Swelling and pain around ankle

If you have swelling and pain around your ankles and you can rule out factors such as trauma and excessive walking, then you are very likely suffering from gout. Gout is common in middle-aged and elderly people and is closely related to the patient's lifestyle habits. Gout can cause swelling and pain in the patient's ankles and other joints. Gout cannot be cured, it can only be relieved. To determine whether you have gout, you need to go to the hospital for a uric acid test.

Gout is a crystal-related arthritis caused by the deposition of monosodium urate (MSU), which is directly related to hyperuricemia caused by purine metabolism disorders and/or decreased uric acid excretion. It specifically refers to acute characteristic arthritis and chronic tophi disease, mainly including acute onset arthritis, tophi formation, tophi-induced chronic arthritis, urate nephropathy and uric acid urinary stones. In severe cases, joint disability and renal insufficiency may occur. Clinical manifestations of gout are more common in middle-aged men, with women accounting for only 5%, mainly postmenopausal women. Gout tends to occur in younger people. The natural course of gout can be divided into four stages, namely, asymptomatic hyperuricemia stage, acute stage, intermittent stage, and chronic stage.

Clinical manifestations are as follows:

1. Most patients with acute gouty arthritis have no obvious signs before an attack, or only experience fatigue, general discomfort, and joint pain. A typical attack often begins with awakening the patient in the middle of the night due to joint pain. The pain progressively intensifies, reaching a peak in about 12 hours, and feels like tearing, cutting, or biting, which is unbearable. The affected joints and surrounding tissues are red, swollen, hot, painful, and have limited function. Usually resolves spontaneously within a few days or 2 weeks. The first attack often affects a single joint, some of which occur at the first metatarsophalangeal joint. Later in the course of the disease, some patients also have involvement of this area. The next most common joints are the dorsum of the foot, heel, ankle, knee, wrist and elbow. The shoulder, hip, spine and temporomandibular joints are less frequently affected. Multiple joints may be affected at the same time, manifesting as polyarthritis. Some patients may have systemic symptoms such as fever, chills, headache, palpitations and nausea, which may be accompanied by increased white blood cell count, increased erythrocyte sedimentation rate and increased C-reactive protein.

2. Intermittent attacks: Gout attacks can last for several days to several weeks and then resolve on their own, generally with no obvious sequelae, or leaving local skin pigmentation, desquamation and itching, etc., and then enter an asymptomatic intermittent period, which can last for several months, years or more than ten years before relapsing. Most patients relapse within one year, and the attacks become more and more frequent, affecting more and more joints, and the symptoms lasting longer and longer. The affected joints generally develop from the lower limbs to the upper limbs, from the distal small joints to the large joints, and the joints such as the fingers, wrists and elbows are affected. A small number of patients may be affected in the shoulder, hip, sacroiliac, sternoclavicular or spinal joints, and may also affect the bursae, tendons and tendon sheaths around the joints. The symptoms tend to be atypical. A small number of patients have no intermittent period and present with chronic arthritis symptoms after the initial onset.

3. Chronic tophi lesions Subcutaneous tophi and chronic tophi arthritis are the result of long-term significant hyperuricemia, with large amounts of monosodium urate crystals deposited in the subcutaneous tissue, synovial membrane, cartilage, bone and soft tissue around the joints. The typical site for subcutaneous tophi to occur is the auricle, but it is also common around joints with recurrent attacks and in areas such as the olecranon, Achilles tendon, and patellar bursa. The appearance is yellow-white growths of varying sizes raised under the skin. The skin surface is thin, and white powdery or pasty substances are discharged after rupture, which does not heal for a long time. Subcutaneous tophi often coexist with chronic tophi arthritis. Large amounts of tophi deposited in joints can cause joint bone destruction, periarticular tissue fibrosis, and secondary degenerative changes. Clinical manifestations include persistent joint swelling, pain, tenderness, deformity and dysfunction. Symptoms in the chronic phase are relatively mild, but acute attacks may also occur.

4. Kidney diseases (1) Chronic urate nephropathy Urate crystals are deposited in the renal interstitium, leading to chronic tubulointerstitial nephritis. The clinical manifestations include decreased urine concentrating function, increased nocturia, low specific gravity urine, small molecule proteinuria, leukocyturia, mild hematuria and tubular urine. In the late stage, it can lead to decreased glomerular filtration function and renal insufficiency. (2) Uric acid urinary stones: The uric acid concentration in the urine increases to a supersaturated state, depositing in the urinary system and forming stones. The incidence rate in gout patients is over 20% and may occur before gouty arthritis occurs. Small stones are excreted in the urine in the form of gravel and may be asymptomatic; larger stones may block the urinary tract and cause renal colic, hematuria, dysuria, urinary tract infection, renal pelvic dilatation and hydrops, etc. (3) Acute uric acid nephropathy: The uric acid levels in the blood and urine increase sharply, and a large amount of uric acid crystals are deposited in the renal tubules, collecting ducts, etc., causing acute urinary tract obstruction. Clinical manifestations include oliguria, anuria, and acute renal failure; a large number of uric acid crystals can be seen in the urine. It is mostly caused by secondary causes such as malignant tumors and their radiotherapy and chemotherapy (i.e. tumor lysis syndrome).