What is gout?
Gout is a disease usually caused by having too much uric
acid in your body. Too much uric acid may not cause
symptoms for years, but after a time it usually causes
painful joint inflammation (arthritis). The most common
site of inflammation is the joint between the foot and the
big toe. Later attacks often affect other joints of the
foot and leg. Less often, the arms and hands are affected.
In addition to the arthritis, gout causes the formation of
tophi. Tophi are lumpy deposits of uric acid crystals just
under the skin. Common places for tophi to develop are in
the outer edge of the ear, on or near the elbow, over the
fingers and toes, and around the Achilles tendon in the
ankle.
Gout can also cause kidney stones made of uric acid.
Most people who have gout are middle-aged men, but it can
occur at any age. Only 5 to 10% of cases of gout occur in
women, most often after menopause.
How does it occur?
Gout usually occurs because too much uric acid is in your
joints. Uric acid comes from the breakdown of substances
called purines. Purines are found in all of your body's
tissues. They are also in many foods. Normally, uric acid
dissolves in the blood and passes through the kidneys and
out of the body in urine. If the levels of uric acid build
up in the blood, sharp uric acid crystals may form in the
joints. The crystals cause pain and swelling. You may have
too much uric acid in your joints when your kidney does not
get rid of enough uric acid or when your body makes too much
uric acid.
Most cases of gout are caused by poor elimination of uric
acid by the kidneys, but it can be hard to know why this is
happening. The specific problem with the kidney is usually
never found.
Some people inherit a tendency to make too much uric acid.
Others may make too much uric acid because they have a
disease such as cancer or certain types of red blood cell
disorders. A diet high in alcoholic drinks and purine-rich
foods (such as meats) can also cause your body to make too
much uric acid.
Uric acid levels in men start to go up after puberty.
Women's uric acid levels usually do not go up until after
menopause. For this reason women are protected from gout
until several years after menopause. The uric acid levels
have to be high for many years before gout develops. Men
with gout usually have their first attack when they are
middle-aged.
Certain conditions, such as dehydration, can cause excess
levels of uric acid. Diuretic medicine (also called water
pills) can increase levels of uric acid. Other medicines
can also affect the level of uric acid in the blood. It is
important to make sure your health care provider knows all
the medicines you are using, both prescription and
nonprescription.
People who have recently had a serious illness or surgery
have an increased chance of having an attack of gout. Some
people have gouty arthritis even though they have normal
uric acid levels.
What are the symptoms?
Some people have high uric acid blood levels for years and
never have any symptoms. Only 10 to 20% of people with high
levels develop the symptoms of:
- sudden, severe pain, especially of just one joint at a
time
- redness
- swelling.
The sudden attacks are sometimes related to physical
illness, trauma, or excessive alcohol use. The symptoms may
last for days to weeks. The arthritis usually occurs before
tophi or kidney stones develop.
The tophi do not cause any symptoms unless they open and
drain. They are often not painful. Depending on their
location, they may limit the movement of joints.
The symptoms of uric acid stones are like those of other
kidney stones. They can cause severe abdominal pain and
sometimes nausea, vomiting, fever, or blood in the urine.
How is it diagnosed?
Your health care provider will suspect that you have gout
if:
- Your first toe joint is inflamed.
- You have a blood test that shows a high level of uric
acid in your blood.
- You are developing tophi.
- You start taking the drug colchicine and your symptoms of
arthritis improve. (Colchicine, an anti-inflammatory
drug, is effective only in gouty-type arthritis.)
To confirm the diagnosis, your provider may take a sample of
fluid from the affected joint or joints and send it to the
lab for tests. If you have uric acid crystals in the fluid,
you have gout.
How is it treated?
Usually, if you have high uric acid levels but no symptoms,
you will not need treatment. In special cases (for example,
if you have a strong family history of gouty arthritis or
kidney stones), you may be treated for gout even though you
do not have any symptoms.
If you have symptoms of gout, the goals of treatment are:
- Stop the pain of gouty arthritis or kidney stones.
- Try to prevent the recurrence of these problems by
controlling the uric acid levels.
- Prevent serious complications such as kidney damage.
Treatment of the arthritis first involves the use of
anti-inflammatory medicines, such as:
- indomethacin
- ibuprofen or naproxen
- corticosteroid drugs, such as prednisone
- colchicine.
Aspirin is not usually recommended because it may keep the
urine from taking the uric acid out of the body.
Anti-inflammatory medicines are sometimes taken daily to
prevent recurrent attacks of gouty arthritis. If the gouty
arthritis becomes a frequent problem, allopurinol and
probenecid may also be prescribed to prevent damaging
deposits of uric acid in the joints.
How long will the effects last?
The sooner treatment is started, the sooner the symptoms
stop, which may be within 24 to 48 hours. If gout is not
treated, it could last a few days to several weeks. A
second attack may occur, but usually not for 6 months to 2
years. In other cases another attack may not occur until
many years later, or never.
How can I help prevent gout?
There is no sure way to prevent gout. However, you can take
these steps to lessen the chance that you will have high
uric acid levels:
- Eat a diet low in purines and do not overindulge in
alcohol. Purine-containing foods include organ meats
(such as sweetbreads, liver, and kidney), shrimp,
anchovies, sardines, and dried legumes. Your consumption
of alcoholic beverages should not exceed 2 ounces a day.
- Drink lots of fluids.
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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