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Gout is a common form of arthritis that causes swollen, stiff and red joints. It often occurs in the joint at the base of the big toe. In this article, we will be discussing what causes gout, its symptoms and how to treat it.
What Causes Gout?
Gout occurs when there is a build-up of urate crystals in the joint due to the high levels of uric acid in the blood. This causes pain and inflammation in the joint. Uric acid develops from the breakdown of substances called purines which are present in your body's tissues and in foods like dried beans, peas and liver  .
Usually, uric acid dissolves in the blood and is eliminated through the urine, but an excess of uric acid leads to the build-up of crystals. Blood and metabolism disorders, kidney disease, diabetes  , heavy drinking  , eating excess amount of foods like shellfish, organ meat, red meat, sweet juices, and salt also cause gout.
Sudden bouts of a gout attack can often happen in the middle of the night giving you a feeling that your big toe is on fire. Gout also attacks your wrists, fingers, elbows, ankles, knees and heels.
Symptoms Of Gout
- Redness and inflammation - The affected joint becomes red, swollen, warm and tender.
- Increased joint pain - Gout pain is usually severe within the first 4 to 12 hours after it begins.
- Motion is restricted - The movement of the affected joint is restricted.
- Pain and discomfort - When the severe pain subsides, the pain and discomfort last from a few days to few weeks.
Stages Of Gout
1. Asymptomatic hyperuricemia - The first stage of gout which occurs when excess uric acid accumulates in the blood.
2. Acute gout - This is the stage when hyperuricemia causes uric acid crystals to build up in one of your joints. The symptoms will last for 3 to 10 days  .
3. Interval gout - This is the period between acute gout attacks and there are no symptoms at this stage.
4. Chronic tophaceous gout - At this stage, hard nodules develop in your joints, skin and soft tissues surrounding it. Chronic tophaceous gout occurs if gout is left untreated.
Risk Factors For Gout 
1. Age - Men are more likely to have gout compared to women. Men aged between 30 and 50 and post-menopausal women are at a higher risk of getting gout  .
2. Family history - If someone in your family has gout, you are more likely to have it too.
3. Diet - Consuming too much of red meat, seafood and sweetened beverages increase uric acid levels in the blood.
4. Obesity - If you are obese, your body produces more uric acid which makes it difficult for the kidneys to eliminate uric acid.
5. Surgery or trauma - A recent surgery or a trauma is a risk factor of gout.
6. Health conditions - Diseases and conditions like diabetes, metabolic syndrome, heart disease, kidney disease, high blood pressure, and thyroid increase the risk of gout.
7. Medicines - Some medicines like cyclosporine and diuretics put you at high risk of gout.
When To See A Doctor
If you experience sudden, severe pain in your joints, visit your doctor immediately. Also if the pain is accompanied by fever, it can be a sign of infection which needs immediate check-up.
Diagnosis Of Gout
The doctor will first check your medical history, ask about your symptoms and conduct a physical examination. A joint fluid test will be done to check the level of uric acid in the joint by taking a sample of fluid from the affected joint. The doctor will also conduct an X-ray to see how much the joint is affected.
Other tests recommended by the doctor are blood test, ultrasound, dual energy CT scan.
Treatment Of Gout
The treatment will depend on the stage and severity of your gout. It is treated with medicines to reduce the complications of gout and prevent the formation of urine crystals.
- Non-steroidal anti-inflammatory drugs like ibuprofen, naproxen sodium, indomethacin and celecoxib reduce pain and inflammation in the joint.
- Colchicine is a type of pain-relieving medicine that lowers joint pain.
- Corticosteroids control pain and inflammation which can either be taken in a pill form or through injections.
- Medicines like allopurinol, xanthine oxidase inhibitors and febuxostat block the production of uric acid.
- Drugs like probenecid and lesinurad remove excess uric acid from the blood.
Natural Home Remedies To Treat Gout
1. Cold or hot water application
Applying hot or cold water compression on the joints is an effective home remedy. However, cold water compression is most effective for treating gout pain.
- Take an ice pack and apply on the affected joint.
- Repeat this many times a day.
2. Lemon juice
Research shows that lemon juice stimulates the formation of calcium carbonate released by the pancreas and helps in the alkalization of blood and urine, neutralizing acids including uric acid .
- Squeeze the juice of one lemon into a glass of warm water and drink it two to three times a day.
Sour, sweet, red and black cherries had in juice or raw form is a useful home remedy for gout treatment  . Eating cherry can prevent you from gout attacks.
- Eating about 10 to 12 cherries a day protects people from recurrent attacks of gout.
Ginger is a culinary spice that has many health benefits. A study shows that ginger helps to reduce gout pain related to uric acid  .
- Boil a cup of water and add 2 teaspoons of freshly grated ginger.
- Steep it for 2 minutes and drink thrice a day.
- Also, you can boil some water in a pan and add 1 tablespoon of freshly grated ginger.
- Soak a wash cloth in it and apply it when cool.
- Do this once per day for 15 to 30 minutes.
Hibiscus is a traditional remedy used for the treatment of gout. It lowers uric acid levels according to a study  .
- In a cup of boiling water, add 2 teaspoons of dried hibiscus flowers.
- Allow it to steep for 5 minutes, strain and drink it twice a day.
6. Nettle tea
Nettle is a wonderful herb which can help lower pain and inflammation. A study shows that it can reduce uric acid in blood and protect the kidneys  .
- In a cup of boiling water, steep 2 teaspoons of dried nettle.
- Drink it thrice a day.
7. Milk thistle
Milk thistle is a herb used for supporting liver health and lowering uric acid levels in the body. It is also effective in preventing kidney injuries  .
- Powder 1 tablespoon of milk thistle seeds and add it to a cup of boiling water.
- Steep it for 3 to 5 minutes, add honey and enjoy.
Complications Of Gout
If gout is left untreated, it can lead to arthritis which will permanently damage your bones. Sometimes, urate crystals accumulate in the urinary tract of people, causing kidney stones.
Prevention Of Gout
- Drink plenty of water.
- Limit alcohol consumption.
- Reduce the intake of sugar-sweetened beverages.
- Lose weight.
- Quit smoking.
- Eat low-fat dairy products.
- Avoid eating purine-rich foods like shellfish, red meat, lamb, beef, pork, etc.
- Eat foods rich in magnesium, vitamin C and nuts, coffee as a part of the gout diet.
-  Ragab, G., Elshahaly, M., & Bardin, T. (2017). Gout: An old disease in new perspective - A review. Journal of advanced research, 8(5), 495-511.
-  Grassi, W., & De Angelis, R. (2011). Clinical features of gout. Reumatismo, 63(4), 238-245.
-  Neogi, T., Chen, C., Niu, J., Chaisson, C., Hunter, D. J., & Zhang, Y. (2014). Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. The American journal of medicine, 127(4), 311-318.
-  Scanu, A., Oliviero, F., Ramonda, R., Frallonardo, P., Dayer, J. M., & Punzi, L. (2012). Cytokine levels in human synovial fluid during the different stages of acute gout: role of transforming growth factor β1 in the resolution phase. Annals of the rheumatic diseases, 71(4), 621-624.
-  MacFarlane, L. A., & Kim, S. C. (2014). Gout: a review of nonmodifiable and modifiable risk factors. Rheumatic diseases clinics of North America, 40(4), 581-604.
-  Abhishek, A., Valdes, A. M., Jenkins, W., Zhang, W., & Doherty, M. (2017). Triggers of acute attacks of gout, does age of gout onset matter? A primary care based cross-sectional study. PloS one, 12(10), e0186096.
-  Biernatkaluza, E. K., & Schlesinger, N. (2015). SAT0318 Lemon Juice Reduces Serum Uric Acid Level Via Alkalization of Urine in Gouty and Hyperuremic Patients-A Pilot Study.
-  Singh, J. A., Bharat, A., & Edwards, N. L. (2015). An internet survey of common treatments used by patients with gout including cherry extract and juice and other dietary supplements. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 21(4), 225-226.
-  Yuniarti, E. V., Windartik, E., & Akbar, A. Effect Of Red Ginger Compress To Decrease Scale Of Pain Gout Arthiris Patients.
-  Kuo, C.-Y., Kao, E.-S., Chan, K.-C., Lee, H.-J., Huang, T.-F., & Wang, C.-J. (2012). Hibiscus sabdariffa L. extracts reduce serum uric acid levels in oxonate-induced rats. Journal of Functional Foods, 4(1), 375–381.
-  Joshi, B. C., Mukhija, M., & Kalia, A. N. (2014). Pharmacognostical review of Urtica dioica L. International Journal of Green Pharmacy (IJGP), 8(4).
-  Karakuş, A., Değer, Y., & Yıldırım, S. (2017). Protective effect of Silybum marianum and Taraxacum officinale extracts against oxidative kidney injuries induced by carbon tetrachloride in rats. Renal failure, 39(1), 1-6.
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