Gout

Definition

Gout is inflammation in and around joints due to uric acid crystals.

Causes

Uric acid comes from the break down of purine from food or human cells. Sometimes the body makes too much uric acid. It may also have problems passing uric acid out of the body through the kidneys. Uric acid crystals form when uric acid levels get too high. This leads to gout.

Risk Factors

Gout is more common in men and older adults. But it can happen in men and women at any age.

Other risk factors are:

• Certain medications, such as:
  • Low-dose aspirin
  • Diuretics
  • Cyclosporin, an antirejection drug
  • Chemotherapy drugs used to treat cancer
• Kidney disease
• Obesity, sudden weight gain, or rapid weight loss
• High blood pressure
• High cholesterol
• Congestive heart failure
• Obstructive sleep apnea
• Anemia
• Psoriasis
• Sickle cell anemia
• Certain types of cancer
• Exposure to lead

Certain foods and drinks may also raise your chances of gout.

• Foods high in purines, such as red meat and seafood
• High-fructose drinks, such as sugar-sweetened sodas and orange juice
• Excess alcohol

Symptoms

Acute Gout

Here are some symptoms:

• Sudden pain in a joint, usually starting in the big toe
• Joints that are red, hot, swollen, and tender

Gout of the Big Toe

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Recurrent Gout

Most people with gout have more than one attack. This attack may be on many joints. Chalky deposits of uric acid called tophi can form. They often form in the elbows and earlobes, but may form in any part of the body.

Diagnosis

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

Your blood and urine may be tested.

Pictures may be taken of your body. This can be done with:

• X-ray
• Ultrasound
• CT scan

Treatment

Treatment depends on whether the gout is acute or recurrent.

Acute Gout

In general, the sooner you get medical help for an acute attack, the better. Treatment depends on:

• The number of joints with gout
• Previous responses to treatment
• Your 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 by mouth or as an injection into the joint
• Colchicine

Recurrent Gout

General Measures

If you get gout more than once, you may be advised to treat it with:

• A low purine diet
• Alcohol avoidance
• Gradual weight loss in those who are overweight
• Stopping or changing medicines that may be causing it
• Drinking more fluids

Medications

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

• Lower the uric acid your body makes
• Raise the amount of uric acid expelled by the kidneys
• Convert uric acid into a byproduct

Prevention

To lower your chance of getting gout:

• Eat a low-purine diet.
• Lose weight slowly over time.