What Is Gout?
Gout is a systemic disorder (that is, one potentially affecting the entire body) marked by elevated blood levels of uric acid, one of the body’s waste products. This buildup in the blood can be caused by overproduction of uric acid, impaired excretion of it in the urine, or sometimes a combination of both. As it accumulates, uric acid may form crystals in the joints. Thus, gout is often first recognized by inflammation of a single joint. The immune system typically reacts to these crystals as if they were foreign invaders and releases substances that produce inflammation. The affected joint becomes swollen, red, warm, and severely painful. Often the first episode of gout affects the base of the big toe (this joint is eventually affected in 90% of patients).
Although symptoms gradually subside within a week, subsequent attacks are likely. These generally strike with no warning, occur with increasing frequency, and affect a number of joints, including the knees, elbows, wrists, and those of the hands and feet. Significantly elevated uric acid levels in the blood, if untreated, may result in kidney stones or deposition of uric acid in the kidneys, possibly causing kidney failure. About 90% of those affected with gout are adult men. In women, the disorder usually strikes after menopause.
Who Gets Gout?
According to the Centers for Disease Control and Prevention (CDC), gout affects approximately 3 million people in the United States each year. Overall, more than 6 million American adults have had gout during their lifetime. The condition is more common in men between the ages of 40 and 50, and in women, incidence increases after menopause. Gout is rare in children and young adults.
Sudden and severe pain in a joint, often the big toe. It can also affect the ankle or knee. Rarely, symptoms develop in two or three joints simultaneously.
Swelling and redness around the affected joint.
Fever (in some cases).
Kidney stone symptoms, which include intermittent pain, sometimes excruciating, beginning in the lower back and traveling to the groin; interruption of the urine stream; inability to urinate except in certain positions; and a frequent urge to urinate but with only small amounts of urine passed.
Genetic factors are often involved; one in four gout sufferers has a family history of the disorder.
A kidney malfunction may result in a buildup of uric acid and thus an attack of gout.
Low doses of aspirin, certain antibiotics, diuretics, and alcohol may raise uric acid levels.
Foods high in purines (like red meat, liver, anchovies, and sweetbreads) may raise uric acid levels.
Obesity and high blood pressure are risk factors, as are diabetes and sickle cell anemia.
Trauma and surgery may also be associated with an acute gout attack.
Chemotherapy may raise uric acid levels as it rapidly destroys cells.
To confirm the diagnosis, fluid from the affected joint will be removed and analyzed for the presence of uric acid crystals and to rule out an infection.
Blood samples will be taken and measured for uric acid levels. However, the blood uric acid level may be normal during a gouty attack. The reason for this is that during an acute attack, uric acid is released from the bloodstream and finds its way into the joint(s). An elevated uric acid level by itself does not establish the diagnosis of gout.
X-rays are taken to look for permanent joint damage in people with chronic gout.
The goal of treatment is to decrease the amount of uric acid in the joints, which helps to reduce symptoms and prevent further attacks. If left untreated, affected joints may be damaged, causing disability.
- NSAIDs (nonsteroidal anti-inflammatory drugs), such as naproxen and indomethacin, are the treatment of choice for gout.
However, these medications are contraindicated in some patients and should be discussed with a physician prior to initiation.
- A doctor may prescribe colchicine to relieve pain and decrease swelling during an acute episode. The drug is taken hourly until symptoms subside or side effects (nausea, vomiting, cramps, diarrhea) begin. Colchicine works best when started within minutes or hours of an attack. In patients without other medical conditions, to treat an acute gout flare, colchicine 1.2mg should be taken at the first sign of gout attack. An additional 0.6mg should be taken 1 hour later. Your physician may recommend additional doses for a few days after the flare subsides. In some patients, prophylactic colchicine can be taken daily to prevent a gout flare; dosing will be determined by your physician.
- Your doctor may prescribe more powerful analgesics, including codeine or meperidine, for rapid relief of severe pain.
- Corticosteroids may be administered in pill form, intravenously, or by direct injections into the joint.
- Bed rest may be necessary for about 24 hours after symptoms abate, since movement can induce inflammation and trigger another attack. Make a small “tent” of the bedding to keep it from touching the affected area.
- Diet and lifestyle changes play a key role in treating gout. The goal of treatment is to reduce blood levels of uric acid by avoiding uric acid-forming foods and beverages and to reduce inflammation through nutrition and supplements. Nutrition recommendations include:
- Achieve and maintain an ideal body weight.
- Eliminate or limit purine-containing foods. It’s especially important to avoid organ meats such as liver, sweetbreads, and kidney. Limit serving sizes of shellfish, brewers yeast (beer), bakers yeast (baked goods and bread), anchovies, sardines, herring, herring, and mackerel as well as beef and pork.
- Eat fresh, unrefined, and unprocessed foods. Include fruits, vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, and halibut).
- Eat unsweetened cherries (canned, fresh, or frozen). Cherries lower uric acid levels and can prevent gout attack. Blueberries, blackberries, and other deeply pigmented berries are also helpful.
- Drink plenty of water—at least 8 glasses daily.
There is no way to prevent gout, but after the first attack, the risk of recurrences can be minimized.
Daily doses of colchicine can reduce the frequency of episodes.
Control your weight, but do not fast; fasting may raise uric acid levels.
Avoid excessive alcohol consumption and foods high in purines, most especially organ meats.
Drink plenty of fluids (especially water).
If you take medications that can raise uric acid levels, talk to your doctor about changing them for medications that do not.
Several medications, including allopurinol (which blocks uric acid formation) and febuxostat—and also probenecid and sulfinpyrazone (which increase uric acid excretion in the urine)—reduce uric acid levels.
When To Call Your Doctor
Call a doctor if you experience any of the symptoms of gout.
Reviewed by Diane M. Horowitz, M.D., Rheumatologist, North Shore Long Island Jewish Health System, Great Neck, NY. Review provided by VeriMed Healthcare Network.