Gout is a condition that causes sudden, excruciating pain and swelling in the affected joints particularly the big toe.

It is a metabolic disorder that results in an excessive amount of uric acid in the blood. The uric acid deposits in the joints in the form of crystals, which cause swelling and pain.

Gout can also arise as a result of a diet that is too rich in proteins, fat and alcohol - a common diet in affluent societies and indulgent lifestyles! When the kidneys are unable to excrete the excess uric acid, it may end up getting deposited as solid crystals in the joints.

Other diseases such as diabetes, hypertension, leukaemia and kidney disorders and certain medications can also cause gout.

If left untreated, the joints may be damaged resulting in deformity and restricted mobility even after an acute attack has subsided.

What happens to the joints in gout?

Purine, a chemical compound found in most foods, is metabolised and degraded in our bodies into uric acid which is then passed out in the urine. In some people, there is an abnormality in the metabolism, which leads to high levels of uric acid in the blood - far more than what the kidneys can excrete into the urine.

The excess uric acid in the blood is deposited as uric acid crystals in the joint cartilage, tendons and other tissues. The uric acid crystals irritate the synovial membrane that covers the joints, resulting in redness, pain and swelling. The joints commonly affected by gout are the big toe, foot, ankle, heel, instep and knee. Gout rarely affects joints of the upper limbs like the fingers or wrists.

What are the symptoms of gout?

The first sign of a gout attack is a sudden, warm throbbing of the affected joint. Within a few hours, this can rapidly escalate into excruciating pain, accompanied by swelling and redness of the joint.

During this period, the skin around the joint will also be very tender, sensitive and sore, setting off extreme pain at the slightest touch. Patients with an acute attack find walking very difficult and painful.

In the chronic stage patients may have chronic pain, reduced function of the involved joint and occasionally extremely large deposits of uric acid crystals or tophi in the joints or other tissues. Many patients with chronic gout have reduced kidney function or kidney failure and hypertension.