Gout

Gout is a common and complex form of arthritis that can affect anyone. It's characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in joints, often the joint at the base of the big toe. Gout occurs when uric acid builds up in the body and forms sharp, needle-like crystals in joints.

Gout attacks can come on suddenly and often wake you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen, and so tender that even the weight of a sheet on it may seem intolerable. Fortunately, gout is treatable, and there are ways to reduce the risk of recurrent attacks.

Gout symptoms come on suddenly and may include:

During an Attack:

• Intense joint pain: Usually starts at night
• Severe pain: Often described as excruciating
• Swelling: Joint becomes swollen
• Redness: Skin over joint becomes red
• Warmth: Joint feels hot
• Tenderness: Extremely tender to touch
• Limited range of motion: Difficulty moving joint

Common Locations:

• Big toe: Most common (podagra)
• Ankles
• Knees
• Elbows
• Wrists
• Fingers

Attack Characteristics:

• Usually starts at night
• Pain peaks within 12-24 hours
• Can last days to weeks
• May resolve completely between attacks
• Attacks may become more frequent over time

Between Attacks:

• May have no symptoms
• May have mild discomfort
• May develop tophi (uric acid deposits under skin)

Seek emergency care if:

• Severe pain with fever
• Signs of infection (increasing redness, pus)
• Severe symptoms
• Multiple joints affected

Managing gout involves:

1. During an Attack:

   • Rest the joint: Don't use it
   • Ice: Apply ice packs (20 minutes, several times daily)
   • Elevate: Keep joint elevated
   • Take medications: As prescribed
   • Stay hydrated: Drink plenty of water
   • Avoid alcohol: Can worsen attack

2. Take Medications as Prescribed:

   • During attack:
     • NSAIDs (ibuprofen, naproxen)
     • Colchicine
     • Corticosteroids
   • Long-term:
     • Medications to lower uric acid
     • Take regularly to prevent attacks
     • Don't stop without doctor approval

3. Dietary Changes (to prevent attacks):

   • Limit purine-rich foods:
     • Red meat and organ meats
     • Seafood (especially anchovies, sardines, mussels)
     • Alcohol (especially beer)
   • Limit high-fructose foods: Sweetened drinks
   • Increase water: Stay well-hydrated
   • Eat cherries: May help reduce attacks
   • Limit alcohol: Especially beer

4. Lifestyle Changes:

   • Lose weight: If overweight (gradually)
   • Exercise regularly: But avoid during attacks
   • Stay hydrated: Drink plenty of water
   • Manage other conditions: Diabetes, high blood pressure

5. Prevent Attacks:

   • Take preventive medications
   • Follow dietary recommendations
   • Stay hydrated
   • Avoid triggers
   • Maintain healthy weight

• Severe pain with fever
• Signs of infection
• Severe symptoms
• Multiple joints affected

• First gout attack
• Recurrent attacks
• Severe pain
• Need for treatment
• Questions about medications
• Need to adjust treatment
• Concerns about prevention

• Following treatment plan
• Attacks well-controlled
• Taking preventive medications
• No new concerns

Diagnosing gout involves:

1. Medical History and Physical Exam:

   • Symptom description
   • Pattern of attacks
   • Physical examination
   • Check for tophi

2. Joint Fluid Analysis (most definitive):

   • Remove fluid from joint
   • Examine under microscope
   • Look for uric acid crystals
   • Confirms diagnosis

3. Blood Tests:

   • Uric acid level: May be elevated (but not always)
   • Other tests as needed
   • Note: High uric acid doesn't always mean gout

4. Imaging Tests (if needed):

   • X-rays: May show joint damage
   • Ultrasound: Can detect crystals
   • CT scan: More detailed images

Treatment has two goals: relieve acute attacks and prevent future attacks:

1. Treating Acute Attacks:

   • NSAIDs: Ibuprofen, naproxen (reduce inflammation)
   • Colchicine: Effective if taken early
   • Corticosteroids: Oral or injected
   • Start treatment as soon as possible

2. Preventing Future Attacks:

   • Medications to lower uric acid:
     • Allopurinol (most common)
     • Febuxostat
     • Probenecid
   • Take regularly: Don't stop during attacks
   • May need long-term: To prevent attacks

3. Lifestyle Modifications:

   • Dietary changes
   • Weight management
   • Limit alcohol
   • Stay hydrated
   • Regular exercise

4. Treat Complications (if present):

   • Tophi (uric acid deposits)
   • Joint damage
   • Kidney stones
   • Other complications

Prevent gout attacks by:

• Take Preventive Medications: If prescribed, take regularly
• Limit Purine-Rich Foods: Red meat, seafood, organ meats
• Limit Alcohol: Especially beer
• Stay Hydrated: Drink plenty of water
• Maintain Healthy Weight: Lose weight gradually if needed
• Limit High-Fructose Foods: Sweetened drinks
• Exercise Regularly: But avoid during attacks
• Manage Other Conditions: Diabetes, high blood pressure

In gout:

1. Uric Acid Builds Up: Body produces too much or doesn't excrete enough
2. Crystals Form: Uric acid forms sharp crystals
3. Crystals Deposit in Joints: Usually in joints
4. Inflammation Occurs: Body's immune response
5. Severe Pain: Inflammation causes intense pain

Causes:

• High uric acid levels:
  • Body produces too much
  • Kidneys don't excrete enough
  • Combination of both
• Risk Factors:
  • Diet high in purines
  • Alcohol consumption (especially beer)
  • Obesity
  • Medical conditions (diabetes, high blood pressure, kidney disease)
  • Medications (diuretics, aspirin)
  • Family history
  • Age and sex (more common in men, older adults)

• More common in men
• Usually starts in middle age
• Risk factors important
• Treatment effective

• Less common, but risk increases after menopause
• May have different presentation
• Same treatment approaches

• More common with age
• May have other health conditions
• May need medication adjustments
• Higher risk of complications

• Diabetes
• High blood pressure
• Kidney disease
• Heart disease
• May need coordination of treatments

If Untreated, Gout Can Lead To:

• Recurrent attacks: More frequent and severe
• Advanced gout: Tophi formation
• Joint damage: Permanent damage
• Kidney stones: Uric acid stones
• Kidney problems: Chronic kidney disease

For some people, dietary changes may help reduce attacks, but medications are usually needed, especially for recurrent gout. Diet is important but usually not sufficient alone.

Many people with recurrent gout need long-term medications to prevent attacks. However, some people may be able to reduce medications with significant lifestyle changes. Discuss with your doctor.

You don't have to eliminate meat completely, but limiting red meat and organ meats can help. Focus on moderation and avoiding triggers. Some people are more sensitive than others.

Gout is caused by uric acid crystals and causes sudden, severe attacks. Other types of arthritis (like osteoarthritis or rheumatoid arthritis) have different causes and patterns.

Gout can't be "cured" but it can be effectively managed. With proper treatment, most people can prevent attacks and live normally. The key is taking preventive medications and following lifestyle recommendations.