There are many similarities between Lyme disease and gout in terms of the symptoms, but the cause of the conditions is distinctly different, as is the treatment for most patients. True gout is an arthritic condition caused by high levels of uric acid building up in the joints and forming crystal-like structures. Uric acid is a substance formed naturally in the body and it can actually be quite beneficial at normal levels through a recently discovered antioxidant action. The problems arise however when levels of uric acid are elevated with patients suffering from gout experiencing excruciating joint pain with obvious swelling and sensitivity in the joints and often in the extremities. The slow creeping of joint pain related to gout is similar to the gradual increase in symptoms in those suffering from Lyme arthritis.
Gout and Lyme Disease Can Coexist
It is, of course, quite possible that many people have both Lyme disease and gout and are only receiving treatment for one which remains ineffective whilst the other condition remains unaddressed. Just as with any new symptoms it is important to get a clear diagnosis rather than simply assuming that the symptom is part of an existing condition.
Stages of Gout
Gout tends to occur in four stages, with the first stage consisting of elevations in uric acid levels but no obvious symptoms yet occurring. The second stage is acute gouty arthritis, where joints become inflamed, red, and painful on even the slightest touch. The third stage is where patients experience intermittent attacks with periods of calm in-between, much like in Lyme disease and Lyme arthritis which often had flare-ups of symptoms making it difficult to diagnose in many people. Patients with the fourth stage of gout, chronic tophaceous gout, is where the soft tissues of the body have deposits of uric acid crystals (known as tophi) which build up to form nodular masses, which are sometimes visible as raised bumps on the ears or in the extremities.
The recently observed antioxidant property of uric acid at proper concentrations in the blood has a possible role in protecting connective tissue in the joints. In protecting cells from attack by hydroxyl free radicals the uric acid may actually help reduce the general wear and tear that occurs as we age. In a similar fashion to cholesterol, uric acid is both made in the body and obtained through the diet and can be both helpful and harmful depending on its concentration.
Who gets Gout and Why?
Gout occurs almost exclusively after menopause in women, and may be associated with hypertension, renal insufficiency, and exposure to diuretics. The possibility of Lyme disease leading to gout is unsubstantiated but may be related to kidney problems resulting from Lyme disease infection, or be a result of intensive medical regimes and long-term antibiotics used to treat Lyme disease by some doctors. Gout that occurs prior to menopause, or in men under the age of thirty is frequently a result of enzyme dysfunction or deficit that is hereditary, or renal disease. Patients taking medications to try to boost their immune system to beat Lyme disease may inadvertently trigger an attack of gout inflammation as it is the ingestion of uric acid crystals by white blood cells that releases pro-inflammatory enzymes. Gout itself is not connected to infection however, but inflammation may be made worse where infection exists due to such substances as pro-inflammatory cytokines triggered by the immune system in Lyme disease.
Chronically Ill at Increased Risk of Gout
Patients who are chronically ill with Lyme disease may become sedentary and suffer from obesity, hypertension, hyperlipidaemia, and diabetes all of which are associated with an increased risk of gout. Lyme disease-associated depression may also cause sufferers to become dependent on alcohol, or adopt desperate dietary patterns to try to alleviate symptoms thus increasing the likelihood of gout occurring. The diarrhoea which sometimes occurs with Lyme disease antibiotics, and other medications may also lead to dehydration which worsens gout symptoms. Low-dose aspirin, when used continually, is also associated with the incidence of gout.
To obtain an accurate diagnosis of gout the physician must determine the presence of uric acid crystals in the affected joint during an attack. This procedure can be extremely painful for a patient to undergo as it involves using a syringe to extract fluid from the joint at a time of already-excruciating joint inflammation and pain. Without the analysis of this fluid however it is not possible to say for certain whether the symptoms are caused by gout or an alternate inflammatory joint condition. Assessing blood levels of uric acid is not a good indication of gout as these may be elevated even in individuals without gout and may be low in those with the condition as concentrations are still high in individual joints. Swelling and pain in a specific joint, especially the big toe, is highly suggestive of gout however but a tick bite may also cause such a reaction especially where co-infections occur alongside Lyme disease.
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