Gout is a form of arthritis characterised by severe pain, redness, and tenderness in joints.

Gout attacks, health experts say, can be sudden and painful, where one may experience burning, and that the affected joint can become stiff and swollen.

If you have gout, Dr Janvier Rusizana, a general practitioner at La Nouvelle Clinic in Remera, Kigali, says you’ll probably have swelling and pain in the joints of the foot, particularly the big toe.

He says sudden and intense pain or gout attacks, can be very painful and unbearable.

The medic says normally, men are more likely to have gout. Women are less likely to get gout; however, he says their risk of developing the condition increases after menopause.

Also, many people have their first episode of gout between the ages of 30 and 50 and the risk of gout continues to increase with age.

Understanding the condition

Rusizana says gout is a type of arthritis that develops from high levels of uric acid in the blood.

The pain and inflammation, he says, occur when too much uric acid crystallizes and deposits in the joints.

According to him, gout is a general term for a variety of conditions caused by acid, and that this build-up usually affects the feet.

"The pain in the big toe is often one of the first symptoms of the condition people tend to come with to the hospital,” he observes.

In most cases, he says, the pain is normally accompanied by more typical arthritis symptoms, such as swelling and warmth in the joints.

Gout pain can vary in severity, for instance, Dr Rusizana says, the pain in the big toe can be very intense at first and after the acute attack, it may subside to a dull ache.

How this happens, Dr Iba Mayele, an obstetrician-gynaecologist at Clinic Galien, Kimironko, says, is that the pain, as well as swelling and other symptoms, are the result of the body launching a defence (by the immune system) against uric acid crystals in the joints.

This attack leads to the release of chemicals called cytokines, which promote painful inflammation.

What are the symptoms?

Mayele says knowing the symptoms of this condition is important because one can seek medical help in time before it develops into complications.

However, he mentions that some people have too much uric acid in their blood, but no symptoms, a condition he refers to as asymptomatic gout.

There are different types of gout symptoms. Some people are asymptomatic, meaning that they have no symptoms, although they have elevated levels of uric acid in their blood, according to Mayele.

These people, he says, don’t require treatment. Others, however, have acute or chronic symptoms requiring treatment.

Dr Francis Kazungu, a general practitioner in Kigali, says when it comes to acute symptoms, they come on suddenly and occur for a relatively short period of time.

On the other hand, he mentions that chronic symptoms are the result of repeated gout attacks over a long period.

"Acute gout symptoms come on quickly from the build-up of uric acid crystals in your joint and last for three to ten days,” he says.

This, Dr Kazungu says, can be manifested by intense pain and swelling, and the joints may feel warm as well.

Pain, redness, and swelling of the foot, especially the big toe, are some of the most common symptoms of acute gout.

"It can be difficult to move or bend, and symptoms typically occur in only one joint at a time, most commonly in the big toe. But other joints are frequently affected as well,” Dr Kazungu adds.

Chronic gout complications

Dr Rusizana says the pain and inflammation associated with gout attacks typically disappears completely between attacks.

However, he notes that the repeated attacks (chronic symptoms) of acute gout can cause more permanent damage.

Along with joint pain, inflammation, redness, and swelling, he says chronic gout can reduce joint mobility.

Dr Rusizana adds that as gout improves, the skin around the affected joint may itch and peel.

Another chronic symptom, he says, is gout can affect many joints throughout the body.

In addition to the big toe, he says other joints affected by gout include, ankles, knees, and fingers.

Dr Mayele says if the gout is not treated, it can become chronic.

He notes that hard lumps called tophi can eventually develop in the joints and the skin and soft tissue surrounding them.

These deposits can permanently damage joints. Other serious complications include nodules under the skin.

"Untreated gout can cause deposits of urate crystals under the skin (tophi). These feel like hard nodules and can become painful and inflamed during gout attacks,” Dr Mayele notes.

As tophi builds up in joints, Dr Kazungu says it can cause deformities and chronic pain, limit mobility, and eventually destroy the joints entirely.

Other complications he says include urate crystals, which can also build up the kidneys.

This, he says, can cause kidney stones and eventually, affect the kidney’s ability to filter waste products out of the body.

Dr Kazungu says gout can cause inflammation of the fluid sac (bursa) that cushions tissues, particularly in the elbow and knee.

Further, he says, inflammation in the bursa increases the risk of infection, which can lead to permanent joint damage.

Signs of infection include worsening redness or warmness around joints and a fever.

Prompt treatment, Dr Kazungu says, is important to prevent gout from turning chronic.

Way forward

If left untreated, Dr Rusizana says gout can eventually lead to arthritis, adding that the condition can lead to permanent damage of the joints.

Depending on the stage and severity of the condition, he says, health practitioners can help with making a treatment plan.

He says the medications given help in relieving pain and bringing down inflammation, as well as preventing future gout attacks by lowering uric acid levels.

Alongside medications, Dr Rusizana says, there is also a need for one to change their lifestyle, in order to help manage the symptoms and reduce the risk of future gout attacks.

For instance, he says patients with gout attack are advised to reduce alcohol intake, lose weight as and quit smoking.

Also, Dr Rusizana says avoiding foods and drinks like red meat, organ meat and certain seafood is important when it comes to staying away from a gout attack.

"Sugar-sweetened beverages and foods containing the sugar fructose can also be problematic, he adds.

Meanwhile, studies suggest that these natural remedies may help lower uric acid levels and prevent gout attacks.