Gout

Regardless of whether you are experiencing the first symptoms or have been suffering from recurring gout attacks for some time – you are the focus of our attention. Because your health deserves not only medical expertise, but also personal attention, understanding and an environment that creates space for healing.

What is gout?

Gout is an inflammatory joint disease that occurs when too much uric acid accumulates in the blood. If a certain threshold value is exceeded, the uric acid can form small, crystal-like deposits in the joints. These crystals irritate the tissue and trigger an inflammatory reaction within a short time: an attack of gout occurs.

It is typically characterized by severe, often throbbing pain in one or more joints that starts suddenly. The metatarsophalangeal joint, the ankle joint, the knees or even the fingers are frequently affected. The affected area swells, turns red and feels very warm. Without treatment, an attack can last up to two weeks, but with targeted therapy the symptoms can usually be alleviated much more quickly.

What happens during a gout attack?

An attack of gout usually begins suddenly, often in the middle of the night. Typical symptoms are severe pain, swelling, redness and a noticeable heat in the affected joint. The big toe joint is often affected, but knees, fingers or ankle joints can also become inflamed.

The attack is triggered by tiny uric acid crystals that are deposited in a joint. These crystals are formed when there is too much uric acid circulating in the blood. Normally, uric acid is excreted via the kidneys. However, in some people this does not work well enough, for example due to a hereditary predisposition, certain illnesses or medication. The concentration of uric acid in the blood then rises and crystals can form. Joints with less blood flow and a lower temperature, such as the big toe, are particularly susceptible.

How does gout progress between attacks?

Some sufferers only experience a single attack. For others, the attacks recur sometimes after months, sometimes after years. If the disease remains untreated, the symptoms can occur more frequently and become chronic. In such cases, so-called gout nodules can form under the skin or uric acid can be deposited in the kidneys. This can lead to kidney stones or kidney damage in the long term.

It is therefore important to recognize gout early and treat it holistically. At the Nuhr Medical Center, we support you not only during acute attacks, but also in the long term in order to prevent further attacks and treat the causes in a targeted manner.

How does gout develop?

Not everyone with an elevated uric acid level automatically develops gout. However, the risk increases if the kidneys excrete too little uric acid. There are many reasons for this. In addition to genetic factors, diseases such as blood formation disorders or rare enzyme defects also play a role.

But external influences also have an effect: If you drink too little, your synovial fluid often has less blood flow and is cooler. This can also promote the formation of crystals. At the Nuhr Medical Center, we therefore not only look at the symptoms, but also at possible metabolic disorders that could be behind the disease.

What can trigger a gout attack?

There are a number of factors that increase the risk of an acute attack of gout. These include:

• certain medications such as dehydration tablets, ASA, medication after organ transplants or in the case of cancer
• purine-rich foods such as offal, red meat, fish and seafood
• Alcohol, especially beer and spirits, as they increase uric acid formation and inhibit excretion
• Sweetened drinks such as soft drinks or juices with a lot of fructose
• Severe overweight

However, nutrition is only one part of the puzzle. The decisive factor is how well the kidneys function and how the metabolism works overall. That’s why we at the Nuhr Medical Center take a holistic approach and develop an individual plan for you that combines nutrition, lifestyle and medical therapy in a meaningful way.

What are the typical symptoms of a gout attack?

An attack of gout often comes on suddenly and usually occurs at night or in the early hours of the morning. The affected joint swells quickly, becomes hot, reddened and extremely sensitive to pressure. Even a light touch, such as contact with the comforter, can be unbearable. The metatarsophalangeal joint of the big toe is most commonly affected, but ankle joints, knees, finger and hand joints or elbows can also become inflamed. The pain reaches its peak within six to twelve hours.

The inflammation usually subsides after a few days, sometimes the skin over the joint peels off. If gout remains untreated, it can lead to permanent joint deformities and restricted movement. In chronic gout, the joints are permanently inflamed.

Which joints are particularly affected by gout?

The metatarsophalangeal joint of the big toe is most commonly affected. Other typical joints are the ankle joint, knee joint, hand and finger joints and the elbow. In rare cases, shoulder and hip joints can also be affected.

How does gout typically progress?

Gout develops over a period of years. At the beginning, there is so-called asymptomatic hyperuricemia (stage I) – the uric acid level in the blood is elevated, but there are no symptoms yet. Only when crystals form and are deposited in joints do the typical symptoms appear.

In acute stage II, the first attack of gout occurs, often triggered by rich meals, alcohol, fasting or certain medications. The attacks can recur over the course of the disease (stage III), with periods of no symptoms between attacks. Without treatment, they become more frequent and more intense.

In the final stage (stage IV), gout becomes chronic. So-called gouty nodules (tophi) form under the skin or in the joints. The kidneys can also be affected. As a result, there is a risk of kidney stones or even impaired kidney function.

What happens if gout is left untreated?

If gout is not treated consistently, there is a risk of serious consequences: Joints are permanently damaged, mobility decreases, pain and inflammation become chronic. Muscles can also be weakened by reduced mobility. In rare cases, uric acid crystals are deposited in unusual places, for example in the carpal tunnel or in the area of the spinal cord, which can lead to nerve damage.

The risk of kidney stones and the resulting urinary tract infections also increases. Around 1 in 100 men affected develop a kidney stone within a year.

How is gout diagnosed?

The diagnosis is initially made on the basis of the typical symptoms and risk factors. A painful swelling at the metatarsophalangeal joint of the big toe is particularly noticeable. For reliable confirmation, a joint puncture is often carried out, during which joint fluid is taken and examined for uric acid crystals in the laboratory. Measuring the uric acid level alone is not sufficient, as it may appear normal during an attack.

How is gout treated?

The treatment of gout is primarily concerned with relieving acute pain and preventing future attacks. In an acute attack, we generally use anti-inflammatory medication. These include non-steroidal anti-inflammatory drugs such as ibuprofen, cortisone preparations or, in certain cases, colchicine. Cooling and immobilization of the affected joint also support the healing process.

In the long term, it is important to lower uric acid levels. This can be achieved either through a targeted change in diet or through medication such as allopurinol. Not all patients require long-term medication. Long-term treatment with medication is particularly useful if the attacks occur frequently, are particularly painful or complications such as gout nodules or kidney stones have already developed.

At the Nuhr Medical Center, we provide you with holistic support. Our experienced internists adjust the medication individually, and we also offer a comprehensive therapeutic concept. This includes occupational therapy, physiotherapy and physical treatments, both on an outpatient and inpatient basis. Your therapy plans are regularly reviewed and tailored to your personal needs.

Which physical therapies can help?

Physical applications can provide relief, especially in cases of chronic gout and when joint damage is already present. These include, among others:

• Ultrasound or electrotherapy for pain relief
• Cold applications to reduce inflammation
• Massages to relax the muscles and promote blood circulation
• Physiotherapy to strengthen muscles and maintain mobility
• Occupational therapy to better cope with limitations in everyday life

These treatments are an integral part of our treatment concept at the Nuhr Medical Center. Our specially trained therapists tailor each treatment to your individual symptoms.

Which medications are used?

To treat an acute attack of gout, we use anti-inflammatory medication such as ibuprofen, colchicine or cortisone. Uricostatic agents such as allopurinol or uricosuric agents such as benzbromarone are used to permanently reduce uric acid levels.

The most suitable therapy depends, among other things, on the function of your kidneys, your metabolic situation and the frequency of the seizures. The internal medicine specialists at the Nuhr Medical Center will guide you through the selection and adjustment of medication with great care and close medical supervision.

What can I do myself to avoid gout?

Even though the predisposition to high uric acid levels is often hereditary, you can do a lot yourself to reduce your risk. A low-purine diet plays a key role in this. We recommend eating lots of vegetables, low-fat dairy products, wholegrain products and drinking plenty of fluids. Animal products, alcohol (especially beer) and sugary drinks should only be consumed in moderation.

Regular exercise, avoiding obesity and a healthy lifestyle help to control uric acid levels in the long term. As part of our holistic Nuhr Med Concept, we support you with comprehensive nutritional advice, medical training therapy and an individually tailored exercise program.

How do you live with gout in everyday life?

An acute attack of gout can severely restrict everyday life. Even simple movements, getting dressed or grasping an object can become a challenge. Over time, many sufferers learn to recognize early warning signs and react accordingly. A seizure can also have a psychological impact: sleep problems, low mood and a feeling of helplessness are not uncommon.

It is important to be open about the illness in your social environment. Those who inform friends, family or colleagues not only receive more understanding, but often also practical support. Feelings of guilt or shame are unfounded, as gout is not a self-inflicted “disease of affluence”, but a medically treatable metabolic disorder.

At the Nuhr Medical Center, we provide you with comprehensive support on your journey: with individual therapy planning, state-of-the-art methods, a multi-professional team and an atmosphere that supports your healing. This allows you to master your everyday life with new energy and a better quality of life.