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Uric acid crystallises in the joint — the attack is fierce, but the cause is well measurable and manageable.
Also known as: gout · hyperuricemia
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Uric acid comes from breaking down purines, the building blocks of genetic material. It is therefore produced by every cell turnover, not only by food — which is why a strict diet on its own often achieves little. When uric acid rises past the limit of solubility, fine crystals form, and where they settle the immune system attacks them. That becomes an attack: overnight one joint, usually the base of the big toe, hot, red, swollen and so painful that the bedsheet is too much. Two things are regularly confused. First: the uric acid level is often normal or even low during the attack — so it is measured two to four weeks afterwards. A normal value does not rule gout out. Second: treating the attack and lowering the uric acid are two different things; lowering does not start during an attack, and once begun it continues for good. Stopping it because a year went well is arranging the next attack. A mere swing is often enough to trigger one — beer, a feast, fasting, an infection, a new water tablet. And gout rarely comes alone: it belongs in the company of excess weight, high blood pressure, fatty liver and weak kidneys.
Uric acid stones form in acidic urine and are the one kind that can be dissolved with medication. Anyone with gout therefore drinks not only for the joints.
Alcohol supplies purines and impairs uric-acid excretion; beer is especially unfavourable.
Fructose (soft drinks, lots of fruit sugar) measurably raises uric acid.
Organ meats, certain fish (sardines, anchovies) and lots of meat supply purines — keep moderate.
Uric acid is then often normal or low and misleads. Two to four weeks later it says what it has to say.
Stopping the lowering treatment because a year was quiet sets up the next attack. Early on it can even provoke attacks — which is why it is accompanied at the start.
Dilutes uric acid and protects the kidney. The simplest measure and the one most easily forgotten.
Water tablets and some blood-pressure drugs raise uric acid. Sometimes there is an alternative — that belongs discussed, not decided alone.
Weight, blood pressure, fatty liver, blood sugar: gout rarely stands alone. Looking only at uric acid treats half of it.
In an attack, anti-inflammatories act — they stop the inflammation, not the uric acid. Allopurinol lowers uric acid production and works preventively, not during an attack. It takes months for the crystals in the joints to dissolve; during that time attacks can even become more frequent.
About one to four in a hundred adults are affected, men three to four times more often than women; in women it usually starts only after menopause. An attack peaks within hours and settles untreated over one to two weeks.
About ten to fifteen sour cherries a day, or one to two tablespoons of sour cherry concentrate in water, over weeks.
From nothing to unbearable within hours, usually starting at night. That speed separates gout from almost everything else at a joint.
The commonest site but not the only one: ankle, knee, wrist and fingers occur as well.
The skin over it often flakes as it settles. It looks confusingly like a joint infection — with fever that needs looking at quickly.
Beer, a big meal, but also fasting, too little fluid, an infection or a new water tablet. It is the movement of the level that triggers, not its height alone.
Crystal deposits after years of high levels. They do not hurt and are the sign that lowering treatment is overdue.
Uric acid crystallises in the kidney too. So creatinine and eGFR belong in the picture, not just the joint.
Beer, offal, fructose raise uric acid.
Beer and sugary drinks affect the uric acid level more than meat — that surprises many.
In the attack cool, do not warm — that is the difference from almost all other joint pain.
TCM assigns the acute gout attack to “heat” and recommends cooling foods. What measurably counts is something else: purines, alcohol, fructose and how much is drunk.
Below the knee on the outside, in TCM the point for tendons and joints. On an acute attack no needle works fast enough.