Gout

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 at a time, but may affect a few or even many. 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 rarely affected.

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 2 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% of patients who have 1 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 1 million Americans, including:

  • Men (usually over age 40) and women after menopause.
  • People who are overweight.
  • People who frequently drink alcohol.

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.

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. Patients who eat more meat and fish (and less dairy) or drink more beer and liquor seem to be more prone to gout. But changing these habits may only partially reduce the likelihood of stopping gout attacks once they have started.

Uric acid in low amounts remains dissolved in the blood, passes through the kidneys and gastrointestinal system, and leaves the body as waste. Uric acid in high amounts (higher than 6.7 mg/dL) will settle out of the blood and 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 (the main cause of elevated levels).
  • Your weight.
  • 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 has 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.

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.