Gout Treatment in Delhi, India

Gout is a form of inflammatory arthritis that causes a build-up of uric acid crystals in the joints. Commonly affected joints include the big toe joint, knees, ankles, feet, and elbows. The symptoms occur in episodes known as gout attacks, which often occur at night when the body’s lowered temperature creates an ideal environment for the formation of uric acid crystals.

Gout is caused due to buildup of uric acid crystals in the joint. Uric acid is a waste product and, under normal conditions, is excreted via urine. However, sometimes, the body produces too much uric acid or is unable to eliminate it efficiently. In such cases, there is accumulation of uric acid in the joints that leads to formation of crystals over time.

Certain factors can increase the levels of uric acid in the body, including:

• Diet: Red meat and shellfish increase the levels of uric acid in the body. Apart from that, beverages that have fructose in them and alcohol, especially beer, also have high levels of uric acid, which increases the risk of developing gout.
• Obesity: Obesity increases the production of uric acid, but not all of it is eliminated efficiently, making the condition a risk factor for gout. 
• Conditions: Medical conditions like hypertension, diabetes, kidney disease increase the risk of developing gout.
• Medicines: Certain medications like immunosuppressants and diuretics also increase the chances of gout development.
• Family history: Having a family history of gout increases the likelihood of developing the condition. 
• Age and Sex: Men between the ages of 30 and 50 are more prone to developing gout than women as women have lower uric acid levels than men. Women are more likely to develop gout after menopause, when uric acid levels tend to increase.

Gout attacks generally happen at night and are very painful. The symptoms in the affected joints include:

• Intense pain: An intense sharp pain in the affected joint (most commonly the big toe) is a characteristic symptom of gout. The pain can turn severe in the first 4-12 hours and can last for upto 14 days if left untreated. 
• Inflammation: Swelling and redness in the joint are other common symptoms of gout.
• Stiffness: Stiffness in the joints and difficulty moving the affected part are also common.
• Tenderness: The affected joint is extremely tender, even to the slightest touch or pressure.

Diagnosis of gout usually involves one or more of the following tests.

Physical Exam

The diagnosis of gout begins with a physical examining of the joint for any signs of swelling, redness, and pain. 

Joint Fluid Test

This test is used to examine uric acid crystals under a microscope. The doctor inserts a needle into the joint to withdraw fluid, which is then examined for crystals.

Blood Test

A blood test may be conducted to measure uric acid levels in the blood. It is important to note that it is not always a sign of gout. 

Imaging Tests

Imaging tests like X-rays and ultrasound may be used to examine the affected joint. These tests can help detect crystals and rule out other causes of joint inflammation.

Gout is categorised into four stages, based on the severity of the symptoms.

Asymptomatic Gout

The first stage of gout is asymptomatic, in which uric acid levels are elevated but no symptoms are present. During this stage, uric acid crystals begin to accumulate in the joints, causing inflammation and pain later.

Acute Gout

Acute gout is characterised by intense pain, swelling, and redness in the affected joint. It occurs as gout attacks, usually resolving in 3-14 days without treatment. 

Intercritical or Interval Gout

The third stage of gout, during which attacks recurs after weeks, months, or even years. Since attacks occur at intervals, it is known as interval gout. During symptom-free periods, uric acid continues to build up. Doctors may prescribe uric acid-lowering medications to prevent future gout attacks.

Chronic Tophaceous Gout

Chronic tophaceous gout is characterised by an accumulation of urate crystals, known as tophi. These appear as hard nodules or bumps under the skin. The bumps are often accompanied by intense joint pain and may lead to kidney stones. Most people never reach this stage, due to effective treatment methods available. For those who reach this stage, doctors prescribe uric-acid reducing drugs to lower the risk of complications.

Gout is typically managed with medications to relieve symptoms and lower uric acid levels.

Medications

• NSAIDs: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) reduce the pain and swelling of gout attacks. Always consult a doctor before taking any medication for gout treatment, as some NSAIDs may interact with other medications or conditions.
• Corticosteroids: Prescription drugs like Corticosteroids reduce the inflammation associated with gout. These can be taken orally or administered via injection for faster relief.
• Colchicine:  This medication works quickly to reduce inflammation and pain, often providing relief within 24 hours of an attack. Colchicine is usually prescribed in low doses due to potential side effects.
• Uric acid production blockers: Medications such as allopurinol or febuxostat help reduce the amount of uric acid produced by the body, preventing future attacks and alleviating symptoms.
• Uric acid removal drugs: Medications like probenecid help improve the kidney’s ability to excrete uric acid from the bloodstream, helping prevent uric acid buildup. 

Low-Purine Diet

The body produces uric acid when breaking down purines from certain foods and drinks. A low-purine diet can help reduce uric acid production. Foods high in purines, which should be limited include seafood (e.g. sardines, trout and tune), red meat and alcoholic beverages.

• Recurrent Gout: Frequent gout attacks, or recurrent gout, can lead to joint damage over time. For some individuals, gout may recur several times a year, potentially causing erosion joint tissues.
• Advanced or Chronic Tophaceous Gout: In advanced gout, urate chrystals accumulate in the form of hard nodules called tophi. These tophi can appear under the skin or around joints, causing pain, stiffness, and sometimes disfigurement.
• Kidney stones: Uric acid crystals may accumulate in the urinary tract, leading to the formation of kidney stones, which may caus pain and further complications.

Certain lifestyle changes can help prevent gout or reduce the risk of recurrent attacks. These include:

• Dietary changes: Reducing the consumption of high-purine foods can significantly lower gout risk. Incorporating low-purine foods like low-fat dairy products, potatoes, rice, bread and fresh fruits and vegetables can further reduce the risk. 
• Limiting Alcohol: Alcohol, particularly beer, contains high-purines levels, it increases the risk of gout. 
• Weight Loss: Being overweight raises uric acid levels, increasing gout risk. Gradual weight loss can help keep the uric acid levels in check, preventing any gout attacks. 
• Stress management: High stress levels have been known to trigger gout attacks. Practising stress management activities like yoga and meditation can help minimise this risk. 
• Hydration: Staying well-hydrated promotes efficient kidney function, helping flush excess uric acid from the body. This prevents the accumulation of uric acid crystals.

Can gout affect parts of the body other than the joints?

Yes, gout can affect other areas besides the joints. In advanced stages, it can cause hard nodules (tophi) under the skin and uric acid build up in the kidneys can lead to kidney stones.

What is the difference between gout and arthritis?

Gout is a type of arthritis while arthritis is a general term that refers to inflammation of the joints and includes various conditions like osteoarthritis, rheumatoid arthritis and gout itself.

Can one exercise during a gout attack?

It is best to avoid exercise during a gout attack, as movement can intensify the pain and inflammation. Resting is the recommended to alleviate gout symptoms.

Is gout a curable condition?

Although not considered curable, gout is a manageable condition. With the help of medications and lifestyle changes, one can easily prevent flare-ups and live a normal life.

What to avoid during a gout attack?

During a gout attack, it is best to avoid Zurich-rich foods and drinks, as well as excessive physical and mental strain.

Reviewed By Dr. Gaurav Govil, Principal Consultant - Orthopaedics & Joint Replacement 07 Jan 2025.