Gout

What is gout?

Gout is a disease usually caused by having too much uric acid in your body. The uric acid may not cause symptoms for years, but after a time too much of it can cause painful joint inflammation (arthritis). It most often first affects the joint between the foot and the big toe. Later attacks often affect other joints of the foot and leg. Less often, the arms and hands have gout.

In addition to the arthritis, gout causes tophi. Tophi are lumps of uric acid crystals just under the skin. Common places to have tophi are the outer edge of the ear, on or near the elbow, the fingers and toes, and around the Achilles tendon near the ankle.

Gout can also cause kidney stones made of uric acid.

Most people who have gout are middle-aged men, but it can occur at any age. It usually does not affect women. When it does, it happens most often after menopause.

How does it occur?

Gout usually occurs because too much uric acid is in your joints. Uric acid comes from the breakdown of substances called purines. Purines are found in all of your body’s tissues. They are also in many foods. Normally, uric acid dissolves in the blood and passes through the kidneys and out of the body in the urine. If the levels of uric acid build up in the blood, sharp uric acid crystals may form in the joints. The crystals cause pain and swelling.

Most cases of gout happen because your kidneys do not get rid of enough uric acid. The specific problem with the kidneys is usually never found.

Gout may also happen because your body is making too much uric acid. There are different reasons this may happen:

• You may have inherited a tendency to make too much uric acid.
• You may have a disease such as cancer or a red blood cell disorder.
• You may eat a lot of purine-rich foods, such as seafood and meat, especially red meat and organ meats.
• You may drink a lot of alcohol.

Some conditions, such as dehydration, can cause high levels of uric acid. Diuretic medicine (also called water pills), which is often used to treat high blood pressure, can increase levels of uric acid. Other medicines can also affect the level of uric acid in the blood.

Uric acid levels in men start to go up after puberty. Women’s uric acid levels usually do not go up until after menopause. For this reason women are protected from gout until several years after menopause. Usually the uric acid levels have to be high for many years before gout develops.

People who have recently had a serious illness or surgery have an increased chance of having an attack of gout. Some people have gouty arthritis even though they have normal uric acid levels.

What are the symptoms?

Some people have high uric acid blood levels for years and never have any symptoms. Only 10 to 20% of people with high levels of uric acid develop symptoms in their joints. Symptoms may include:

• sudden, severe pain, especially of just 1 joint at a time
• redness
• swelling.

Sudden attacks are sometimes related to physical illness, injury, or drinking too much alcohol. The symptoms may last for days to weeks. The symptoms of pain, redness, and swelling usually happen before tophi or kidney stones develop.

The tophi do not cause any symptoms unless they open and drain. They are often not painful. Depending on where they are on your body, they may limit movement of a joint.

The symptoms of uric acid stones are like those of other kidney stones. They can cause severe abdominal pain and sometimes nausea, vomiting, fever, or blood in the urine. Kidney stones can also cause blockage of urine flow, which can damage the kidneys if it is not treated.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and your family and personal medical history. He or she will examine you and ask about medicines you are taking, both prescription and nonprescription. Your healthcare provider will suspect that you have gout if:

• Your first toe joint is inflamed.
• You have a blood test that shows a high level of uric acid in your blood.
• You are developing tophi.
• You start taking the drug colchicine and your arthritis symptoms get better. (Colchicine, an anti-inflammatory drug, is effective only for gouty-type arthritis.)

To confirm the diagnosis, your provider may take a sample of fluid from the affected joint or joints and send it to the lab for tests. If you have uric acid crystals in the fluid, you have gout.

How is it treated?

Usually, if you have high uric acid levels but no symptoms, you will not need treatment. In special cases (for example, if you have a family history of gout or kidney stones), you may be treated for gout even though you do not have any symptoms.

If you have symptoms of gout, the goals of treatment are:

• Stop the pain.
• Try to keep the problem from coming back by controlling the uric acid levels.
• Prevent serious complications such as kidney damage.

Treatment of the arthritis first involves the use of anti-inflammatory medicines, such as:

• ibuprofen or naproxen
• corticosteroid drugs, such as prednisone
• colchicine.

Aspirin is not usually recommended because it may keep the urine from taking the uric acid out of the body.

Anti-inflammatory medicines are sometimes taken daily to prevent recurrent attacks of gouty arthritis. If the gouty arthritis becomes a frequent problem, allopurinol and probenecid may also be prescribed to prevent deposits of uric acid that could damage the joints.

A new medicine called febuxostat (Uloric) has been approved by the FDA to prevent gout. It works by preventing the formation of the uric acid crystals that cause the painful gouty arthritis. Uloric appears to have fewer serious side effects than allopurinol, the medicine usually prescribed to control uric acid levels in the blood.

How long will the effects last?

The sooner treatment is started, the sooner the symptoms stop. You may start feeling better 24 to 48 hours after you start treatment.

If gout is not treated, it could last a few days to several weeks.

You could have another attack, but usually not for at least 6 months to 2 years. It could be years before you have gout again or you may never have another attack.

How can I help prevent gout?

There is no sure way to prevent gout. However, you can take these steps to lessen the chance that you will have high uric acid levels:

• Eat a diet low in purines. Purine-containing foods that you should avoid include meat–especially red meat and organ meats such as sweetbreads, liver, and kidney–shrimp, anchovies, sardines, and dried legumes (beans).
• Do not drink a lot of alcohol. Do not drink more than 2 ounces of alcohol a day.
• Drink lots of fluids.