Description

Gout is a common and complex form of arthritis that can affect anyone. It is characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on which it may seem intolerable.

Gout symptoms may come and go, but there are ways to control the symptoms and prevent flares.

Symptoms

The signs and symptoms of gout almost always occur suddenly, and often at night. They include:

  • Intense pain in the joints. Gout usually affects the big toe, but can occur in any joint. Others are affected joints include the ankles, knees, elbows, wrists and fingers. The pain is most severe within the first four to 12 hours after it begins.
  • The persistent discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. After the attacks is likely to last longer and affect more joints.
  • The swelling and redness. The affected joint or joints become swollen, tender, warm and red.
  • Limited range of motion. As gout progresses, you may not be able to move your joints normally.

When to see a doctor

If you experience sudden, severe pain in the joints, call your doctor. The drop that is not treated can lead to a worsening of the pain and the damage to the joints. Seek medical attention right away if you have fever and a joint is hot and inflamed, that may be a sign of infection.

Causes

Gout occurs when urate crystals accumulate in the joints, causing inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in the blood. Your body produces uric acid when it breaks down purines-substances that are found naturally in the body.

Purines are also found in certain foods, including red meats and organ meats, like liver. Purine-rich seafood including anchovies, sardines, mussels, scallops, trout, and tuna. Alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose) to promote higher levels of uric acid.

Normally, uric acid dissolves in the blood and passed through the kidneys into the urine. But sometimes the body produces too much uric acid or the kidneys excrete too little uric acid. When this happens, uric acid build up, forming sharp, needlelike urate crystals in the joints or surrounding tissue that cause pain, inflammation and swelling.

Risk factors

You are more likely to develop gout if you have high levels of uric acid in your body. The factors that increase the level of uric acid in the body include:

  • Of the diet. Eating a diet rich in red meat and seafood, and drinks sweetened with fruit sugar (fructose) to increase the levels of uric acid, which increase the risk of gout. The consumption of Alcohol, especially beer, increases the risk of gout.
  • Weight. If you are overweight, your body produces more uric acid and the kidneys have more difficulties in the elimination of uric acid.
  • Medical conditions. Certain diseases and conditions that increase the risk of gout. These include, without treating high blood pressure and chronic diseases, such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases.
  • Certain medications. Low-dose aspirin and some medications used to control high blood pressure — including thiazide diuretics, angiotensin-converting enzyme inhibitors (acei) and beta — blockers can also increase the levels of uric acid. So may the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
  • The family history of gout. If other members of your family have had gout, you're more likely to develop the disease.
  • The age and the sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women, uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50, while women tend to develop signs and symptoms after menopause.
  • A recent surgery, or trauma. Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, receiving a vaccination can trigger a gout flare.

Complications

People with gout may develop more severe conditions, such as:

  • Recurrent gout. Some people may never experience gout signs and symptoms again. Others may experience the drop several times each year. Medicines can help prevent gout attacks in people with recurrence of the disease of gout. If left untreated, gout can cause erosion and destruction of the joints.
  • Advanced gout. Untreated gout can cause deposits of urate crystals that form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas, such as fingers, hands, feet, elbows or Achilles tendons along the back of the ankles. Tophi are usually not painful, but they can become swollen and tender during gout attacks.
  • Stones in the kidney. Urate crystals can collect in the urinary tract of people with gout, cause kidney stones. Medications can help reduce the risk of kidney stones.

Diagnosis

Doctors usually diagnose gout based on your symptoms and the appearance of the affected joint. Tests to help diagnose gout may include:

  • The joint fluid test. Your doctor may use a needle to remove fluid from the affected joint. Urate crystals may be visible when the fluid is examined under a microscope.
  • Blood test. Your doctor may recommend a blood test to measure the levels of uric acid in the blood. Blood test results can be misleading, however. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but not out of the normal levels of uric acid in the blood.
  • The images of x-rays. x-rays of the joint may be useful to rule out other causes of inflammation of the joints.
  • Ultrasound. This test uses sound waves to detect urate crystals in the joints, or tophi.
  • Dual-energy computed tomography (DECT). This test combines X-ray images taken from different angles to view the urate crystals in the joints.

Treatment

Gout medications are available in two types and are focused on two different kinds of problems. The first type helps to reduce the inflammation and pain associated with gout attacks. The second type works to prevent gout complications by reducing the amount of uric acid in the blood.

Which type of medication is right for you depends on the frequency and severity of symptoms, along with any other health problem you may have.

Medications to treat gout attacks

The medications used to treat gout flares and prevent future attacks include:

  • Nonsteroidal anti-inflammatory drugs (Nsaids). Nsaids include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as the most powerful prescription Nsaids, such as indomethacin (Indocin, Tivorbex), or celecoxib (Celebrex). Nsaids can lead to risks of stomach pain, bleeding and ulcers.
  • Colchicine. Your doctor may recommend colchicine (Colcrys, Gloperba, Mitigare), a nonsteroidal anti-inflammatory drug that effectively reduces the pain of the gout. The efficacy of the drug may be offset, however, by side effects, such as nausea, vomiting, and diarrhea.
  • Corticosteroids. Corticosteroids, such as prednisone may control gout inflammation and pain. Corticosteroids may be in pill form, or they can be injected into your joint. Side effects of corticosteroids can include mood changes, increased levels of blood sugar and high blood pressure.

Medications to prevent complications of gout

If you experience several attacks of gout of each year, or if your gout attacks are less common, but particularly painful, your doctor may recommend a medication to reduce the risk of gout-related complications. If you already have the evidence of the damage of the drop in x-rays of the joint, or you have tophi, chronic kidney disease or kidney stones, medicines to lower the body's level of uric acid may be recommended.

  • Drugs that block the production of uric acid. Drugs such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) to help limit the amount of uric acid that is produced in the body. Side effects of allopurinol include fever, rash, hepatitis, and kidney problems. Febuxostat side effects include rash, nausea, and reduction of the function of the liver. Febuxostat may also increase the risk of heart disease-related death.
  • Drugs that enhance the elimination of uric acid. Medications such as probenecid (Probalan) help to improve your kidney's ability to remove uric acid from your body. The side effects include a rash, stomach pain and kidney stones.

Lifestyle and home remedies

Medications are often the most effective way to treat gout attacks and prevent the recurrence of symptoms flares. However, the lifestyle choices are also important, and it is possible that you want:

  • Choose healthier drinks. Limit alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, drink plenty of non-alcoholic beverages, especially water.
  • Avoid foods high in purines. Red meat and organ meats, such as liver, are especially high in purines. Purine-rich seafood including anchovies, sardines, mussels, scallops, trout, and tuna. Low-fat dairy products can be a better source of protein for people prone to gout.
  • Exercise regularly and lose weight. Keep your body at a healthy weight reduces the risk of gout. Choose low-impact activities such as walking, biking, and swimming, which are easier on your joints.

Preparing for your appointment

Make an appointment with your doctor if you have symptoms that are common to the drop. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammation of joints (rheumatologist).

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

  • Write down your symptoms, including when they started and how often they occur.
  • Important note to the personal information, such as recent changes or of the main stress factors in your life.
  • Make a list of your key medical information, including any other condition you are being treated, and the names of the medications, vitamins, or supplements you are taking. Your doctor will also want to know if you have a family history of gout.
  • Have a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Questions to ask the doctor at the first appointment are:

  • What are the possible causes of the symptoms or condition?
  • What tests do you recommend?
  • There are treatments or lifestyle changes that could help my symptoms?
  • You should see a specialist?

Questions to ask if you are referred to a rheumatologist include:

  • What are the possible side effects of the medications you are prescribing?
  • How soon after the start of treatment should say to my symptoms start to improve?
  • Do I need to take long-term medications?
  • I have these other health conditions. How can I best manage them together?
  • You recommended changes in my diet?
  • It is safe for me to drink alcohol?
  • There are brochures or web sites that you would recommend for me to learn more about my condition?

If any of the additional questions that occur during their medical appointments, don't hesitate to ask.

What to expect from your doctor

Your doctor may ask you a series of questions. Be ready to answer them may reserve time to go over any points you want to talk in-depth. Your doctor may ask:

  • What are your symptoms?
  • When was the first experience these symptoms?
  • Do your symptoms come and go? What's the frequency?
  • Is there anything in particular seem to trigger your symptoms, such as certain foods, or physical or emotional stress?
  • Are you being treated for any other medical condition?
  • What medications are you currently taking, including over-the-counter and prescription medications, as well as vitamins and supplements?
  • Do any of your first-degree relatives — such as a father or a brother — has a history of gout?
  • What do you eat in a typical day?
  • Do you drink alcohol? If so, how much and with what frequency?
Symptoms and treatment of Gout