Gout is a form of arthritis that most often affects the joint at the base of the big toe. In most cases, a gout attack occurs suddenly, causing severe pain in the affected joint. If not treated, gout can cause long-term damage to the joints, tendons, and surrounding tissues.
Definition & Facts
It is estimated that 8.3 Americans live with acute or chronic gout. The condition is most likely to affect men between the ages of 40 and 50; however, the risk for women does increase after menopause. An individual is more susceptible to developing gout if he or she has certain health conditions, including diabetes, obesity, high blood pressure, or impaired kidney function.
It is also common for individuals with gout to have a family history of the condition. Diet also plays a significant role in the development of gout. People who consume high amounts of alcohol, red meats, seafood, and fructose, are more likely to experience episodes of gout.
Symptoms & Complaints
- Joint pain, joint swelling, and heat on the joint. The pain often starts suddenly in the middle of the night and can even awaken a person from sleep. The toe may be so tender that even the weight of the sheet causes significant pain.
- The skin around the affected joint may be red or even purple in color, similar to an infection.
- It may be difficult to move the affected joint.
- Once gout starts to resolve, the skin around the joint may start to itch and peel.
- Some individuals with gout develop nodules, called tophi, on the ears, elbows, and hands. These nodules are the result of urate crystals that form beneath the skin.
People who experience a gout attack are likely to experience repeat episodes. In fact, nearly 80 percent of individuals suffering a first gout attack have a second episode within two years.
Gout is the result of a buildup of uric acid in the blood, also called hyperuricemia. Normally, uric acid is excreted by the kidneys. Individuals with gout either produce too much uric acid, or their kidneys do not effectively excrete the uric acid. While the exact reason for excess uric acid in unclear, it does appear that genetics may be a factor.
It is not uncommon for individuals to have elevated uric acid levels for years before ever having a gout attack. Gout pain occurs when the uric acid forms crystals that deposit in the joints. Certain factors may trigger a gout attack in susceptible individuals, including:
- Being overweight.
- Eating a diet rich in high-purine foods, such as meat, seafood, certain green and cruciferous vegetables, dried peas and beans, and mushrooms.
- Excess alcohol consumption, especially red wine and beer.
- Regular use of medications that increase uric acid levels or decrease the amount of water and salt in the body. These include diuretics, aspirin, and niacin.
- Rapid weight loss.
- Health conditions such as high blood pressure or diabetes.
In rare cases, an individual may be born with a condition resulting in a deficiency of the enzyme that helps regulate uric acid levels.
Diagnosis & Tests
Anyone experiencing sudden joint pain or swollen, red, tender joints should see a doctor even if the symptoms resolve on their own. Even after the pain of acute gout has gone away, the excess uric acid can still cause joint irritation and damage. The first step in diagnosing gout is a physical examination, which will typically reveal the tell-tale redness and inflammation around the base of the big toe.
This may be followed by blood tests to check for elevated uric acid levels in the blood. A urinalysis can also be used to measure uric acid concentrations in the urine. The most definitive diagnosis is through an arthrocentesis. This procedure involves using a needle to obtain a sample of joint fluid to check for the presence of uric acid crystals. X-rays may be useful in identifying joint damage caused by long-term gout or to rule out other forms of arthritis or causes of joint pain.
Treatment & Therapy
The goal of gout treatment is to reduce the acute pain and inflammation and prevent future attacks and complications, including joint damage and kidney damage. For an acute attack, the doctor will typically recommend that the patient rest the affected joint and use ice to reduce swelling.
Short-term medications may be beneficial if prescribed in the early stages of a gout attack. This typically includes nonsteroidal anti-inflammatory drugs (NSAID's), oral corticosteroids, and colchicine to reduce inflammation and pain. If an individual experiences repeated episodes of gout or chronic gout, the doctor may prescribe long-term medications. This regimen is designed to lessen the likelihood of repeated attacks. Long-term gout medications may include:
- Uricosuric agents that help lower serum uric acid levels.
- Xanthine oxidase inhibitors, such as allopurinol or febuxostat, that inhibit the action of an enzyme involved in purine metabolism and reduce the production of uric acid. These drugs can also help lessen the size of gout-related tophi.
- Pegloticase, which helps turn uric acid into a harmless substance that can be excreted through urine.
- Daily colchicine as a prophylactic measure to prevent future gout attacks.
In very rare instances, a patient may require surgery to remove large tophi that do not respond to xanthine oxidase inhibitors. Alternative therapies, such as meditation, deep breathing, and relaxation techniques may help individuals cope until the pain and other symptoms resolve.
Prevention & Prophylaxis
Lifestyle and dietary changes may help to prevent future gout attacks, including:
- Staying well hydrated, drinking plenty of water
- Limiting intake of drinks sweetened with fructose.
- Avoiding alcohol.
- Limiting intake of meat, seafood, and high-purine foods.
- Obtaining protein from low-fat dairy products.
- Losing weight.
Certain foods may also help lower uric acid levels. This includes coffee, cherries, and fruits high in vitamin C. Herbs and supplements, such as devil’s claw, eicosapentaenoic acid, and folic acid may help reduce uric acid levels and inflammation; however, more studies are needed to determine their efficacy in treating gout.