Gout – Causes, Symptoms, Diagnosis, And Treatment
What is gout?
Gout is a type of inflammatory arthritis that develops in people with high levels of uric acid in the blood. This condition occurs when uric acid builds up in blood and causes inflammation in the joints. Recurrent attacks of gout results in red, tender, hot, and swollen joints. Pain starts quickly in less than twelve hours. Mostly, the joint at the base of the big toe is affected, but it can affect any joint.
Acute gout is a painful condition that often affects only one joint, but more than one joint may be affected. Chronic gout is the repeated attacks of pain and inflammation.
What causes gout?
Gout is caused by having a higher-than-normal level of uric acid in your body. This condition occurs if your body produces more uric acid or your body has a hard time getting rid of uric acid. Uric acid crystals form when uric acid builds up in the fluid around the joints (synovial fluid). These crystals cause the joint to become inflamed, causing pain, swelling, and warmth.
Gout may occur after taking medicines that interfere with the removal of uric acid from the body. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have a higher level of uric acid in the blood.
Gout may run in families. The problem is more common in men, in women after menopause, and people who drink alcohol. As people become older, gout becomes more common.
Gout may also develop in people with:
- Kidney disease
- Sickle cell anemia and other anemias
- Leukemia and other blood cancers
What are the symptoms of gout?
The initial symptom of gout is sudden onset of pain in a joint, which can become red, hot, stiff, and swollen. The joint may look as if it has a boil on it or the skin can become shiny and peeling.
The following are the symptoms of gout:
- Only one or a few joints are affected. The big toe, knee, or ankle joints are most often affected.
- The pain starts suddenly, often during the night. Pain is often severe, described as throbbing, crushing, or excruciating.
- The joint appears warm and red. It is usually very tender and swollen (it hurts to put a sheet or blanket over it).
- There may be a fever.
- The attack may go away in a few days but may return from time to time. Additional attacks often last longer.
Chronic gout, also called gouty arthritis, can lead to joint damage and loss of motion in the joints. People with chronic gout will have joint pain and other symptoms most of the time.
Deposits of uric acid can form lumps below the skin around joints or other places such as the elbows, fingertips, and ears. The lump is called a tophus, from Latin, meaning a type of stone. Tophi (multiple lumps) can develop after a person has had gout for many years. These lumps may drain chalky material.
How is gout diagnosed?
The following tests may be done for diagnosis of gout:
- Synovial fluid analysis (shows uric acid crystals)
- Uric acid — blood
- Joint x-rays (may be normal)
- Synovial biopsy
- Uric acid — urine
How is gout treated?
Taking treatment for gout as soon as possible is important if you have a sudden attack. Initially, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin. The doctor may increase the dose for a few days.
Your doctor may prescribe the following medications:
- Colchicine to help reduce pain, swelling, and inflammation.
- Corticosteroids (such as prednisone) are also very effective. Your doctor may inject the inflamed joint with steroids to relieve the pain.
The pain normally goes away within 12 hours of starting treatment. Most of the time, all pain is gone within 48 hours.
Your doctor may prescribe other medicines if you have several attacks during the same year or your attacks are quite severe resulting in damage to joints, tophi, or kidney disease or kidney stones.
The doctor may prescribe one of the following medicines to decrease the uric acid level in your blood:
- allopurinol (Zyloprim)
- febuxostat (Uloric)
- probenecid (Benemid)
The following diet and lifestyle changes may help prevent gouty attacks:
- Decreasing alcohol, especially beer (some wine may be helpful).
- Losing weight.
- Exercising daily.
- Limiting your intake of red meat and sugary beverages.
- Choosing healthy foods, such as dairy products, vegetables, nuts, legumes, fruits (less sugary ones), and whole grains.
- Drinking coffee and taking vitamin C supplements (can help some people).
This feature is for informational purposes only and is not intended to substitute the expert guidance of a doctor. We advise seeing a doctor if you have any health concerns.