Gout is an inflammatory joint disease closely related to abnormalities in uric acid metabolism, with its core symptoms primarily manifested as episodic pain and swelling in the joints. When the concentration of uric acid in the blood is too high, sodium urate crystals form and deposit in the joints or surrounding tissues, triggering an acute inflammatory response. The severity of symptoms and frequency of attacks vary from person to person, ranging from occasional mild discomfort to severe acute attacks that can make walking impossible.
The symptoms of gout typically present a characteristic "acute attack-remission cycle." Initially, there may only be a brief sensation of joint discomfort, but as the condition progresses, the frequency and duration of attacks may gradually increase. Patients often experience symptoms suddenly at night or in the early morning, with the most common initial site being the base of the big toe, although joints such as the ankle, knee, and wrist may also be affected. Early recognition of symptom characteristics aids in early diagnosis and treatment, preventing long-term complications such as joint damage or kidney issues.
The early signs of gout may be easily overlooked and often present with the following characteristics:
• Intermittent joint discomfort: Patients may feel slight swelling or burning sensations in areas such as the toes or heels after exercise or with changes in weather.
• Brief stabbing pain: There may be sudden, needle-like pain around the joints that resolves on its own after a few minutes.
• Mild swelling: Reversible swelling may occur in the tissues surrounding the joints, but the changes in appearance may not be significant.
These early signs may occur several times a week or month, but due to their mild nature and high self-limiting potential, they are often misinterpreted as sprains or residual effects of overusing the joints. It is worth noting that some patients may have had metabolic abnormalities for several years before the first acute attack, without exhibiting obvious symptoms.
Typical acute gout attacks have the following core symptoms:
The peak of an attack usually occurs within a few hours and can last from several days to two weeks. About 20% of patients may experience multiple joints affected during their first attack, and these patients are at a higher risk of developing chronic gout in the future. Symptoms during the intervals between attacks may completely disappear, but the metabolic abnormality persists.
Symptoms may vary depending on which joints are affected:
• First metatarsophalangeal joint: About 50% of initial attack sites, may be accompanied by skin peeling or scaly rashes during attacks.
• Heel and ankle joints: Pain may radiate to the calf, affecting walking stability.
• Fingers and wrists: May be misdiagnosed as rheumatoid arthritis and require uric acid testing for confirmation.
It is noteworthy that about 15% of patients may simultaneously present with nodular hard lumps at the affected site during their first attack, which may be early signs of tophi. The appearance of these subcutaneous nodules indicates that the condition has entered a chronic stage, necessitating immediate adjustment of treatment strategies.
In the early stages of the disease, intervals between attacks may last for several years, but as abnormalities in uric acid metabolism continue, the frequency of attacks may gradually increase:
• The average interval between the first attack is 1-2 years.
• Untreated patients may progress to monthly attacks within 10 years.
• Those who remain uncontrolled long-term may develop "chronic gouty arthritis," leading to permanent changes in joint morphology.
Symptoms in the chronic stage include:
In patients with poor metabolic control, about 30% may develop symptoms of kidney stones within 10 years, presenting as lower back pain, hematuria, or painful urination. Symptoms of this renal complication may occur simultaneously with or separate from joint symptoms, requiring ultrasound or X-ray to confirm the location of crystal deposits.
Immediate professional medical assistance should be sought when the following symptoms occur:
Even after symptoms subside, continuous monitoring of uric acid levels is necessary. If the following signs of chronic complications appear, immediate specialist evaluation should be arranged:
• Long-term joint stiffness with limited activity upon waking.
• Persistent kidney discomfort accompanied by urinary abnormalities.
• Attack frequency has not decreased despite regular treatment.
Early diagnosis can be confirmed through blood uric acid measurement and joint fluid examination to check for the presence of crystals. Delayed treatment may lead to irreversible joint damage. The trajectory of changes in gout symptoms is closely related to metabolic control, and patients should establish a healthy management habit of long-term monitoring of uric acid levels and symptom diaries.
In addition to prescribed pain medications, applying ice to the affected joint for 15-20 minutes several times a day can help reduce swelling. It is also advisable to avoid putting weight on the affected joint, elevate the affected area above heart level, and maintain a comfortable environment while avoiding excessive activity.
In dietary control, besides avoiding high-purine foods, what other dietary principles should be particularly noted?In addition to reducing the intake of high-purine foods such as red meat, shellfish, and alcohol, it is recommended to increase the intake of low-fat dairy products and low glycemic index (GI) foods. Additionally, limit sugary drinks and processed foods, and ensure adequate daily intake of vitamin C (such as citrus fruits), which helps lower blood uric acid levels.
Can gout patients engage in light exercise during acute attacks?During acute attacks, vigorous exercise should be suspended, but light activities such as slow walking can be performed to promote blood circulation. However, the affected joint must rest completely to avoid pressure; if the pain is severe, bed rest is recommended until symptoms subside before resuming exercise.
Do long-term users of uric acid-lowering medications need regular liver and kidney function tests?Yes. Long-term use of uric acid-lowering medications (such as allopurinol or febuxostat) may affect liver and kidney function, and it is recommended to conduct blood tests every 3-6 months to monitor liver and kidney function indicators. If there is a history of renal insufficiency, the physician may adjust the medication dosage or choose alternative treatment options.
Can changes in weather or humidity trigger gout attacks?Indeed, climate changes can trigger gout attacks, as low-temperature environments make uric acid more likely to crystallize. A damp and cold environment may cause the tissues around the joints to contract, exacerbating pain. It is advisable to maintain a suitable room temperature, use heaters, or wear warm clothing, and continue regular medication to stabilize blood uric acid levels.
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