What Causes Gout After Surgery
Gout after surgery can be an extremely frustrating experience. Fortunately, new medical research is assisting us in understanding how a surgical solution may result in the same symptoms.
Gout is an excruciatingly painful form of arthritis caused by an excess of uric acid in the body (hyperuricemia). This may result in the formation of uric acid crystals in the joints. It usually affects one joint at a time, usually the big toe.
Obesity and poor dieting are some of the biggest risk factors that may lead to the development of gout. Pain and other symptoms may be relieved with surgery. Studies show that bariatric surgery has the highest success rate in alleviating gout symptoms and hyperuricemia.
However, a recent study also found that gout flare-ups are more likely in the days following surgery.
The good news is that, while gout may be excruciatingly painful and incapacitating, it is also highly treatable in nearly all patients. However, it is critical to detect and treat it as soon as possible to avoid pain and complications.
Let’s take a closer look at what gout is, and why gout after surgery may occur.
Gout: What Is It and How Does It Affect Your Body?
Gout is becoming more and more common. According to studies, there could be as many as 5 million gout sufferers in the United States alone. Even more conservative estimates put the figure at above two million people.
Gout was formerly thought to be a disease that exclusively affected middle-aged and older men. Younger people and women are increasingly being included in the mix. However, the cause of the rise in incidence among younger people is unclear.
That being said, greater life expectancy, weight gain, and diuretic use could all contribute to the increase in older adults.
What Causes Gout Flare-Ups?
Gout is associated with uric acid buildup. Uric acid is produced as part of the body’s purine metabolism. Purines are chemical substances formed when the body breaks down any of the numerous purine-containing substances. This includes nucleic acids derived from our diet or cell breakdown.
Gout may occur when a person produces too much uric acid or is unable to excrete enough of it in their urine (or both). The inability to eliminate enough uric acid in the urine is the most common cause of gout (approximately 90% of cases).
The following factors may increase your chances of developing gout:
- obesity, hypertension, and/or diabetes
- having a close relative who suffers from gout
- kidney issues
- consuming foods that cause uric acid build ups, such as red meat, offal, and seafood
- consuming an excessive amount of beer or spirits
The Different Stages of Gout
Gout is a painful and incapacitating form of inflammatory arthritis. It normally affects only one joint at a time, most commonly the big toe. However, gout is a progressive disease which means it may eventually spill over to practically any joint or soft tissue in the body.
Gout attacks are frequently described by patients as a sudden onset of swelling, redness, and even warmth. Of course, there is excruciating pain in the affected joint.
Gouty arthritis may develop as a result of frequent flare-ups, according to the Centers for Disease Control and Prevention (CDC). This is a more serious version of the condition. A more direct medical intervention may be required in many cases.
The best way to understand gout is to think of it in four stages:
- Stage 1 (High uric acid): This stage normally has no symptoms and is left untreated. Uric acid elevation without gout or kidney stones
- Stage 2 (Acute flares): During this stage, acute gout attacks produce pain and inflammation in one or more joints.
- Stage 3 (Intercritical periods): These are periods when a person appears to be normal yet is in danger of having another acute episode.
- Stage 4 (Advanced gout): This is a stage of chronic gouty arthritis marked by uric acid “lumps,” or tophi, and recurrent acute gout attacks. In addition, there is often pain in between attacks.
Long-Term Gout Complications
While gout flare-ups may appear to be only temporary, uric acid buildup in the body may cause long-term damage.
Urate crystal clusters called tophi develop under the skin. They may affect any joint or cartilage, including your fingers, hands, feet, and ankles. Tophi may appear on the ears as well. Tophi might not always cause pain, but it may destroy your joints, bones, and cartilage if left untreated.
Deformity and joint damage
When you have chronic gout, your joints swell regularly. Tophi and chronic inflammation may cause permanent joint damage, deformity, and stiffness. In severe cases of chronic gout, surgery to repair or replace joints may be required.
Kidney failure and kidney disease
Urate crystals can form kidney stones, which may cause kidney damage and scarring. They are also thought to harm the kidneys over time, causing kidney disease, particularly if gout is not treated.
When Is Surgery for Gout Necessary?
There is currently no permanent cure for gout. Taking medications and changing one’s lifestyle, on the other hand, may help people manage their gout symptoms. As a result, some people may only have gout symptoms once in a while.
Others are not so fortunate, and they may experience regular chronic flares. At this point, the condition is referred to as chronic tophaceous gout. Uric acid tophi are formed in this more advanced form of gout. These are hard deposits that may form beneath the skin and damage the cartilage and bones.
In severe circumstances, a doctor may prescribe surgery if the tophi:
- gets infected.
- cause severe joint deformity
- cause excruciating pain
- vital nerves are compressed
Since gout is a progressive disease, its symptoms will only grow worse over time if left untreated. Left unchecked, these symptoms may cause irreversible damage.
Surgical Options for Tophaceous Gout
For people with advanced gout, there are currently three surgical options. They are as follows:
- Tophi Removal:
Tophi removal entails the removal of any infected, bloated, or painful growths. A tophus is removed while as much of the surrounding tissue as possible is preserved. If the tophus is infected or causing serious discomfort or deformity, a doctor may recommend this procedure.
- Joint Fusion:
Joint fusion surgery involves fusing the bones in a joint together, as the name suggests. While this operation may limit an individual’s movement, it helps alleviate symptoms such as persistent discomfort. Smaller joints are more commonly fused by surgeons since they may help with pain relief.
- Joint Replacement:
In some circumstances, doctors may advise patients to receive a joint replacement. Doctors use this procedure to replace a damaged, painful joint with an artificial joint. This surgery may help in pain relief and movement. This procedure is most commonly performed on the knee.
Prevalence of Obesity in Rising Gout Cases
Gout and hyperuricemia affect around 4% and 21% of the population in the United States, respectively, according to studies. These rates have risen in recent decades. Experts believe it’s because obesity, a key gout risk factor, is becoming more frequent.
In contrast to other types of arthritis, gout is caused by changes in the body’s metabolism rather than the immune system. Gout is caused by a mix of genetic, medical, and environmental factors. Each of these factors contributes to hyperuricemia or an increase in uric acid levels in the blood.
The foods we consume may have a substantial impact on the onset of gout symptoms. This is due in large part to purine, an organic compound found in many foods. When purines are consumed, it is broken down by the body and converted to the waste product uric acid.
The kidneys generally filter it out of the bloodstream and eliminate it through urine. However, the body may sometimes produce more purines than the kidneys may effectively break down. That’s when uric acid starts to build up and form the crystals that cause attacks.
Gout After Bariatric Surgery
Weight loss has been shown to lower serum urate levels, which reduces the likelihood of gout attacks. Bariatric surgery and a comprehensive treatment plan may help you or someone you care about lose weight and improve their health in the long run.
Weight loss associated with bariatric surgery has been shown to alleviate gout symptoms and hyperuricemia without a doubt. Gout flare-ups after surgery, on the other hand, are more likely in the near term.
No one knew what was causing the increase in flare-ups for a long time. Some experts speculated that the cause could be linked to the changes in the body following bariatric surgery. Furthermore, the numerous clinical proclivities before and after surgery should be considered.
And that’s exactly what doctors looked at next.
Studies Shed Light on Gout After Surgery
In two famous studies, doctors assessed the clinical features and risk factors for gout flare during the postsurgical period in patients who had previously been diagnosed with gout.
Some of the most common risk factors for gout flare-ups include:
- A meat- and seafood-rich diet
- Sodas, fruit juice with high fructose or sucrose content
- Medications such as diuretics or low-dose aspirin
- Chronic kidney disease
- Postoperative period for patients with a gout history
A total of 70 patients served as the control group in a study that looked into the clinical aspects of gout after surgery. These individuals had a history of gout and had visited a rheumatologist before undergoing surgery under general anesthesia. Those who experienced gout after surgery were compared to patients who did not develop a gout flare.
The original group contained a total of 184 patients. Two types of individuals were then removed from the study group. The first were patients who had surgery under local anesthesia or surgery to establish arteriovenous fistulas for hemodialysis. The second was patients whose electronic medical records lacked appropriate clinical information. A total of 70 patients were chosen in the end.
The study found that patients who had high uric acid levels before surgery had a higher risk of developing gout after surgery. Interestingly, the study also found that decreasing serum urate levels were more likely to cause gout flares than increasing urate levels.
50 of the 70 patients (71.4%) had lower serum uric acid levels after surgery. Reduced uric acid levels after surgery may be associated with starvation, fasting, and fluid administration.
One study included two groups of 67 patients each. The first group consisted of gout patients who developed gout after surgery. The second group of patients had a history of gout but did not have gout attacks after surgery.
The characteristics of postsurgical gout attacks were evaluated and compared to those of presurgical gout attacks in both patients and controls. Also considered were the demographics, medical histories, laboratory data, and surgical characteristics to determine risk factors for postsurgical gout.
Some interesting insights were revealed:
- Gout after surgery usually occurs within 8 days.
- Lower extremity joints were frequently targeted in the attacks.
- The location and number of affected joints reflect the characteristics of the patient’s gout attacks before surgery.
- Patients who had previously undergone cancer surgery were more likely to have elevated presurgical serum urate levels.
- There are two ways to avoid gout attacks after surgery: 1) Adequate presurgical serum uric acid control and 2) prophylactic colchicine administration.
Based on the findings of both studies, it was clear that controlling uric acid levels before surgery is a critical factor in reducing the risk of gout after surgery. Therefore, it is critical to continue taking allopurinol without interruption or the risk of experiencing a gout flare. Speak to your doctor, first!
Add Gout Management to Your Daily Routine
Bariatric surgery may help you avoid some of the long-term difficulties associated with gout. However, clinicians and patients should be aware that bariatric surgery is not recommended as a first-line treatment for gout.
You should not undergo bariatric surgery solely to alleviate your gout symptoms. As usual, discuss with your doctor a gout treatment plan that is right for you!
Posted by Spiro Koulouris