Gout

Overview

Gout is a type of rheumatic disease. People with gout suffer from swelling, redness, pain, heat, and stiffness in one or more of their joints. Gout usually appears in one joint at a time, and the first joint it affects is often the big toe. Other commonly affected joints include the wrists, knees, ankles and elbows.

Gout is a result of the formation of uric acid deposits in either the joint space between two bones, or the connective tissue. Uric acid is produced as the body breaks down purines, which are found in many foods and occur naturally in the body’s tissues. Uric acid deposits occur when the kidneys do not dispose of all of the body’s uric acid, and the acid builds up to form crystals, which then cause gout.

Causes

• Gout can be hereditary. Roughly 18% of people suffering from gout have family members who have also suffered from it.
• Eating an excess amount of foods that contain purines, such as liver, anchovies, and gravies, increases the risk of gout.
• Overweight individuals are more likely to suffer from gout, since they have more tissue, which contains more purines. An increase in the breakdown of these tissues causes excess in the production of uric acid, which can lead to gout.
• Consuming excess amounts of alcohol can cause gout, since alcohol can interfere with the body’s removal of uric acid.
• Certain medications interfere with the body’s breakdown of uric acid. These include anti-inflammatory medicines like aspirin, diuretics, and the vitamin niacin.
• Men are more likely to suffer from gout than women, and adults are more prone to gout than children.
  

Symptoms

Doctors often have trouble diagnosing gout. Symptoms vary, and can often appear to be related to other conditions. Almost all people with gout have hyperuricemia (a buildup of uric acid in the blood) at some point, but it may not be present during acute attacks of gout. Also, most people with hyperuricemia do not suffer from gout. Nonetheless, there are certain identifiable symptoms:

• Hyperuricemia almost always accompanies gout, although it may not be detectable at the time of severe attacks.
• Uric acid crystals build up in the joint fluid
• A sudden, severe attack of arthritis that affects only one joint, and makes that joint swell, turn red and appear warm.
  

Gout often occurs in three stages:

1. Sudden joint pain and swelling that lasts for 5 to 10 days
2. Periods of no symptoms, followed by periods of acute attacks
3. If left untreated, gout can progress and cause attacks that last for long periods of time, often in more than one joint.

Treatment Options

Most commonly, people with gout are given high doses of nonsteroidal anti-inflammatory drugs (NSAIDs), which they take orally, or corticosteroids, which can either be taken orally or can be injected directly into the joint.

• NSAIDs are taken every day, and reduce the inflammation caused by the uric acid crystal deposits. They do not, however, treat the buildup of uric acid.
• Corticosteroids are anti-inflammatory hormones, and people respond quickly, with the attack going away completely within about a week.
• If neither of these treatments work, the drug colchicine is most effective in the first twelve hours of an attack.
• To reduce the chance or frequency of having future attacks, patients may be prescribed medications to treat hyperuricemia.

Preventing Future Attacks

People suffering from gout can take certain steps to reduce the frequency and severity of future attacks. While there is no cure for gout, proper treatment and prevention measures can increase the chances of living a normal and healthy life.

• Eat a balanced and healthy diet. Avoid foods that contain a high amount of purines, and drink large amounts of water, since it helps the body process and remove uric acid.
• Maintain a healthy weight and exercise on a regular basis. However, dieting with the intent of losing large amounts of weight quickly are not recommended, since these diets often increase blood uric acid levels.
• Visit your doctor regularly, informing them of any family history of gout or hyperuricemia. Go to your doctor at the first sign of symptoms, and take any medications they prescribe.