Gout

What Is Gout?

Gout is a disease that causes sudden, severe episodes of pain, tenderness, redness, warmth and swelling (inflammation) in some joints. It usually affects one joint at a time – often the large joint of the big toe. It also can affect other joints, such as the knee, ankle, foot, hand, wrist and elbow. In rare cases, it may later affect the shoulders, hips or spine. Gout usually does not "spread" from joint to joint. If you have gout in one joint, you will not necessarily get it in another.

Gout generally occurs in three phases:

1. Sudden joint pain and swelling that usually goes away after 5 to 10 days. 2. A period of no symptoms at all, followed by other acute episodes. 3. After a number of years, if left untreated, persistent swelling, stiffness and mild to moderate pain in one or more joints can occur after numerous acute episodes.

Gout can affect individuals differently. Some people have one episode and never have any other problems. Other people have several episodes along with lasting joint pain and damage.

Gout affects approximately 2.1 million Americans. It can occur at any age, but typically affects men between 40 and 50.

There is no cure for gout, but it can be controlled very well with medication. Proper treatment can help you entirely avoid episodes and long-term joint damage.

Acute Episodes

Gout episodes usually develop very quickly. The first one often occurs at night. You may go to bed feeling fine, but then wake up in the middle of the night with extreme joint pain.

During an episode you may notice:

 sudden, severe joint pain and swelling  shiny red or purple skin around the joint  extreme tenderness in the joint area

At first, gout episodes are usually few and far between. They last only a week or so, then disappear completely. If the disease is not controlled by medication, episodes may occur more frequently and may last longer. Repeated gout episodes can damage the affected joint(s). If your joints have been damaged, you may experience stiffness and limited motion after an episode.

An episode of gout can be triggered by:

 drinking too much alcohol  eating too much of certain foods  surgery  sudden, severe illness  crash diets  joint injury  chemotherapy Gout-related pain and swelling are caused by uric acid crystals that are deposited in the joint. Uric acid is a substance that normally forms when the body breaks down waste products called purines. Uric acid is usually dissolved in the blood and passes through the kidneys into the urine. In people with gout, however, the uric acid level in the blood is so high that uric acid crystals are deposited in joints and other tissues. This causes inflammation of the joint lining (synovium).

Development of Tophi

After several years, uric acid crystals can build up in the joint(s) and surrounding tissues. They form large deposits called tophi (TOE-fy) that look like lumps just beneath the skin. Tophi are often found in or near severely affected joints, on or near the elbow, over the fingers and toes, and on the outer edge of the ear. If the tophi are not treated, they can damage joints.

Other Problems

Uric acid crystals can form stones in the kidneys, in the ureters (tubes that connect the kidneys and bladder), or in the bladder itself. Several factors may cause these deposits to form. The deposits may occur when you don’t drink enough liquids, which prevents the urine from dissolving all the uric acid. They may also form as a result of metabolic abnormalities, such as the body’s inability to make urine less acidic.

In other cases, a diet rich in foods that further increase the amount of uric acid produced by the body may increase the chances of developing kidney stones. If your doctor suspects that diet is a contributing factor, you may be asked to collect several urine samples. Tests will determine the amount of uric acid your body produces. These tests are particularly helpful because some people with gout produce and eliminate a large amount of uric acid, and may be more likely to develop kidney stones.

Gout is a disease that may be associated with high blood pressure or kidney infections. Because these problems can cause kidney damage, your doctor will check for complications and treat them if they occur.

Diagnosis

To diagnose gout, your doctor will examine you and ask you to describe your symptoms. Your doctor may take a blood test to measure the amount of uric acid in your blood. A high level of uric acid in your blood, however, does not necessarily mean you have gout, nor does a normal level mean you do not have it.

Your doctor may check for other arthritis-related conditions, such as pseudogout or infectious arthritis. These conditions resemble gout but are not caused by uric acid crystals. To determine which condition you might have, your doctor may have to remove fluid from an affected joint and examine it for crystals.

Treatment

Gout treatment mainly consists of taking medication(s) and watching your diet. The goals of treatment are to relieve pain, shorten the duration of inflammation during an acute episode, prevent future episodes and prevent joint damage. Treatment must be tailored for each person and may have to be changed from time to time.

Medications are used to:  relieve the pain and swelling of an acute episode  prevent future episodes  prevent or treat tophi  prevent uric acid kidney stones.

Gout medications are powerful, so you need to understand why you are taking them, what side effects may occur, and what to do if you have any problems.

In addition, dietary adjustments often are recommended for people with gout. Because obesity can be linked to high uric acid levels in the blood, doctors often recommend special diets to help people with gout lose or control their weight. But fasting or trying to diet too severely can raise uric acid levels and make the gout worse.

Most people with gout are able to eat what they like, within limits. Those with kidney stones due to uric acid may need to avoid or limit foods that raise your uric acid level, such as sardines, anchovies, broths, gravies, brains, kidneys, liver and sweetbreads. People with gout can drink coffee and tea, but may need to limit alcohol intake. To help flush uric acid crystals from their bodies, people with gout should drink at least 10 to 12 eight-ounce glasses of non-alcoholic fluid each day.

The Arthritis Foundation acknowledges with appreciation Louis A. Healey Jr., MD, The Mason Clinic, Seattle, Wash., and Herbert S. Diamond, MD, Western Pennsylvania Hospital, Pittsburgh, Pa., for their assistance with this booklet.