Got Gout?

For today’s question, we ask, “what kind of blood test should I get for gout?” or, even, “should I get a blood test if I have or if I suspect I have gout?”

First and foremost, many different scenarios may come to mind when the words “blood test” and “gout” are combined in a question—and we plan to tackle them all in typical Got Gout? fashion (straight to the point and not leaving anything behind).

Before we think of scenarios, let us answer the question in the simplest manner first. The blood test associated with gout is a specific type of blood test that checks the level of uric acid in the blood—particularly in the blood plasma. You may call it the uric acid blood test, or any name you wish so long as it gives you the results you’re looking for—concentration of uric acid in your blood. The test is done like any other blood test—by taking a sample of blood from a vein (usually in the arm) via needle and syringe. More information about the test before we end this article.

Moving on to scenarios, probably the first and most common scenario is when someone suspects he or she may have gout. Quite frankly, a good and experienced physician should be able to tell just by looking at the affected joint and/or by checking your symptoms if what you have is indeed gout. More often than not, a blood test may not even be required. If it is indeed gout, pain and anti-inflammatory medications are usually prescribed, then a follow-up visit to discuss long-term management (gout is a chronic ailment) which might include a blood test usually follows.

Another scenario arises when a patient is already a gout veteran—has either had an episode or multiple episodes of gout in the past. If no uric acid blood test has been administered in the history of the patient, a physician might order one to pinpoint something that might be causing the high uric acid levels. It may be that the patient simply consumes too much foods high in purines, has a hard time getting rid of uric acid—kidney problem—or worse, both.

Also part of the above scenario is when a doctor wants to find out if the course of treatment is working. Obviously, if it’s not working, certain adjustments should be made—a lifestyle change for the patient, perhaps.

A different scenario comes way before a gout attack even happens (should it happen). Gout is hereditary and if you have history, it may be wise, especially if you have come of age, to have your uric acid checked. At this point, all you may need is a simple adjustment in your diet. This can not only prevent you from experiencing excruciating pain, but save up on medical bills as well.

Going back to the blood test itself, the normal uric acid range falls between 3.6 mg/dL and 8.3 mg/dL or milligrams per decilitre. A high concentration of uric acid in the blood is called hyperuricemia and hypouricemia for the opposite. An abnormal concentration is not in itself a medical condition, but is associated with a medical condition such as, you guessed it, gout.

Uric acid can also be detected in the urine. A urine uric acid test also exists. This test comes in conjunction with the blood test to see if the kidneys are efficiently getting rid of uric acid. We will discuss this the urine test in detail in a future post.

Pardon me for the rather bleak article title; I am out of sorts and low on originality today. Grapes and gout. To say the least, it is a winning combination. There you go. But why?

First comes potassium. Grapes is a good source of potassium—containing about 190 milligrams per 100-gram serving. It is believed that potassium keeps uric acid liquid and prevents it from crystallizing. As we all know, once uric acid crystallizes, it accumulates on joints, hence, gout. Keeping it liquid means keeping it at bay for the kidneys to excrete (diuresis).

Next comes flavonoids. Grapes, particularly red grapes, contain the flavonoids quercetin and anthocyanin. These same plant metabolites are what makes berries and cherries—virtually, foods that end in “ies”—good for gout. Flavonoids are naturally-occurring anti-inflammatories. This trait also makes grapes good for gout during an attack, and not only as a preventive measure. However, although known to reduce swelling, its effect is minimal compared to prescription anti-inflammatory drugs.

Grapes keep bodily fluids alkaline. When the body is in an acidic instead of an alkaline state, its ability to excrete uric acid becomes less efficient. Grapes are known to be as some of the most alkaline-inducing foods. The rule here is as follows: the sweeter the grape, the better it is at inducing alkalinity.

Also deserving special mention are grapes’ water and vitamin C content. Grapes are about two-thirds water. Although nothing compared to simply drinking glasses of water, water is water and is good for gout nonetheless. As for vitamin C, grapes contain about 10 milligrams per serving. Not much, but again, useful nonetheless. Vitamin C keeps purines from hyper-metabolizing (into uric acid).

There you go. The above are what make grapes good for gout. Grapes contain more good stuff and have also been heavily linked with preventing heart disease, high blood pressure, and even certain cancers. They are, indeed, small wonders of nature.

Wednesday has sort of unofficially become our Gout in Images day, so today we feature another set of photos related to gout: gout in the elbow.

Unlike most other joints commonly affected by gout, the elbows are more prone to other ailments that have symptoms of inflammation. Regular arthritis is one, and bursitis, the inflammation of the fluid-filled sac called the bursa between the tendon and skin, looks awfully like gout—especially in the elbow—under simple observation.

Anyway, below are some pictures you can use for comparison. The latter photos show tophi have formed. In this case, it would be hard to mistake the condition for any other except gout.

A word of warning once again, this post is not suited for those with a weak stomach.

The onset of gout in the elbow. Affected area is clearly swollen and red.

Once you feel something in your elbow, visit a physician. It is likely that they will take a fluid sample to analyze for uric acid crystals. Only then can an official diagnosis be made.

A more advanced case where tophus is already present.

Gout in women is rarer than in men. Older women, or those who are already menopausal, are more at risk.

Severe uric acid crystal formation.

Another severe and rare case of elbow gout where both elbows are affected.

Do not let it come to this. Cases like these have rendered elbows immovable and useless, and would already require removal surgery.

It may seem paradoxical but there are some rare cases wherein a low to normal uric acid level may present itself at the onset of gout.

Hyperuricemia is the condition where the level of uric acid in the blood is abnormally high. Gout cannot NOT be caused by this as it is the crystallization of uric acid—from concentration—and the buildup of this on joints that defines gout.

So, how then can gout happen without hyperuricemia?

It can therefore only mean that at the time of an attack, acute or chronic, when testing is conducted—uric acid test—the levels have already subsided or are temporarily normal.

This phenomenon can happen due to a number of reasons. Patients who suddenly find themselves under attack without a history of hyperuricemia may not be able to saturate their blood (serum) at certain temperatures, especially those required for proper testing. It may also be due to hyperuricemia that is only triggered by outside causal factors such as obesity and alcoholism. When these patients suddenly stop the affecting cause, perhaps from previous experiences with gout, they suddenly become normouricemic (from normouricemia—a state/condition of normal uric acid levels). Finally, it may also be due to an undergoing treatment cycle with a uricosuric drug, which might have just kicked in during the attack itself.

Whichever way, such are just technicalities or odd coincidences that happen. Gout and uric acid cannot be separated by strict medical definition. If at all, the more real irony is persistent hyperuricemia from people who do everything to avoid it. Such cases are hereditary, or, a case of bad genes that allow their bodies to hyper-metabolize purines (uric acid comes from the breakdown of purines) even at minute levels. Learn more about this and gout in general from browsing our other articles.

Welcome as we premiere another segment here at Got Gout? called Gout Terms Defined; what it is about is pretty much self-explanatory.

Definition of “polyarticular gout”

Today’s term is actually quite simple, even though it may seem and sound medically deep. “Polyarticular” comes from the Latin word articulus, which means joint or a joint. Polyarticular gout is nothing but gout that happens on multiple joints at the same time. It is the opposite of monoarticular gout, which is gout happening at only one joint. Most gout cases—even yours, probably—as long as only one joint is affected per episode is technically monoarticular gout.

Polyarticular gout happens; I would imagine it to be really painful and disturbing, as one is too much to handle already. They also say that it can happen to first-timers, accounting for about fifteen percent of recorded cases.

You might also encounter the term being paired with words such as “acute” and “tophaceous.” For example, acute polyarticular gout or tophaceous polyarticular gout. Acute in medicine simply means happening only once or in a short term. It is the opposite of chronic which is long term or recurring. Tophaceous is how one would describe the occurrence or presence of tophi. We just previously defined tophus (singular of tophi), which is the deposit of uric acid crystals enough to form a nodule or bulge out of the skin.

Answering this question seems like a backwards move for Got Gout? as we have covered far more advanced topics in previous posts. However, this also marks our decision to conjure a regular questions-and-answers segment wherein we’ll answer every conceivable gout-related inquiry for any discerning patient—newbies or veterans alike.

So, going back to the question: NO, gout is NOT contagious.

Gout is not an infection; gout is not viral. It is caused by the decisions you make and the lifestyle you choose—the foods you eat, drinking, not exercising, or basically just not taking care of yourself. You cannot possibly give it to someone else just by staying near him or her. If at all, gout is believed to be hereditary which in a very technical way is still “passing it on to someone.”

However, birds of the same feather flock together. I guess it would also be pertinent to note that people from the same household eat the same foods. Friends drink when friends drink. People who do not exercise are probably surrounded by people who are alike. All we’re saying is don’t be surprised if you get gout just around the same time someone you know or are related to does.

Gout is caused by excess uric acid in the body, which is caused by eating foods high in purines. To know everything you need to know about this painful ailment, we highly suggest spending some more time in this site.

This series of photo posts will now become a regular feature here at Got Gout? Today, we follow suit from our previous what-are-tophi article. Gouty tophi, plural of tophus, are very deforming. Most of the pictures here are not for those with a weak stomach—don’t say we did not warn you, it will get really gory.

However, we shall start mildly.

Above is a micrograph—a photo taken from a microscope—of a tophus.

This next photo was taken from an arthroscope while performing removal surgery on a knee joint.

Tophi can occur almost anywhere on the body. Above, the uric acid crystals chose to accumulate on the outer ear.

Another tophus; this time on the helix of the ear.

Tophus on the elbow.

We move over to the hands. This is where it starts to get gory. Tophi at the joints of the finger.

An almost unusable hand with gouty tophi.

Extreme deformation at the index finger.

Just when you thought it couldn't get worse.

Jesus. You can clearly see the removed solidified uric acid crystals.

Picture above shows tophus and not just gout. Swelling from regular gout is more uniform.

Remember this photo? From our uric acid crystals post—surgery to remove crystals on toe.

To be able to answer this question comprehensively, we need to first split it into two contexts: first is if nuts directly cause gout, and second, if nuts are bad for gout.

To tell you the truth, I am one of the many who have always associated nuts with gout. Call it wisdom of the elderly but I have always been under the impression that nuts are “high in uric acid.”

To explain how many levels of wrong that last statement was, we need to establish one thing: uric acid cannot be ingested. Uric acid is not present in foods, it is a byproduct (of our bodies) from the metabolism slash breakdown of purines. If at all, these alleged high uric acid foods are actually foods high in purines. Also, nuts are actually not high in purines.

So, going back to the original question(s), the first answer would be that nuts do not directly cause gout. However, to be able to answer the second question (are nuts bad for gout?) with absolute certainty, we need to clear up some technicalities.

Nuts by strict botanical definition are fruits. Examples include hazelnuts, chestnuts, pecans and acorns; these are what scientists call true nuts. However, there are other foods that moonlight as “nuts” such as cashew nuts, pistachios and peanuts.

True nuts are not high in purines. In fact, given that an ideal gout diet should be low in protein (but protein is essential for everyone), nuts are recommended as an alternative protein source along with low fat dairy and eggs.

Peanuts, on the other hand, are legumes like peas and beans. These are foods that fall in the moderate purine content category. If we are to visualize this protein source-purine content chart, those under low would include nuts and eggs, those under moderate would include legumes and beef, and those under high would include animal internal organs such as liver and kidney, and fish such as anchovies and sardines.

So there you go. Nuts do not cause gout. They do contain purines, as all protein sources do, but they are not that bad for gout—talking about true nuts. And, other “nuts” such as peanuts can still be consumed in moderation.

Defining tophi in the context of gout

Tophi is a step up for the worse in the world of gout as it is a rife accumulation of uric acid crystals, enough to break through the skin and cause malformation.

Those not in the know may ask the question “what is tophi?” which is grammatically incorrect. Tophi is in plural form—that of the word tophus, derived from the Latin word tophos, which is a porous volcanic stone. In the context of gout, a tophus may also be referred to as tophaceous gout.

Anyone who has reached the point of tophi formation has had a longstanding, uncontrolled bout with high levels of uric acid for years. They are known on average to develop ten years after the onset of gout. However, recorded cases prove they can develop anywhere from three years, earliest, to forty-two years, latest.

As opposed to gout, tophi do not only form around joints. They have been seen on cartilages and bones, and in rare cases even in the kidneys and the nasal cartilage. Another rather interesting contrast with gout is that tophi is more common among women. Also, depending on where they form, tophi can be anywhere from harmless to critical, sometimes deeming a joint or an organ unusable.

Treating tophi follows the same principles as with gout. By lowering uric acid levels, a tophus will eventually dissolve itself. But, we’ll reserve that for another post. For now we hope we’ve defined tophi in rather easy-to-digest manner for the gout-concerned citizen.

Gout may be a common ailment, but gout in the fingers is rather rare. Even if you have had gout (elsewhere) in the past, the symptoms—when it happens in the fingers—may come as a surprise to you. For one, non-gouty arthritis normally happens in the hands so there can be some misdiagnosis at the start.

Personally, I have not had gout in the fingers—thank goodness, as I have heard horrible things about it. It can cause malformation from the accumulation of tophi. But don’t fret, as long as you catch it early and start with treatment and detoxification, the worst can be prevented.

To say for sure if it is in fact gout in the fingers, you should at least familiarize yourself with the symptoms. If you are a gout veteran, at least you are already familiar with the pain (and the burning sensation) which can be advantageous compared to first-timers. Below is a shortlist for reference should the dreaded day arrive. So, without further ado, below are some finger gout symptoms.

Minus the knuckles, there are two joints in every finger except the thumb. Uric acid crystals can accumulate in any of these joints, which means gout can attack any finger. It can also happen to more than one finger at a time; it most commonly happens to the index finger and thumb.

Older people are more susceptible to gout in the fingers. It takes years for gout crystals to accumulate in the finger joints to the point that they cause intense swelling. Finger gout is also common to post-menopausal women.

When it happens, you can just suddenly wake up with a red, swollen and painful finger. However, with gout, the swelling and the pain usually increases in a matter of days (even hours). It will come to the point where you will not be able to move the whole finger (not just the joint) and even render the affected hand useless.

If it happens in the finger pad (outermost joint), the cuticles can become malformed and even break.

The swelling is, of course, reddish, but it also appears somewhat shiny due to the skin being stretched. The affected area might also feel hot—the burning sensation the ailment is notorious for.

The affected area should also become extremely sensitive even to the slightest touch. Discomfort can arise even from the touch of soft things such as clothing (cloth).

Because gout and non-gouty arthritis comes and goes, even your doctor might not be able to tell if it is in fact gout just by looking at it. It is important to have your uric acid levels checked as soon as possible so treatment, including relief from pain, and detoxification can be started as soon as possible.