles, knees, wrist and elbow on different times, sometimes all at once, he pointed to arthritis.  Stubborn as he was, he didn’t deem it necessary to go see a doctor.  He became dependent on over-the-counter drugs for pain and occasional swelling; even when he had limited movement in the affected joint.

He developed very red or purplish skin around the affected joints;  a few nodules (tophi) had appeared on some parts of his hands, elbows, and ears, but he just shrugged them off as part of his aging (he was 50).

When pain became so intense and he was having a lot of other discomfort from a malfunctioning kidney, he was brought to the hospital.  But it was too late for treatments and lifestyle changes. 

Gout can occasionally be difficult to diagnose because the symptoms of gout mimic several other conditions. To confirm a diagnosis of gout, a medical professional will take a sample of fluid from the inflamed joint and will view it under a microscope. If a patient has gout, urate crystals will be evident. The absence of crystals, however, does not completely rule out a diagnosis of gout.

Gout symptoms are most often felt in the large joint of the big toe, but can affect other joints such as:   instep, ankle, heel, knee, Achilles tendon, wrist, finger, and elbow. The symptoms may include :  warmth, pain, swelling, and extreme tenderness in joints….  BUT similar symptoms may be related to other medical conditions  such as:

  • Rheumatoid arthritis (RA)  which affects more than one joint and generally affects both sides of the body, especially  the hands and wrists.   Most of the time, gout affects only one joint and is more common in the feet or toes.
  • Osteoarthritis  develops slowly and is ongoing, while a gout attack develops quickly and you may not have symptoms between attacks.

Medical professionals make use of  four stages to classify the severity of gout in a patient. With proper management of lifestyle and medication, it’s possible to avoid the latter stages and the health consequences that go along with them… if diagnosed and managed before complications set in!

 Stage 1 – Asymptomatic Hyperuricemia

 – Elevated levels of uric acid
–  No symptoms of gout
–  Treatment usually not necessary.

Most people will have elevated levels of uric acid for many years before their first attack.  Many people with elevated uric acid will never have an attack. The risk of an attack increases as the uric acid level increases.

Stage 2 – Acute Gout Attack – A gout attack awakens someone at night by intense pain and swelling in the joint- Pain goes away (even without treatment) after three to 10 days- This is the time to see a physician to obtain appropriate therapy and to rule out another form of arthritis as the cause of the painful joint.Another gout attack may not occur for months or years.
Stage 3 – Intercritical Gout
– Symptom-free period between attacks
– Joints functioning normally
– Consult your physician to:  Determine if any medications you are taking may aggravate the condition; review dietary guidelines for gout; assess alcohol intake and if there is need to cut back; assess BMI and if there is a need to lose weight; and discuss therapeutic options to prevent or treat future attacks.

Unfortunately, if ignored, this phase is frequently followed by continued attacks of gout. Despite a lack of symptoms, there may be ongoing inflammation. A low level of inflammation may be associated with risks for heart disease and stroke.

Stage 4 – Chronic Tophaceous Gout – This is the stage of chronic arthritis- Deformity and destruction to affected bone and cartilage occur- Kidney damage is possible- An ongoing destructive inflammatory process is active.

With proper medical attention and treatment, most gout patients will not progress to this advanced, disabling stage.

Gout is found in higher rates in people with high blood pressure, coronary artery disease, and heart failure. Hyperuricemia, in fact, has been associated with a higher risk of death from heart conditions.   Studies also found an association between gout and having the metabolic syndrome — a collection of problems, such as abdominal obesity, high blood pressure, high triglycerides levels, and low “good” cholesterol levels. This syndrome increases a person’s risk of heart disease and diabetes.
If we will continue to disregard  hyperuricemia and  pay no attention to pains and swellings, nodules and irregularities in our bone structure especially starting with our toes, gout may already be causing havoc and other complications in our internal body organs!
Again, lifestyle changes and prevention is BETTER than … the big D.

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Symptoms & Stages