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Gout

What is GOUT?

Gout is a form of inflammatory arthritis that causes sudden, severe pain, swelling and tenderness - most often in the large joint of the big toe. However, gout isn’t limited to the big toe; it can affect other joints including the feet, ankles, knees, hands, wrists, elbows and sometimes soft tissue and tendons. It usually affects only one joint at a time, but it can become chronic and, over time, affect several joints.

A gout attack can last anywhere from a few days to two weeks, if untreated. Prompt medical attention can usually resolve gout symptoms within a few hours or a couple of days. Some people never experience a second gout attack; others enjoy a long period with no gout symptoms only to have gout reappear just as suddenly as it struck the first time. For a more in-depth look at gout, read All About Gout.

An estimated 6.1 million Americans have experienced at least one gout attack. The disease most commonly affects men and can manifest anywhere from age 30 onward. Women get gout too, although they are at a slightly lower risk, and it usually appears after menopause. To learn more, read Women Get Gout, Too.

For centuries, people believed gout was caused by eating rich foods and drinking too much. Today we know that although diet and excessive drinking aren’t the true causes of gout, they do play a role in triggering a gout attack. Certain foods high in purines such as seafood and organ meats, along with alcohol - especially beer - can raise uric acid levels and trigger a gout attack. In fact many people report a first attack after a night of heavy drinking. Take a more detailed look at foods’ purine content

Medications may also be to blame. Diuretics, or “water pills,” which are frequently used to lower blood pressure, boost urine production, but they may also lower the kidneys’ ability to remove uric acid. That, in turn, can raise uric acid levels in the blood and cause a gout attack. Gout caused by diuretics can be “cured” simply by adjusting the dosage. Gout attacks also can be triggered by conditions such as injuries and infections. Get for a list of potential gout triggers.

What causes it?

Gout results from a condition called hyperuricemia, which simply means you have a high level of uric acid in the blood. Uric acid forms when the body breaks down waste products called purines. Some people’s bodies produce too much uric acid; other people’s kidneys can’t eliminate it quickly enough.

A gout attack occurs when uric acid that isn’t eliminated from the body forms crystals in the fluid that lubricates joint linings, causing painful joint swelling and inflammation. If gout is left untreated, these crystals can form tophi - lumps in the affected joints or surrounding tissues.

What are the symptoms/effects?

A doctor who has experience with gout attacks may be able to recognize this type of inflammatory arthritis simply by evaluating signs and symptoms, such as:

  • how quickly the attack came on
  • the severity of the inflammation and pain
  • which joints are involved
  • the number of joints affected
  • your medical history, including medications you’re taking
  • your eating and drinking habits
  • the level of uric acid in your blood, as determined by a lab test
  • Gout attacks usually occur at night. You may go to bed feeling fine and wake up with one or all of the following in and around the affected joint:
  • sudden, severe pain and swelling
  • shiny red or purple skin
  • extreme tenderness

How is it diagnosed?

The only way for your doctor to make a definite diagnosis of gout is to examine synovial fluid - a lubricating liquid found inside your joints - under a microscope. The presence of uric acid crystals signifies gout. Blood tests can determine if your uric acid levels are elevated, but not everyone with a high level of uric acid develops gout.

What are the treatment options?

Although gout is incurable, it can be controlled - and you can get on with living your life. Once your doctor has confirmed a gout diagnosis, you’ll work together to come up with a treatment plan likely involving both medication and lifestyle changes.

The first objective will be to relieve the pain and inflammation of the current gout attack. Once the gout attack is under control, which can take a few hours or a couple of days, you and your doctor will focus on managing the disease long-term.Your efforts will center on preventing future attacks, avoiding the long-term damage to your joints and chronic pain associated with uncontrolled gout and preventing the formation of tophi, lumps of crystallized uric acid that can form in the affected joints or surrounding tissues.

In addition to medications for gout and lifestyle changes, a viable treatment plan will require you to make certain changes in your diet and activity level. For example, eating a lot of certain foods high in purines can cause uric acid levels to rise. Read a discussion of Safe Foods for Gout.

Staying hydrated is equally important - you’ll need to drink plenty of water and perhaps a glass or two of milk.

Because obesity is linked to high uric acid levels, shedding excess weight can help reduce risk of a future gout attack. Be sure to take the pounds off slowly, however. You’ll want to avoid fad diets or fasting, which also have been linked to gout.

Finally, educating yourself about gout is one of the best steps you can take. Remember, you are your best advocate - become knowledgeable on the disease, stay abreast of information on new treatments and maintain an open line of communication with everyone on your health-care team.

Who is at risk?/How can I prevent it?

Gout affects an estimated 2.1 million Americans. Men in their 40s and 50s are most likely to develop gout. But by age 60, gout affects men and women roughly equally. After age 80 more women than men have gout.

High uric acid levels (hyperuricemia), which can lead to gout, occur for one of two reasons: the body produces too much uric acid or the body is not efficient at excreting uric acid in the urine. For more than 90 percent of people with gout, the cause is the latter. There are certain inborn errors of metabolism that can cause hyperuricemia, but these genetic disorders account for a very small fraction of people with gout.

  • Avoid foods high in purines, such as organ meats, anchovies, shellfish, bacon and gravies, and increasing intake of dairy foods
  • Avoid alcohol, which increases the production of urate and impairs excretion
  • Lose weight to reduce blood urate levels
  • Avoid medications that contribute to hyperuricemia, including diuretics
  • With appropriate treatment, gout is one of the most controllable forms of arthritis