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Gout

In the United States, approximately 3.9 percent of people age 20 and older have gout.

This condition is a type of arthritis that most often affects the big toe. The attacks can happen suddenly, causing intense discomfort that can make it hard to walk and get comfortable. Gout occurs when urate crystals start to build up in the joints. High levels of uric acid in a person’s blood can lead to the formation of urate crystals. Purines, a substance that your body naturally has, is also found in different foods, such as steak, seafood, and alcoholic beverages. When your body is breaking them down, it produces uric acid.
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Causes of Gout

Under normal circumstances, the uric acid will dissolve and be excreted via the urine. However, if the body is producing too much or the kidneys are not excreting it efficiently, it can start to accumulate. The crystals that it can form are needle-like and sharp. Certain factors may increase a person’s risk of developing gout. These include:
  • Eating a diet rich in foods that contain purines
  • Certain medical conditions, such as metabolic syndrome, high blood pressure, kidney or heart disease, and diabetes
  • Family history of gout
  • Obesity
  • Certain medications, such as organ transplant anti-rejection medications and thiazide diuretics
  • Being male
  • Recent surgery or trauma
  • Being age 30 to 50

Symptoms

The symptoms usually come on quickly with little warning. In many cases, they start at night. The following are the possible symptoms:
  • The joint pain is usually intense. Any joint can be affected, but it is usually the big toe. Other joints that are commonly affected include the knees, wrists, ankles, elbows, and fingers. Within the first 12 hours of the attack, the pain is typically the most severe.
  • The affected joint can appear red. This is due to gout causing inflammation. The joint might also become tender, warm, and swollen.
  • Once the severe pain starts to go away, it is possible for some discomfort to linger. This lingering pain can last up to a few weeks for some people.
  • As this condition progresses, people might find that their range of motion becomes limited. For example, with gout in the big toe, it may be hard to move the toe up or down.
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Once someone has one episode of gout, they are at risk for future attacks. In some cases, recurrent attacks can happen up to several times per year. With recurrent attacks comes the risk of joint destruction or erosion.

When gout is not treated, it can become more advanced. At this point, it is possible to develop tophi, a type of nodule that may occur under the skin. The common areas for these nodules include the fingers, elbows, feet, hands, and along the Achilles tendon.

It is possible for the crystals that develop with gout to also develop in the kidneys and urinary tract. This could lead to kidney stones.

It is important to make an accurate diagnosis so that the right treatment can be administered. In addition to a physical examination of the affected joint, the following might be performed:
  • Blood testing to evaluate uric acid levels
  • Ultrasound to look for tophi or urate crystals
  • Joint fluid testing to look for crystals
  • X-rays to look at the joint
  • Dual energy CT scan to look for urate crystals

Medications are the typical course of treatment for gout. The following may be prescribed:

  • Colchicine can be used to reduce gout pain. Once the acute phase of a gout attack ends, this medication might be prescribed at a lower dose to help to prevent recurrent gout.
  • Non-steroidal anti-inflammatory drugs can reduce inflammation to alleviate a person’s pain. During an attack, the dose may be higher.
  • Corticosteroids might be used short-term orally or via injection to reduce pain.
  • Uricosuric medications can help to improve how well the body removes uric acid.
  • Xanthine oxidase inhibitors can help to reduce the uric acid production in the body.
There are some guidelines to follow to reduce the risk of gout:
  • Avoid or limit alcohol
  • Limit the intake of foods that contain purines
  • Achieve and maintain a healthy body weight
  • Drink plenty of fluids
If you suspect that you have gout, it is important to see their doctor promptly. There are treatments that can help to reduce the frequency and severity of the attacks. It is also important to take advantage of any preventative methods to reduce the risk of attacks.

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