Gout is classified according to its course and severity:

1. Asymptomatic Hyperuricemia:
   • Elevated uric acid levels in the blood without symptoms.
2. Acute Gout Attack:
   • Sudden, severe joint pain, usually in the big toe (podagra), accompanied by swelling and redness.
3. Intercritical Phase:
   • Symptom-free intervals between gout attacks.
4. Chronic Gout:
   • Repeated attacks lead to permanent joint and tissue damage.

Gout arises from an accumulation of uric acid, which deposits in crystals. The causes are varied and include:

• Primary gout:
  • Genetic predisposition leads to overproduction or reduced excretion of uric acid.
• Secondary gout:
  • Diseases such as kidney weakness, leukemia, or psoriasis increase uric acid production.
• Increased purine intake:
  • Purine-rich foods such as meat, seafood, or alcohol (especially beer) promote uric acid formation.
• Medications:
  • Diuretics and other medications can inhibit uric acid excretion.
• Overweight:
  • Leads to increased uric acid production.

The symptoms vary depending on the stage of the disease:

- Acute gout attack:

- Sudden, severe pain in one or more joints, usually at night.

- Swelling, redness, and overheating of the affected joint.

- Fever and general malaise may occur.

- Chronic gout:

- Formation of tophi (nodules of uric acid crystals) in joints, skin, or ears.

- Permanent joint damage with limitations in mobility.

- Kidney stones or kidney failure due to deposits in the kidneys.

The diagnosis is based on medical history, clinical examination, and laboratory diagnostic tests:

• Medical History:
  • Collection of symptoms, family history, and dietary habits.
• Physical Examination:
  • Visual inspection and palpation of the affected joints for swelling, redness, and tenderness.
• Laboratory Tests:
  • Determination of uric acid levels in blood and urine.
  • Analysis of joint fluid for uric acid crystals.
• Imaging Techniques:
  • X-ray: Visualization of joint damage in advanced stages.
  • Ultrasound: Detection of crystal deposits in joints or soft tissues.

Acute Gout Attack: The treatment aims to relieve pain and inflammation:

• Medications:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac.
  • Colchicine to inhibit the inflammatory reaction.
  • Glucocorticoids (cortisone) for severe symptoms.
• Cooling:
  • Local application of cooling pads to reduce swelling and pain.
• Resting the joint:
  • Avoiding stress until the attack has subsided.

Long-term treatment: The following measures are used to prevent further attacks and reduce uric acid levels:

• Medication therapy:
  • Allopurinol to inhibit uric acid production.
  • Febuxostat or uricosurics to promote uric acid excretion.
• Dietary changes:
  • Reduction of purine-rich foods such as meat, offal, and alcohol.
  • Increased consumption of fruits, vegetables, and low-fat dairy products.
• Weight management:
  • Weight reduction to decrease uric acid production and joint stress.

Surgical interventions: In advanced gout with tophi or joint damage, surgical measures may be necessary:

• Removal of tophi:
  • Surgical removal of crystal nodules to restore function.
• Joint replacement:
  • In severe damage, an artificial joint may be implanted.

To prevent gout attacks and the development of chronic gout, the following measures are recommended:

1. Dietary adjustment: Avoidance of purine-rich foods and alcohol.
2. Hydration: Adequate fluid intake to promote uric acid excretion.
3. Regular exercise: Promotion of general health and weight reduction.
4. Medication prophylaxis: Taking uric acid reducers in cases of hyperuricemia.
5. Control of underlying conditions: Treatment of risk factors such as diabetes or high blood pressure.