Diagnosis of gout: what tests need to be done

Signs of gout

Gout pain is the main symptom, usually pain in the joints of the fingers, feet, elbows, knees and others. This is precisely where the complexity lies, because these are symptoms of numerous rheumatological diseases. This circumstance explains the difficulty of diagnosis. To determine the diagnosis, doctors rely on the external manifestations of the disease, as well as on data from laboratory and instrumental diagnostic methods. Diagnosis and its complexity largely depend on the severity of the clinical picture, as well as the reasons that provoked the development of the disease. Examination, history taking, instrumental and laboratory diagnostic methods will reveal:

hyperuricemia - increased levels of uric acid, and this is the main reason leading to the disease and provoking symptoms;
accumulation of salt crystals (urates), including in the tissues surrounding the joints;
an inflammatory reaction that causes severe pain.

If the disease persists for a long time, the kidneys are also affected, so assessing their functioning and early detection of failures is one of the mandatory points in the examination.

Features and causes of the disease

The main cause of gout is hyperuricemia , a persistently elevated level of uric acid in the blood. It can increase both due to its excessive formation, and due to problems with utilization and excretion by the kidneys.

Uric acid is formed from the breakdown of purines and nucleic acids. It contains urates - insoluble salts that tend to crystallize and accumulate in the joints, destroying them. In the periarthrial form of gout, deposition occurs in the tendons. The process develops slowly, and it may take 10-20 years for the first symptoms to appear.

Other diseases can provoke salt deposition: kidney disease, diabetes, hypothyroidism, arterial hypertension, obesity. Nutrition plays an important role. Meat, seafood, alcohol, and beer are rich in purines. Sugary carbonated drinks make it difficult to remove uric acid. Some medications, including diuretics, can trigger gout.

As a rule, during an attack, one joint becomes inflamed; the big toe, wrist, elbow, and hand are more likely to be bothered. Less commonly, the process affects the knees, arches of the feet, and ankles. An unbearable pressing pain occurs, the site of inflammation swells, becomes hot, and the skin turns red.

After the acute period, the condition returns to normal, but salts continue to accumulate. The next exacerbation may occur in a few months or later. In uncomplicated cases, in the intervals the physiological mobility of the joints is preserved, there is no malaise.

In “experienced” patients, salt deposits are visible to the naked eye - tophi - growths that bother and interfere with everyday activities. Tophi disfigure fingers, toes, feet, and elbows. This course of the disease is called tophi gout.

Beginning of the examination: survey

Joint pain and poor health are symptoms that require consultation with a rheumatologist. The signs that are characteristic of the disease are not specific, so a complex and lengthy diagnosis is needed. And an important role in this matter is to clarify complaints and anamnesis.

What worries the patient, when the first symptoms appeared, what preceded them and, most importantly, how they developed. Have you had joint pain in the past: how long ago, which joints were affected. Taking into account the hereditary factor, it is necessary to determine the family history of the disease, as well as the presence of bad habits: smoking, alcohol abuse, etc. It is important to find out how much water a person drinks per day, whether he has been taking medications for a long time and which ones, as well as kidney disease, which may affect their filtering abilities.

Development of the clinical picture

Anamnesis and examination allow, in some cases, to make a preliminary diagnosis, even before laboratory and instrumental examination methods are carried out. During an external examination, the doctor assesses the presence of an inflammatory process in the joints and surrounding tissues, the mobility of the joint, and the amplitude of its movements. Regular examinations by a doctor are necessary to assess the clinical picture, its development, to make a diagnosis and, of course, prescribe treatment for gout.

Instrumental examination methods

Some types of hardware examination will help to determine the cause of pain in the joints and tissues surrounding it. The appearance of symptoms is a reason for ultrasound, CT and radiography. It is worth remembering that in the early stages of the development of the disease, these examination methods are ineffective, since destructive processes in the tissues are not expressed. Instrumental examination methods will help identify rheumatological diseases. When prescribing instrumental diagnostics, the following nuances are taken into account:

Ultrasound is most informative on days 3-4 after an acute attack. The study will reveal destructive changes in the joint, swelling and hardening of soft tissues. But later ultrasound is ineffective.

CT scan will help identify tophi. This examination method is most informative in the later stages of the disease, when salt crystals form in the periarticular tissues. In the early stages of gout, CT can determine the compaction of periarticular tissues.
X-rays in the early stages of the disease are performed to exclude other rheumatological diseases. If a diagnosis is made, it is carried out only in the chronic course of the disease to assess structural changes and the condition of the joints.
Scintigraphy is a visualization method. Radioactive isotopes are introduced into the blood, which makes it possible to accurately determine the places where salt deposition occurred. This examination method detects the disease even in the early stages, when the formation of urates is just beginning.

What tests are needed?

Laboratory tests are carried out even in the early stages. Moreover, it is possible to calculate not only the disease in its early stages, but also predisposing factors for its development. With the help of laboratory diagnostics, a so-called differential diagnosis is carried out, that is, the difference between one disease and another. A general blood test
is a mandatory examination, which is most informative during acute attacks of the disease.
A biochemical blood test
will show an increased concentration of uric acid.
The same examination method will reveal an increased concentration of C-reactive protein, calcium, as well as an increased concentration of lipoproteins, lipids, etc. A general urine test
is mandatory, although it is carried out to assess kidney function. The amount of uric acid that is excreted by the kidneys is assessed. There is an interesting pattern here: during pathological processes in the kidneys, the volume of uric acid that is excreted in the urine is usually minimal. Based on the data obtained, a diagnosis is made, treatment tactics are developed: diet, medications for gout, physiotherapeutic treatment methods, etc. Only a doctor can treat gout, taking into account all sorts of nuances, the clinical picture and, of course, the reasons for its formation. In the following materials we will continue the conversation about the treatment of the disease.

Text: Yulia Lapushkina.

Gout is a disease of the joints caused by the deposition of uric acid salts in them. The patient experiences attacks of intense joint pain, the joints become swollen, the skin over them turns red, most often the big toe.

English synonyms

Gout, Podagra.

Symptoms

Symptoms of gout appear suddenly, often at night.

Severe joint pain. Typically first in the big toes, but sometimes in the feet, ankles, knees, arms, wrists. The most intense pain persists during the first 12-24 hours from the onset of the attack.
Prolonged aching pain in the joints. After severe pain passes, some discomfort remains in the joints - from several days to several weeks. Over time, pain attacks become more intense and last longer as more and more joints are affected.
Inflammation and redness of the joints. The affected joints swell, turn red, and become very sensitive.
Lumps under the skin (tophi). With a long course of gout, tubercles may form under the skin, most often in the area of the fingers and toes, on the elbows, knees, and the skin of the ears.

general information

Gout occurs when the level of uric acid in the blood rises. Uric acid salts begin to settle in the joints and surrounding tissues, causing inflammation and severe pain. The concentration of uric acid in the blood may increase as a result of impaired excretion from the body, as well as increased formation, which is associated with excessive consumption of purines.

Purines are substances from which uric acid is formed. Some foods contain purines and, accordingly, increase the amount of uric acid in the body:

alcohol (especially beer, wine),
honey, coffee, strong tea, chocolate, cocoa,
cheeses,
broths (meat, chicken, fish),
raw smoked products,
by-products from internal organs (heart, kidneys, liver, brain, tongue),
fish, canned meat,
legumes (peas, beans, eggplants, beans, nuts, seeds, soybeans),
sorrel, spinach,
cauliflower,
mushrooms, mushroom broths,
raspberries, figs

Since uric acid is excreted in the urine through the kidneys, in case of kidney disease the process of its excretion may be impaired, which predisposes to gout.

For some people, gout flares up frequently, while for others it only flares up a few times a year. Taking medications will help prevent recurrence of gout attacks.

With gout, nodules (tophi) consisting of deposits of uric acid salts sometimes appear under the skin on the fingers, arms, legs, and elbows. They usually do not cause pain, but during gout attacks they become very tender and swollen.

Crystals of uric acid salts can deposit in the urinary tract of people with gout, forming stones. In such cases, medications help reduce the risk of kidney stones.

Who is at risk?

The risk group includes people with high levels of uric acid in the body.

Uric acid levels increase:

regular consumption of alcohol (especially beer),
chronic diseases (diabetes, hyperlipidemia, atherosclerosis),
high blood pressure,
taking certain medications, such as those used to treat hypertension, heart failure, or prescribed after organ transplantation,
hereditary predisposition,
age and gender - gout is more common in men, since their normal uric acid levels are higher than in women (however, after menopause, women's uric acid levels increase; in both women and men, gout most often develops at the age of 40- 50 years.

Diagnostics

The diagnosis of gout is most often made taking into account the characteristic symptoms and history of the disease.

Laboratory diagnostics

Serum uric acid. Elevated levels of uric acid are an argument in favor of the diagnosis of gout. However, not all people who have elevated uric acid levels suffer from gout. At the same time, in a small number of patients with severe manifestations of this disease, the level of uric acid in the blood may be within normal limits.
During the acute period of the disease, the level of uric acid in the serum is not so important, since uric acid is released into the tissues and its concentration in the blood may decrease.
Complete blood count (without leukocyte count and ESR) (CBC). During an acute attack of gout, your white blood cell count may rise moderately and your erythrocyte sedimentation rate (ESR) may increase significantly.

Other studies

Study of synovial (joint) fluid. The detection of uric acid crystals in it is specific for gout.
X-rays of joints and bones for gout are of auxiliary value. In the later stages of the disease, large tubercles may be visible on bone radiographs - signs of deposition of uric acid salts in them.

Treatment

Treatment for gout usually involves taking medications.

Depending on the characteristics of the patient’s body, the doctor determines the most suitable medications for him. There are medications to treat acute attacks, to prevent recurrent attacks, and to reduce the risk of complications from gout.

In addition to taking medications, you can relieve a gout attack by:

drinking large amounts of water during an attack (2-4 liters per day),
complete rest (it is recommended to place the affected limb higher, for example, place a pillow under the foot),
a diet primarily consisting of liquid foods (milk, milk soups, lactic acid products, jelly, compote, vegetable and fruit juices, liquid porridges).

During an attack, it is necessary to avoid alcohol and foods that increase the level of uric acid in the blood.

Prevention

Drinking enough fluid (2-4 liters per day).
Quitting alcohol. Alcoholic drinks, especially beer, increase uric acid levels in the blood.
Healthy eating. It is necessary to consume more fruits, vegetables, whole grains, low-fat or low-fat dairy products. You should limit your consumption of meat, poultry, and fish.
Maintaining normal weight. If you are overweight, gradual, smooth weight loss through exercise and a healthy diet is recommended.

Recommended tests

Serum uric acid
Clinical blood test (with leukocyte formula)

Main symptoms and treatment of gouty arthritis

Patients are bothered by severe pain in the joints: even the slightest touch to them becomes unbearable, while the joints become very swollen, the skin over them acquires a purple tint and its temperature is increased. Often the patient’s body temperature rises, chills appear, and blood tests reveal an increased level of uric acid.

An exacerbation very often occurs suddenly, often at night, and lasts on average from two to five days, sometimes going away even without treatment. However, after some time the pain may return again. The intervals between attacks become shorter, and the attacks themselves become longer.

In 10% of patients, after the first attack of the disease, remission occurs (it can last up to 10 years or more). In other patients, relapses may occur two to three times a year. With each subsequent attack, the number of joints involved increases, and relapses become more severe and prolonged.

The presence of tophi nodules on the hands, feet, as well as under the skin on the ears and on the back surface of the elbow joints is a manifestation of the chronic form of gout, since they usually appear no earlier than three or more years after the first gouty attack and their number can vary. Sometimes tophi nodules form not only under the skin, but also in the kidneys and other internal organs (this is usually detected by ultrasound, CT).

Very often, gouty arthritis of the joints is combined with diabetes mellitus, obesity and hypertension, and atherosclerosis. In 1/3 of patients with gout, urolithiasis develops, and sometimes renal failure develops. All these diseases mutually aggravate each other. But in some patients, an attack of urolithiasis is the first manifestation of gout, which is detected after examining the patient for urolithiasis.

Therapy methods

Treatment for gout is aimed at controlling the level of uric acid in the body and stopping acute attacks. Drug therapy is prescribed during periods of exacerbation to relieve inflammation and reduce pain. There are drugs that reduce the concentration of uric acid and stimulate its excretion.

To reduce production, a low-salt diet is also prescribed, eliminating foods and drinks rich in purines.

Surgical treatment is carried out to remove gouty tophi if they become inflamed, compress soft tissues and nerve endings, and interfere with blood circulation.

To prevent complications and joint destruction, when only an implant can save you from disability, regularly visit a rheumatologist and do not refuse treatment, even if exacerbations occur infrequently. The diagnostic department will prescribe effective treatment that will help improve the quality of life and avoid consequences.

Causes and mechanism of development of gouty arthritis

It has now been established that this disease is caused by metabolic disorders, and a diet high in meat only aggravates this disease, but is not the cause of its occurrence.

Predisposing factors:

sedentary lifestyle, systematic overeating, obesity;
unbalanced diet (predominance of protein (meat) foods, regular consumption of alcoholic beverages, absence or very little consumption of fresh vegetables and fruits);
hereditary predisposition, diabetes mellitus;
kidney diseases of various nature, taking certain medications (aspirin, riboxin, etc.);
occupational hazards (for example, lead intoxication).

Gout can also be secondary, for example, in diseases of the cardiovascular system (hypertension, congenital and acquired heart defects), blood diseases (myeloid leukemia), etc.

With gouty arthritis, purine compounds and uric acid salts accumulate in the blood in large quantities, which are formed in excess, but are slowly eliminated. This leads to their deposition in the form of crystals - urates in joints, tendons, under the skin in the form of nodules (tophi), surrounded by a connective tissue capsule, as well as in the kidneys.

Most often the process is localized in one or two joints of the big toes, sometimes in the joints of the hands, and less often in the ankle, elbow and knee joints. The hip and shoulder joints are rarely involved in the process during gout.