What is gout?
Gout is a form of arthritis that causes sudden, severe
attacks of pain, tenderness, redness, warmth, and swelling (inflammation) in
some joints. It often affects one joint or only a few joints at a time.
The large toe is most often affected, but gout can also affect other joints in the leg (knee, ankle, foot) and less often in the
arms (hand, wrist, and elbow). The spine is almost never affected.
What are the symptoms of gout?
- Sudden, intense joint pain, which often first occurs in the early
- Swollen, tender joint that's warm to the touch
- Red or purple skin around the joint
What causes gout?
Gout was once incorrectly thought to be a disease of
the rich and famous, caused only by eating too much rich food and drinking fine
wines. Although diet and excessive drinking of alcohol can contribute to the
development of gout, they are not the main cause of the disorder.
Gout results from abnormal deposits of sodium urate
crystals around the joint cartilage and their later release into the joint
fluid. Urate crystals can also form in the kidney, causing kidney stones.
Sodium urate is formed from uric acid, a natural
chemical in the body. Uric acid comes from the natural breakdown of RNA and DNA
(the genetic material in cells). Some foods contain large amounts of uric acid,
especially red meats and internal organs (such as liver and kidneys), some
shellfish, and anchovies.
Uric acid in normal amounts remains dissolved in the
blood, easily passes through the kidneys, and leaves the body as waste. Uric
acid in high amounts will deposit in joints and make a person more likely to
The amount of uric acid in your blood can change depending on:
- How efficiently your kidney gets rid of the uric acid in the blood
- What you eat
- Your overall health
- How much alcohol you drink
- What medicines you are taking
- Sudden illnesses
Not everyone with high levels of uric acid will
develop gout. The kidneys' ability to rid the body of uric acid is partly
determined by heredity. Yet, just because someone in the family suffers from
gout does not mean everyone in that family will have the disorder. Often, the
effect of heredity is modified by the risk factors mentioned above that affect
uric acid, as well as male sex and age. All of these factors increase the risk
How frequent are gout attacks?
Gout attacks can recur from time to time in the same
or different joints. The initial attack may last several days to two weeks
unless it is treated.
Over time, gout attacks may occur more often, involve
more joints, have more severe symptoms, and last longer. Repeated attacks can
damage the joint. Lumpy collections of uric acid called tophi can develop near
joints, in the skin, or within bones.
Some people will only have a single attack. However,
about 90 percent of patients who have one gout attack will have at least a
second attack, although it may not occur for several years after the initial
attack. Others may have attacks every few weeks.
Who is affected by gout?
Gout affects more than one million Americans, including:
- Men (usually over age 40) and women after menopause
- People who are overweight
- People who frequently drink alcohol
- People who use diuretics ("water pills") to lower blood pressure or to
treat heart disease
When gout affects women, it is usually after
menopause, especially in women who are taking certain medicines. Younger
patients may be affected by gout if they have been taking certain medicines for
long periods of time, frequently drink alcoholic beverages, or have certain
How is gout diagnosed?
Gout cannot be diagnosed simply from a blood
test, since many people have elevated blood uric acid levels, but never develop
gout. Rather, gout is diagnosed from the fluid withdrawn from an inflamed joint.
The fluid is observed under a microscope for sodium urate crystals.
Fluid is removed through a needle from the inflamed
joint during a procedure called arthrocentesis. Removing the fluid may reduce
pressure within the joint and thereby reduce pain. A lack of crystals does not
necessarily rule out a diagnosis of gout. Occasionally, crystals may not be
observed the first time, but may be seen if additional fluid is removed at
another time during a subsequent attack.
Since gout can cause chronic joint pain and involve
other joints, it is extremely important that an accurate diagnosis be made.
Then, your doctor can prescribe the appropriate specific treatment.
How is gout treated?
There is no cure for gout, but it can be treated and
controlled. Symptoms are often relieved within 24 hours after treatment has
begun. Attacks can be prevented with appropriate therapy!
The goals of treatment are to:
- Relieve pain and inflammation
- Prevent future gout attacks that could lead to permanent joint damage
The type of treatment prescribed will depend on
several factors, including the person's age, type of medicines he or she is
taking, overall health, medical history, and severity of gout attacks.
Gout is mainly treated with medicine.
Anti-inflammatory drugs will reduce the pain and
swelling of attacks. They are usually continued until the gout attack completely
resolves. If side effects from the therapy occur, treatment may be changed to a
different medication. Your health care provider will discuss the potential side
effects with you.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally prescribed
to treat sudden and severe gout attacks. NSAIDs usually reduce inflammation and pain within hours.
- Corticosteroids (also called steroids) may be prescribed for people who
cannot take NSAIDs. Steroids also work by decreasing inflammation. Steroids
can be injected into the affected joint or given as pills.
- Colchicine is sometimes used in low doses for a long period of time to
reduce the risk of recurrent attacks of gout.
Drugs that affect uric acid levels
Some patients may need to take medicines that lower
the level of uric acid in the blood. (Examples are allopurinol, probenecid and
febuxostat, also called Uloric®). These drugs are recommended for
patients who have had multiple attacks of gout or kidney stones due to uric
acid. The goal of treatment is to reduce the uric acid level to less than 6 mg/dL.
The goal of lowering the blood uric acid is to slowly
dissolve joint deposits of sodium urate. Lowering the uric acid will not treat
an acute attack, but will over time prevent additional attacks from occurring.
Sudden lowering of the uric acid level may cause an acute attack of gout. To
prevent acute attacks in people who are taking uric acid-lowering drugs,
colchicines, or an NSAID is temporarily prescribed. If an attack occurs while
taking a medication to lower the uric acid, this medicine should NOT be stopped.
Side effects of medicine
Not all patients will develop side effects from gout
medications. How often any side effect occurs varies from patient to patient.
The occurrence of side effects depends on the dose, type of medication,
concurrent illnesses, or other medicines the patient may be taking.
Some side effects are more serious than others. If any
rash or itching develops while taking allopurinol, the medicine should be
stopped immediately and your physician notified.
Can gout be treated through diet?
Dietary changes for most people do not play a major
role in controlling their uric acid levels. However, limiting certain foods that
cause an increased production of uric acid and reducing alcohol intake are often helpful.
National Institute of Arthritis and Musculoskeletal
and Skin Diseases. Health Information: Gout: Questions and Answers about Gout.
www.niams.nih.gov Accessed 1/5/11
Arthritis Foundation. Disease Center: Gout
www.arthritis.org Accessed 1/5/11
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/10/2010...#4755