Gout

Definition

Gout occurs when uric acid crystals build up in the joints. This causes the joints to be inflamed, causing pain.

Causes

Gout typically occurs if you have high levels of uric acid in your blood. A high level of uric acid in the blood is called hyperuricemia. However, you could also have normal uric levels and still have gout.

The uric acid can then form crystals in the joints causing the pain and inflammation.

The liver metabolizes uric acid, and the kidneys get rid of it through the urine. Levels of uric acid build up when:

• Too much uric acid is produced
• Not enough uric acid is eliminated

If you have gout and hyperuricemia, your body doesn't eliminate enough uric acid.

Risk Factors

Gout is more common in men over the age of 30 years, but gout can occur in men and women at any age. Other factors that may increase your risk of gout include:

• Obesity, sudden weight gain, or rapid weight loss
• Family members with history of gout
• Kidney disease
• Diabetes mellitus
• High blood pressure
• Certain types of cancer
• Certain medications, such as:
  • Low-dose aspirin
  • Diuretics
  • Cyclosporin, an antirejection drug
  • Chemotherapy drugs used to treat cancer

Certain foods and beverages may also increase your chances of gout.

• Foods high in purines, such as organ meats, shellfish, some vegetables, and gravies
• High-fructose drinks, such as sugar-sweetened sodas and orange juice
• Excess alcohol, especially beer

Symptoms

Acute Gout

Symptoms may include:

• Sudden onset of severe pain in an inflamed joint, usually starting in the big toe
• Joints that are red, hot, swollen, and tender
• Increased pain 24-48 hours after the onset of symptoms

Gout of the Big Toe

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Recurrent Gout

Most people with gout have another attack. This attack may affect many different joints. With recurrent gout, tophi can form. Tophi are chalky deposits of uric acid that most commonly occur in the elbows and earlobes, but may form anywhere

Gout can also lead to other health problems, such as:

• Kidney stones
• Kidney disease
• Joint destruction

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. A sample of fluid from the affected joint will be taken. This fluid will be tested for uric acid crystals.

Your bodily fluids may be tested. This can be done with:

• A sample of fluid taken from the affected joint
• Blood tests
• Urine tests

Images may be taken of your bodily structures. This can be done with:

• X-ray
• CT scan
• Ultrasound
• MRI scan

Treatment

Treatment depends on whether the gout is acute or recurrent.

Acute Gout

In general, the sooner treatment begins for an acute attack, the more effective it is. Treatment depends on:

• The number of joints affected
• Previous responses to treatment
• Overall health

General Measures

Putting an ice pack on the joint may ease the pain. Keeping the weight of clothes or bed covers off the joint can also help.

Medications

Medications may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids—may be given orally or as an injection into the affected joint
• Colchicine

Recurrent Gout

General Measures

General measures used to treat recurrent gout include:

• A low purine diet
• Alcohol avoidance
• Gradual weight loss in those who are obese
• Stopping or changing medications that may be causing recurrent gout
• Increasing fluid intake

Medications

If you have recurrent gout, or you have kidney stones, tophi, or reduced kidney function, you may be given medications to:

• Lower the production of uric acid
• Increase the excretion of uric acid by the kidneys
• Convert uric acid into a different byproduct

Prevention

To help reduce your chance of getting gout:

• Eat a low-purine diet.
• Limit how much alcohol you drink. Avoid binge drinking.
• Drink a lot of fluids.
• Lose weight gradually.