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 usually affects one joint at a time.
The large toe is most often affected, but gout can also affect
other joints in
the leg (knee, ankle and foot) and, less often, joints in
the arm (hand, wrist
and elbow). The fingers are rarely involved and the spine is
almost never
affected.
What are the symptoms of gout?
·
Sudden, intense joint pain, which often first occurs in the
early morning hours
·
Swollen joint that is warm to touch
·
Red or purple skin around the joint
Gout was once incorrectly thought to be a disease of the
rich and famous, caused by consuming too much rich food and fine wine. Although
diet and excessive drinking contribute to gout, they are not the main cause of
the disorder.
Gout results from abnormal deposits of sodium urate crystals
in the joint cartilage that are later released into the joint fluid. Uric acid
crystals, which are related to sodium urate, also can 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 (ribonucleic acid)
and DNA (deoxyribonucleic acid), the genetic material in cells. Some foods
contain large amounts of uric acid, especially red meats and organ meats (such
as liver and kidneys), some shellfish and anchovies.
Uric acid in normal amounts remains dissolved in the blood,
and easily
passes through the kidneys and leaves the body as waste.
Uric acid in high
amounts, however, makes a person more likely to develop
gout.
The amount of uric acid in your blood can change depending
on what you eat, your overall health, how much alcohol you drink, what
medicines you are taking or sudden illness.
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 suffers from gout does not
mean everyone in that family will have the disease. Often, the effect of
heredity is modified by the risk factors mentioned above that affect uric acid,
as well as male gender and age. All of these factors increase the risk of gout.
Gout attacks can recur from time to time in the same joint.
The initial attack may last several days to two weeks unless 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.
Some people will have only a single attack. However,
approximately 90 percent of patients who have one 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.
Gout affects more than 1 million Americans, including men
usually over age
30, people who are overweight, people who frequently drink
alcohol and
people who use diuretics ("water pills") to lower
blood pressure or to treat
heart disease.
When gout affects women, it is usually after menopause,
especially in women who are taking certain medications. Less often, younger
patients may be affected by gout if they have been taking certain medications
for long periods of time, frequently drink alcoholic beverages or have certain
genetic disorders.
Gout cannot be diagnosed simply from a blood test, because
many people have elevated blood uric acid levels but do not have gout.
Rather, gout is diagnosed from the fluid of an inflamed
joint. The fluid is observed under a microscope for sodium urate crystals.
Fluid is removed from the inflamed joint through a needle
during a procedure called arthrocentesis. Removing the fluid may reduce
pressure within the joint and thereby reduce pain.
If crystals are not seen, the diagnosis of gout cannot be
made with certainty. Occasionally, crystals may not be observed the first time,
but may be seen if additional fluid is removed at another time during a
subsequent attack.
Since gout can cause chronic joint pain and involve other
joints, it is extremely important that an accurate diagnosis be made. Then your
physician can prescribe the appropriate treatment.
There is no cure for gout, but it can be treated and
controlled. Symptoms are often relieved within 24 hours after treatment has
begun.
The goals of treatment are to relieve pain and inflammation,
and prevent future gout attacks which could lead to permanent joint damage.
The type of treatment prescribed will depend on several
factors, including the person's age, type of medications he or she is taking,
overall health, medical history and severity of gout attacks.
Gout is mainly treated with the following medications.
Anti-inflammatory medications 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 health care provider
will discuss the potential side effects with you.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen or naproxen 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 can be used either in moderate
doses to treat an acute or attack or sometimes in low doses for a long period
of time to reduce the risk of recurrent attacks.
Some patients may need to take medications that lower the
uric acid in the blood. Examples are allopurinol or probenecid.
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 deposits of sodium urate in
the joint.
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 a NSAID is temporarily prescribed.
In addition, uric acid-lowering therapy (with allopurinol or
probenecid) is not started during a gout attack, since sudden lowering of the
uric acid can cause a new attack or prolong an existing one.
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 medications the patient may be taking.
Some side effects are more serious than others. Before any
medication is prescribed, your health-care provider will discuss with you the
potential benefits and risks of taking the medication.
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 that cause
an increased production of uric acid and reducing alcohol intake is often
helpful.