Gout
What is it?
Gout is a form of acute arthritis that causes sudden and recurring attacks of severe pain and swelling in
the joints. The most commonly affected joint is the big toe, but it may also affect other joints of the foot, leg, arms, and
hands.
Who gets it?
Of the approximately one million Americans affected by gout, over 80% are men. While men tend to see symptoms beginning in their late 30s to early 40s, women usually don't have symptoms before their 60s. However, gout can develop at any age. People who are overweight, drink large amounts of alcohol regularly, take medications called diuretics for high blood pressure, and have high triglyceride levels (a measure of fatty substances in the bloodstream) are more likely to develop
gout.
What causes it?
Gout is associated with hyperuricemia , which is abnormally high levels of uric acid. Uric acid is a waste product that is found naturally in the bloodstream. The kidneys normally filter the uric acid and release it in your urine. But sometimes the kidneys can't eliminate enough of the uric acid, either because the body is producing too much, or the kidneys are not working well enough. That's when the uric acid builds up. Uric acid also tends to increase in men once they reach puberty. By the time a man reaches his late 30s or early 40s, levels have been high enough for a long enough time to cause the symptoms of gout. High levels of uric acid in the blood cause crystals, called urate crystals, to form and settle in the fluid around the joints. Redness, pain, and swelling occur when white blood cells surround and attack the urate crystals.
Some people produce high levels of uric acid because they have inherited an enzyme abnormality. Others produce high levels because they are overweight, drink large amounts of alcohol, or their diet is too rich in foods such as dried peas and beans, sardines, liver, and anchovies. These foods are high in a substance called purine, which breaks down into uric acid. In other cases, certain diseases, such as blood cancers and some types of kidney disease, cause uric acid to build up. Dehydration and certain medications, such as diuretics, are also common causes of high levels of uric acid. However, some people can have normal uric acid levels but still develop gout. Gout sometimes occurs soon after an illness or surgery. Doctors believe women tend to develop gout later in life because estrogen protects against hyperuricemia. After menopause, estrogen levels fall and it's easier for the urate crystals to build up in the joints.
What are the symptoms?
Attacks of gout usually occur suddenly, without warning, and often during the night. The joint most commonly affected is around the big toe. However, pain can also occur in other joints such as the heel and ankle. The hand, wrist, or elbow may also be affected, but these areas are not as common. The pain is so severe that you may not be able to tolerate putting any weight on the joint, or even the lightest touch against that area. The affected area looks red and swollen, and may even feel warm to the touch. You may feel sick, with a low-grade fever, chills, and a rapid heartbeat. At first, symptoms affect only one joint and last for just a few days. They may not occur again for months or even years. However, when the gout symptoms do return, they tend to last longer, affect multiple joints, and begin to occur more frequently. The urate crystals can eventually form hardened lumps, called tophi, under the skin around the joints, in the kidneys and other organs, and around the outer edges of the ears. Tophi deform the joints and decrease the range of joint motion. Tophi on the hands and feet can rupture and the crystals that are released look like a chalky substance. When the urate crystals harden in the kidneys, they create symptoms much like kidney stones, including severe abdominal pain, nausea, vomiting, fever, and blood in the
urine.
How is it diagnosed?
Your doctor can diagnose gout based upon your symptoms and a physical examination of the affected area. While blood tests may be used to check uric acid levels, these levels may be normal during an attack. However, if your doctor uses a special needle to remove a sample of joint fluid, he or she can see urate crystals in the fluid by looking at the sample under a special microscope. The presence of tophi, which can be seen under the skin around the joints, can also confirm the diagnosis of
gout.
What is the treatment?
To treat gout, your doctor will first focus on relieving your pain by controlling the joint inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen sodium, or indomethacin, are available over-the-counter and are effective in relieving pain and swelling. If you cannot take these types of drugs because you have a peptic ulcer or kidney disease, your doctor may recommend another anti-inflammatory drug called colchicine. It has also been very effective in relieving gout, but can cause diarrhea and other side effects while you are taking the drug. Sometimes, corticosteroids such as prednisone and adrenocorticotropic hormone can be injected directly into the joint to quickly stop the inflammation. Corticosteroids can also be taken orally, but are never used for more than a few days to avoid side effects. Aspirin and aspirin-related drugs should be avoided because they only worsen gout. To prevent future attacks and reduce your risk of permanent joint damage, your doctor will work on lowering your uric acid levels.
Sometimes simply losing weight will reduce these levels. Doctors recommend that anyone with gout gets plenty of rest, avoids alcoholic beverages, maintains a healthy weight, eats only small amounts of purine-rich foods, and drinks plenty of fluids, such as water. However, if you have repeated, severe attacks despite these measures, you may need to take drugs such as probenecid and sulfinpyrazone, which increase the excretion of uric acid by the kidneys. These drugs don't work for everyone and can cause kidney stones. Some people have more success with allopurinol, which actually blocks the production of urate and can dissolve kidney stones. However, it too has potential side effects, including a skin rash and liver damage. Once you begin to take probenecid, sulfinpyrazone, or allopurinol, you must continue to take them for life to prevent the return of gout. You can dissolve the urate crystals and relieve pain during an attack by applying hot, then cold compresses. This is called contrast hydrotherapy, and doctors recommend that you alternate three-minute hot compresses with 30-second cold compresses. If you have tophi, you will find that they will shrink as your uric acid levels come down, and your range of motion around those joints will improve. However, extremely large tophi may need to be removed surgically. People with high uric acid levels but no gout symptoms require no treatment at all unless there is a family history of gout or kidney
stones.
Self-care tips
While there is no cure for gout, its symptoms can be managed through a combination of drug therapy and lifestyle changes. Lifestyle changes mean maintaining a healthy weight, getting plenty of rest, exercising, and drinking plenty of water, especially if you are taking diuretics for high blood pressure. If you must drink alcoholic beverages, drink no more than two ounces in one day. Also avoid foods that are rich in purine, which produces urate. These include organ meats, such as liver, kidney, and sweetbreads; sardines; anchovies; shrimp; red meat; gravies; dried beans; beer; and wine.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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