gout is a disease rheumatic painful , which causes inflammation in the joints due to deposits of urate (salt of uric acid) in the tissues, tendons and ligaments. It is a very common condition, since its prevalence amounted to 2.4% of the adult population in Spain, which represents more than 800.000 patients, according to the study EPISER 2016 of the Spanish Society of Rheumatology (SER) . In addition, an estimated that 1 of every 3 persons affected are not diagnosed , because "sometimes the first symptoms may be trivial or non-existent, and there are atypical cases in women or in elderly patients, that go unnoticed", according to the Dr. Enrique Calvo , a rheumatologist at the University Hospital Infanta Leonor (Madrid).
There are numerous patients followed in other specialties different to the Rheumatology with chronic kidney disease, psoriasis, high blood pressure or ischemic heart disease they also have hyperuricaemia and gout undiagnosed. In Spain, it is estimated that 7% of adult males have high levels of uric acid in blood (hyperuricemia).
"If in addition one takes into account that I would include as a drop also to those patients who have uric acid kidney stones or tophi (accumulation in tissue of uric acid under the skin in areas like elbows) and have not consulted the doctor never for that reason, as well as to the people who have deposits of uric acid crystals in the joints or in some other location without having any symptoms (drop subclinical) , it is very likely that the figure is more high, and can exceed one million Spanish people with this disease," warns Dr. Calvo.
The technique to achieve the definitive diagnosis is still through an optical microscope, although ultrasound has also demonstrated its effectiveness and is gaining ground
The gold standard to reach a definitive diagnosis of gout continues to be the test with optical microscope, polarized light , which allows you to detect the cause of the disease, the uric acid crystals in the fluid of inflamed joints or in material removed from tophi, with a high specificity. Also, explains Dr. Calvo, "the obtaining liquid joint of a patient with inflammation of a knee, an ankle, an elbow, a wrist or big toe of the foot may allow, make a follow-up study microbiology , biochemical and cell count. Occasionally there can be the presence of two types of crystals in a joint (pyrophosphate of calcium and urate), or detection of a bacterial infection added to the drop."
however, he adds the rheumatologist - in recent years, various imaging techniques such as the DECT (computed tomography dual-energy) and, above all, ultrasound (a safe and more accessible) have emerged as useful tools that improve the accuracy of the diagnosis of gout, joining also to the new criteria of international classification used in the studies of this disease.
in Addition, the ultrasound allows us to quantify the number of joints with inflammation and/or deposit crystalline, , and also helps to guide the doctor in injections joint and removing material to study by means of puncture. That is why it is each time more present in the consultations of Rheumatology and other specialties such as Primary Care or Orthopedic surgery.warning signs of gout
The most characteristic symptoms of joints with gout are 4: pain (can be very severe, even with minimal rubbing, producing sometimes limp to the patient), swelling, heat and redness . In the opinion of the specialist, "is usually typical to find elevated values uric acid in some analytics of the patient, but does not have to be high serum uric acid levels at the time of the attack, it is not always equally high. In addition, the concentrations in blood can vary and are not uncommon cases of gout levels are apparently low in uric acid".concentrations in the blood may vary and are not uncommon cases of gout levels are apparently low uric
"you could say that any patient with joint inflammation, recurrent or resistant to treatment started in the Emergency department or Primary Care should be referred for consultation by Rheumatology for their assessment. Can also be referred to a rheumatologist those cases in which there are difficulties in the management (by co-morbidities such as renal disease or cardiovascular) or before doubt in the clinical diagnosis in patients with high levels of uric acid in the blood and/or with a history of gout in family, because, although they may not have typical symptoms, may be suffering from subclinical forms or little symptomatic of the disease", says Dr. Calvo.Updated Date: 24 September 2019, 03:00