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?

In the initial period, gout attacks may occur rarely, such as once or few times every several years. Later these can becomes more frequent and may occur several times a year.

Gout attacks can recur from time to time in the same or different joints.

The initial attack may last up to one week, and at times up 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 erode into the bones.

Who is affected by gout?

Gout affects more than one million Americans, including:

  • Men of all ages (may start in young men) and postmenopausal women
  • People who are overweight
  • People who frequently drink alcohol
  • People whose diet is rich in organ meats, shellfish, and animal meats

When gout affects women, it is usually after menopause. Younger patients may be affected by gout if they have been taking certain medicines for long periods of time, are transplant patients, frequently drink alcoholic beverages, have chronic kidney disease, or have certain genetic disorders.

What causes gout?

Gout results from excessive amount of uric acid in the body that leads to an abnormal deposit of uric acid crystals (also known as monosodium urate crystals) in the joints and soft tissue. The collection of uric acid in the soft tissue leading to a lump is called tophus (tophi for multiple lumps). Uric acid crystals can also form in the kidney, causing kidney stones.

Monosodium 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). Alcohol and certain foods contain large amounts of uric acid, especially red meats and internal organs (such as liver and kidneys), some shellfish, and anchovies. However, most meats contain uric acid. Patients who eat more meat and fish (and less dairy) or drink more beer and liquor are more prone to gout. A family history of gout may be a risk factor for developing gout, but is not the case in all patients. Certain medications can increase the risk for gout, such as diuretics. Avoiding alcohol and consuming a diet low in animal meats and higher in vegetables and fruits has been shown to help reduce the level of uric acid in the blood and the likelihood of developing gout attacks. Insuring adequate hydration with water and maintaining normal kidney function is important.

Uric acid in low amounts remains dissolved in the blood, and would be less likely to lead to a gout attack. Uric acid in high amounts (higher than 6.8 mg/dL) can lead to crystals that could deposit in joints and make a person more likely to develop gout.

The level of uric acid in your blood can change depending on:

  • The kidney function (the lower the kidney function, the higher the urate levels)
  • What you eat
  • How much alcohol you drink
  • What medicines you are taking
  • How much water you drink (hydration)
  • Your weight and metabolic risk factors

The above mentioned are considered modifiable risk factors.

Not everyone with high levels of uric acid will develop gout. Having a strong family history of gout may increase one’s risk for gout, but this does not mean that everyone with a family history of gout 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.

What are the symptoms of gout?

  • Sudden, intense joint pain, which often first occurs in the early morning hours
  • Swollen, tender joint that is warm to the touch

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