Gout

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from the Cleveland Clinic, Ohio. Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

Overview

What is gout?

Gout is a form of arthritis that causes sudden, severe attacks of pain, tenderness, redness, warmth, and swelling (inflammation) in some joints. It often affects one joint at a time but may affect a few or even many. The large toe is most often affected, but gout can also affect other joints in the leg (knee, ankle, foot) and less often in the arms (hand, wrist, and elbow). The spine is rarely affected.

How frequent are gout attacks?

Gout attacks can recur from time to time in the same or different joints. The initial attack may last several days to 2 weeks unless it is treated.

Over time, gout attacks may occur more often, involve more joints, have more severe symptoms, and last longer. Repeated attacks can damage the joint. Lumpy collections of uric acid called tophi can develop near joints, in the skin, or within bones.

Some people will only have a single attack. However, about 90% of patients who have 1 gout attack will have at least a second attack, although it may not occur for several years after the initial attack. Others may have attacks every few weeks.

Who is affected by gout?

Gout affects about 1 in 100 adults. Men are more commonly affected than women. A first attack of gout typically develops in middle age, but it sometimes occurs in younger people. It tends to run in some families, as there is a family history of gout in about 1 in 5 cases. It may be that the genetic makeup that you inherit from your family may be a factor in becoming an under-excreter of uric acid (urate).

Causes

What causes gout?

Gout was once incorrectly thought to be a disease of the rich and famous, caused only by eating too much rich food and drinking fine wines. Although diet and excessive drinking of alcohol can contribute to the development of gout, they are not the main cause of the disorder.

Gout results from abnormal deposits of sodium urate crystals around the joint cartilage and their later release into the joint fluid. Urate crystals can also form in the kidney, causing kidney stones.

Sodium urate is formed from uric acid, a natural chemical in the body. Uric acid comes from the natural breakdown of RNA and DNA (the genetic material in cells). Some foods contain large amounts of uric acid, especially red meats and internal organs (such as liver and kidneys), some shellfish, and anchovies.

Patients who eat more meat and fish (and less dairy) or drink more beer and liquor seem to be more prone to gout. But changing these habits may only partially reduce the likelihood of stopping gout attacks once they have started.

Uric acid in low amounts remains dissolved in the blood, passes through the kidneys and gastrointestinal system, and leaves the body as waste. Uric acid in high amounts will settle out of the blood and deposit in joints and make a person more likely to develop gout.

The amount of uric acid in your blood can change depending on:

• How efficiently your kidney gets rid of the uric acid in the blood (the main cause of elevated levels).
• Your weight.
• What and how much you eat.
• Your overall health.
• How much alcohol you drink.
• What medicines you are taking.
• Sudden illnesses.

Not everyone with high levels of uric acid will develop gout. The kidneys' ability to rid the body of uric acid is partly determined by heredity. Yet, just because someone in the family has gout does not mean everyone in that family will have the disorder. Often, the effect of heredity is modified by the risk factors mentioned above that affect uric acid, as well as male sex and age. All of these factors increase the risk of gout.

Symptoms

What are the symptoms of gout?

• Sudden, intense joint pain, which often first occurs in the early morning hours.
• Swollen, tender joint that's warm to the touch.
• Red or purple skin around the joint.

Treatment

How is gout treated?

There is no cure for gout, but it can be treated and controlled. Symptoms are often dramatically improved within 24 hours after treatment has begun. Attacks can be prevented with appropriate therapy to lower the blood uric acid level.

The goals of treatment are to:

• Relieve pain and inflammation.
• Prevent future gout attacks that could lead to permanent joint damage.

The type of treatment prescribed will depend on several factors, including the person's age, type of medicines he or she is taking, overall health, medical history, and severity of gout attacks.

Gout is mainly treated with medicine.

Medicines that treat gout attacks

Anti-inflammatory drugs: Anti-inflammatory drugs will reduce the pain and swelling of attacks. They are usually continued until the gout attack completely resolves. If side effects from the therapy occur, treatment may be changed to a different medication. Your healthcare provider will discuss the potential side effects with you. If you have kidney disease, heart failure, diabetes, ulcer disease or other chronic conditions, the choice of therapy to treat the gout is affected.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally prescribed to treat sudden and severe gout attacks. NSAIDs usually reduce inflammation and pain within hours.

Corticosteroids (also called steroids) may be prescribed for people who cannot take NSAIDs. Steroids also work by decreasing inflammation. Steroids can be injected into the affected joint or given as pills.

Colchicine is sometimes used in low doses for a long period of time to reduce the risk of recurrent attacks of gout.

Drugs that affect uric acid levels

Some patients may need to take medicines that lower the level of uric acid in the blood. (Examples are allopurinol, probenecid, and febuxostat). These drugs are recommended for patients who have had multiple attacks of gout or kidney stones due to uric acid.

The goal of lowering the blood uric acid is to slowly dissolve joint deposits of sodium urate. Lowering the uric acid will not treat an acute attack but will over time prevent additional attacks from occurring. Sudden lowering of the uric acid level may cause an acute attack of gout. To prevent acute attacks in people who are taking uric acid-lowering drugs, colchicine, or an NSAID is temporarily prescribed.

If an attack occurs while taking a medication to lower the uric acid, this medicine should NOT be stopped; stopping and starting the uric acid lowering medication may cause additional attacks.

Side effects of medicine

Not all patients will develop side effects from gout medications. How often any side effect occurs varies from patient to patient. The occurrence of side effects depends on the dose, type of medication, concurrent illnesses, or other medicines the patient may be taking.

Some side effects are more serious than others. If any rash or itching develops while taking allopurinol, the medicine should be stopped immediately, and your physician notified.

Can gout be treated through diet?

Dietary changes for most people do not play a major role in controlling their uric acid levels. However, limiting certain foods, such as fructose containing corn syrup, that cause an increased production of uric acid and reducing alcohol intake are often helpful.

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