Gout

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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 morning hours
  • 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 develop gout.

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 of gout.

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 genetic disorders.

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

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.

References:

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

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