Surgery can cause gout

What helps with gout?

Status: 10/14/2019 9:25 a.m. | archive
Gout often begins in a single joint, such as the metatarsophalangeal joint of the big toe.

Gout is a metabolic disorder in which the concentration of uric acid in the blood is increased. As a result, uric acid crystals form which, for example, accumulate in the joints, bursae and tendons, where they lead to painful inflammation and, if left untreated, to joint damage. The crystals also settle in the kidney. If the gout is left untreated, it can lead to kidney stones and damage. Genetic factors and an unhealthy diet are often the cause of gout.

Men are more likely to develop gout

About one to two percent of the adult population in Germany suffers from gout. 80 percent of gout patients are men. The disease usually begins between the ages of 40 and 60. Women usually do not get gout before menopause - the female sex hormones protect them until then. Those affected often have a predisposition that their bodies do not excrete uric acid as well.

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Gout often starts in the big toe

The disease usually begins with violent attacks of pain as an acute attack of gout (acute gouty arthritis) on a single joint.

  • It happens very often Big toe joint. This is because uric acid crystals precipitate first in low temperature tissues.
  • Also Ankle and knee joints, the Metacarpophalangeal joint or the Metatarsus can be affected.

The severe attack of pain comes very suddenly, usually at night or in the early morning hours. The painful joint is extremely sensitive to the touch, swollen, reddened or discolored bluish and hot. Often there is also a fever.

Uric acid level increased

If you have gout, the level of uric acid in the blood is increased (hyperuricemia). Uric acid is produced when purines are broken down in food. A lot of it is found in offal, meat and sausage. But purines are also a normal building block of the human genome (DNA). They are released when cells break down or disintegrate.

The level of uric acid in the blood increases when:

  • the diet contains too many purines, which are broken down into uric acid.
  • more uric acid is produced in the body because many cells break down, for example when dieting.
  • the kidneys excrete too little uric acid.

A lack of exercise, obesity, an unhealthy diet, stress, operations, cancer and infections can also trigger a gout attack. Often several causes come together in gout patients. An excessively high uric acid level can also be genetic, although relatives of the patient tend to have elevated uric acid levels.

Forms of gout

Doctors differentiate between two forms of gout:

  • Primary form: A congenital metabolic defect is the cause of the increased uric acid level. The kidneys usually excrete less uric acid than is necessary. An enzyme defect is very rarely responsible for the body producing too much uric acid.
  • Secondary form: Other diseases or disorders are responsible for hyperuricemia. Secondary gout develops, for example, as a result of leukemia or other blood diseases in which many cells are broken down - sometimes also with kidney diseases or when taking certain medications.

Causes of gout

In most cases, gout diseases can be traced back to a genetic disorder of the kidney: it is unable to excrete an increased amount of purines, for example after excessive consumption of purine-rich foods such as meat and alcohol. If the concentration of uric acid in the blood exceeds certain limits, it precipitates in the form of crystals.

Risk factors for gout

In addition to a genetic predisposition, other risk factors often come together in gout patients:

  • high consumption of meat, fish, alcohol, and fructose in juices, smoothies, and processed foods
  • Sedentary lifestyle
  • Obesity
  • stress
  • Operations
  • cancer
  • Infections

Fructose increases the risk of gout

Fructose increases the level of uric acid in the blood similar to alcohol. Just a few minutes after consuming fructose, the uric acid level in the blood rises:

  • Fructose causes purines to be formed in the intestines, from which uric acid is produced.
  • Fructose inhibits uric acid excretion through the kidneys.

Even one fructose-containing sweet drink a day, for example fruit juice, increases the risk of gout in healthy people by 45 percent. Anyone who already suffers from gout should therefore avoid drinks and foods containing fructose.

Treatment for gout

Therapy for gout should be tailored to the patient's individual situation. Important here:

  • Stage of gout: acute or chronic
  • individual factors, e.g. B. Number of seizures, existing joint changes
  • general risk factors

Diet for gout

Regular physical activity and a healthy and varied diet with little meat, fish, alcohol and fructose can in many cases significantly reduce the uric acid level. Even if pulses and other vegetables contain a lot of purines, they should not be completely removed from the menu - as was often recommended in the past. With fructose, it is not the fruit itself that is on the cross-off list, but rather concentrated fruit as in juices or smoothies.

Overweight people should reach their normal weight. Rapid weight loss and protein-rich diets should be avoided. Both can additionally increase the uric acid level.

Treat gout with medication

After an acute gout attack, the aim of treatment is to relieve the pain as quickly as possible and to end the inflammation - for example with so-called nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac.

After the symptoms have subsided, long-term therapy can prevent the progression of the gout and further gout attacks. She is recommended when

  • more than two gout attacks occur per year.
  • there are kidney stones accompanying the gout.
  • if the gout leads to further changes in the body.

Long-term therapy should begin two weeks after an acute gout attack at the earliest.

A commonly used remedy is allopurinol. In the first few months after starting therapy, more gout attacks may occur. Because when the uric acid level drops, uric acid deposits are released from the tissue.

In the case of impaired renal function, the active ingredient febuxostat should be prescribed instead of allopurinol. It is also used when allopurinol only insufficiently lowers the uric acid level.

People who suffer from severe cardiovascular disease in addition to gout, for example heart attack, stroke or unstable angina pectoris, should not take febuxostat if possible, as it increases their mortality. They should be treated primarily with allopurinol.

If the uric acid level in the blood is increased without symptoms occurring, drug therapy does not make sense according to the current study situation.

Diet for gout

Purines are mainly found in meat and fish, but also in legumes and beer. You also have to be careful with fructose. What can you eat with gout? more

Experts on the subject

Priv.-Doz. Dr. med. Thomas Kötter, specialist in general medicine
General practitioners in front of the mill gate
Academic teaching and research practice at the University of Lübeck
Kronsford Allee 17, 23560 Lübeck
(0451) 773 43
www.luebmed.de

Prof. Dr. rer. nat. Martin Smollich, pharmacologist
Institute for Nutritional Medicine
Head of the Pharmakonutrition group
University Medical Center Schleswig-Holstein
Ratzeburger Allee 160, 23538 Lübeck

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