Gout

Overview

Gout is a common condition that causes sudden severe joint pain, usually affecting the big toe, feet, ankles, knees, hands, and wrists. It can be treated effectively, and if necessary, there are medications that can help to prevent frequent attacks. Lifestyle changes may also prevent or reduce episodes. We will work with you to find the best approach to treatment and prevention.

Gout occurs when uric acid, a waste product of the body, builds up in your blood. This happens if your body produces extra acid or doesn't eliminate enough, or if you eat or drink too many foods with purines. Purines are found in anchovies, sardines, shrimp, and organ meats such as kidneys and liver. Beer and other alcoholic beverages may also elevate uric acid levels.

Normally, uric acid dissolves in the blood. It passes through the kidneys and out of the body in urine. But when uric acid builds up, it can form crystals that lodge in the joints and cause intense pain.

The initial gout attack can last several days to 2 weeks unless it is treated. Some people will only have one attack. In others, attacks can recur from time to time in the same joint.

Gout is more common in males, women after menopause, and people with high blood pressure. Heavy alcohol use, diabetes, obesity, sickle cell anemia, and kidney disease also increase the risk of a gout attack

Symptoms

The primary symptom of gout is sudden onset of severe pain in a joint and red or purplish skin, swelling, and tenderness. Gout attacks are often followed by periods of no symptoms in the affected joint or joints

:Other symptoms may occur and can include the following

The big toe, ankle, and knee are most often affected, but gout may affect the fingers, especially if you have osteoarthritis. You may also experience limited movement. Some people may develop symptoms in more than one joint

With chronic gout, there is pain in the joints that may go on for long periods of time

In people with untreated high uric acid levels, uric acid may collect in the joints. If large amounts of uric acid build up, it may cause lumps or nodules to form. These are called tophi. These tophi may also cause damage to the joints and subsequent deformities

Diagnosis

Gout may be difficult for us to diagnose because the symptoms may be indistinct and can mimic symptoms of other conditions
:Most of the time, however, the diagnosis is made by using a combination of criteria
Your history of pain and swelling of one joint at a timeLack of symptoms between attacks

Blood test showing high levels of uric acid

Rapid improvement after anti-inflammatory medication

f the diagnosis is unclear, then we can perform a joint aspiration. As little as 1 drop of fluid can reveal the presence of uric acid crystals (monosodium urate), confirming the diagnosis

Risk Factors

:There are several factors that can increase your risk of developing gout; including

Advanced age. Gout usually occurs in middle-aged men who have certain health issues like obesity, high blood pressure, unhealthy cholesterol levels, or heavy alcohol use. After menopause, the risk increases in women. At age 60 the incidence is equal in men and women, and after 80, gout occurs more often in women

Family history. About 20 percent of people with gout have a family history of this condition

Obesity. Researchers report a clear link between body weight and uric acid levels

Foods and alcoholic beverages. Eating a lot of purine-rich food like meat and seafood, or drinking a large amount of alcohol, particularly beer


Exposure to lead

Use of hydrochlorothiazide, a medication used to treat high blood pressure

Various surgeries and illnesses. People who have had organ transplants or who have thyroid problems, leukemia, and lymphoma are at higher risk

Prevention

:Lifestyle changes may help to prevent gout. There are a number of steps you can take, including

Lose weight by eating fewer calories and increasing your activity levels each day

Avoid foods high in purines such as organ meats like kidneys or liver as well as anchovies, sardines, and shrimp

Choose low-fat foods and complex carbohydrates, such as whole grains and foods high in dietary fiber
Avoid red meat and fish and eat more low-fat dairy foods like low-fat or skim milk, low-fat or nonfat yogurt, or low-fat cottage cheese

Avoid sugar-sweetened drinks like soft drinks and fruit juice high in fructose

Avoid alcoholic beverages, especially beer and hard liquor

Medication

Medications can be given to prevent gout in patients who develop frequent or severe attacks. Usually more than 2 or 3 attacks a year are a reason to start medication to prevent gout. The goal of treatment is to lower the concentration of uric acid in the blood

Preventive Medications


Uricosuric drugs, which increase the excretion of uric acid via the kidneys. The most common drug in this group is probenecid

Losartan (Cozaar), commonly used for hypertension treatment, may lower uric acid

Allopurinol reduces the formation of uric acid. It is usually recommended if you have tophi development or if you are more than 60 years old

Combinations of these medications may be used in some patients

Oral colchicine in low doses has been used in the past for prevention of gout but is used less now because of long-term side effects to muscles

We may need to change or adjust the medications you take for other chronic conditions. Medications commonly used for hypertension like hydrochlorothiazide or chlorthalidone may cause uric acid levels to increase in the bloodstream

Medications for Acute Gout Attacks

:Other medications are sometimes used, including the following

For pain relief, nonsteroidal anti-inflammatory drugs such as naproxen 500 mg twice a day or indomethacin 50 mg three times a day are most commonly used. You should not use them if you have problems with stomach or intestinal bleeding, kidney disease, or allergy to these medications. Other nonsteroidal anti-inflammatories like nabumetone may be used for patients with gastrointestinal problems



Colchicine can be very effective if taken soon after the attack starts. Oral colchicine is mainly used as bridge therapy. Gout can flare with the addition of medications like allopurinol. Maintaining twice-daily colchicine can minimize this risk. This type of treatment, known as bridge therapy, is often continued for 3 to 6 months. It has the disadvantage of causing diarrhea, nausea, and vomiting in a number of patients



Glucocorticoids (cortisone) may be injected into the affected joint or may be given orally in a pill form in patients who cannot take nonsteroidal anti-inflammatories or colchicine. Prednisone is a common form of oral glucocorticoid we use for this purpose

Remember that if you are already on treatment for gout, it is important to continue taking the medication as prescribed even during an acute attack