What are the Symptoms of Gout?

Enrique Calvo (a rheumatologist at Hospital Universitario Infanta Leonor in Madrid) warned that there could be over one million Spanish with gout. Gout is a painful rheumatic condition that causes inflammation of the joints and tendons.

He also said that one third of sufferers are not diagnosed. This is because symptoms may be non-existent or banal, and it’s possible for some cases to go untreated in elderly or women. Patients with undiagnosed hyperuricemia or gout are often seen in other specialties than rheumatology, such as psoriasis and arterial hypertension. He said that Spain has 7 percent of adults with high blood levels of uric acids (hyperuricemia).

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He also said that it was possible that the number of people with gout could be higher if they take into consideration that patients with uric acids kidney stones or tophi (tissue deposits of uric Acid under the skin in places such as the elbows), as well as those who have uric- acid crystals in their joints or elsewhere without experiencing any symptoms (subclinical Gout).

However, the expert stated that the best way to diagnose gout is to use a polarized optical microscope. This allows for the detection of the cause of the disease, namely the uric acids crystals in fluid from inflamed joints and material taken from tophi.

He also explained that joint fluid can be obtained from patients with inflammation at the knee, ankle, elbow or wrist to allow for a complimentary microbiological, biochemical, and cell counting study. He said that sometimes two types of crystals (calcium pyrophosphate or urate) may be found in a joint. Sometimes, a bacterial infection can also be detected.

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The rheumatologist said that DECT (dual energy computed tomography), and most importantly, ultrasound (harmless, more accessible) are useful imaging tools that have improved the accuracy of gout diagnosis. They have also been included in the new international classification criteria for studies on this disease.

Ultrasound can also be used to determine the severity of joint inflammation or crystal deposits. It can also guide the physician to perform joint infiltrations and extract material for study via puncture. It is used in Rheumatology, Primary Care and Traumatology.

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Gout Symptoms warning Signs

Gouty joints are characterized by pain, swelling, heat, and redness. It is common to see elevated uric acids in blood tests. However, uricemia doesn’t always have to be high at time of attack. The expert explained that blood levels can vary and there are cases of gout where the uric acid level is not apparent. According to him, patients with persistent joint inflammation or inflammation that resists treatment in Primary Care or the Emergency Room should be referred for evaluation to Rheumatology.

Calvo stated that there may be cases in which the management is difficult (due to comorbidities like renal disease or cardiovascular disease) and when the clinical diagnosis is uncertain in patients with high blood uric acid levels and/or a family history gout. Although they don’t have typical symptoms, these patients could suffer from subclinical, or barely symptomatic forms.

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