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Gout

What is gout?

Gout is a type of inflammatory arthritis that causes sudden, severe attacks of pain, swelling, and redness in the joints. Although gout typically affects the big toe, other joints can also be involved. Usually, the first episodes of gout affect only one joint, but as the disease becomes more severe, the episodes can affect several joints at the same time. If left untreated, joint damage can occur. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.

What causes gout?

Gout pain occurs when excess uric acid, one of the body’s normal waste products, accumulates because the body makes too much of it or fails to excrete it. In healthy individuals, uric acid dissolves in the blood and passes through the kidneys before it is excreted in urine. With gout, uric acid forms into crystals that accumulate in the fluid that lubricates your joints.

Gout is strongly associated with the following risk factors:

  • Gender: Men get gout more than women and they tend to be diagnosed at younger ages than women. The onset of gout among men is typically between the ages of 30-50 years, although it may begin earlier for those with a genetic predisposition. Women are more likely to experience gout after menopause.
  • Obesity: Being overweight or having metabolic syndrome is associated with gout.
  • Diet: A diet high in fructose, meat (especially red meat and organ meat), some types of seafood, and excessive alcohol consumption (especially beer and spirits) increases your risk of gout.
  • Concurrent diseases: Medical conditions such as diabetes, high blood pressure, high cholesterol, and chronic kidney disease are associated with an increased risk of gout. Medications used to treat some of these conditions also affect blood levels of uric acid. Joint trauma or surgery can trigger a gout flare-up.
  • Genetic Predisposition: Gout is rare in children, unless they have an inherited genetic disorder that predisposes them to gout.

What are the symptoms of gout?

  • Joint pain: Sudden and severe joint pain that can last a week or longer. Initial gout attacks involve one joint but subsequent attacks can involve more joints.
  • Joint changes: The affected joint or joints become warm, swollen, red, and/or tender.
  • Limited mobility: With joint pain and swelling, the joint can become stiff and range of motion can become more limited.
  • Urate crystals: Hard lumps of urate crystals can form beneath the skin (known as tophi).
  • Kidney stones: Over time, the same urate crystals that form in the joints can be found in the kidneys. Kidney stone symptoms include pain (sometimes excruciating, from the lower back to the groin), difficulty urinating, and a frequent urge to urinate but with minimal amounts of urine produced.

Stages of gout

Gout is a chronic disease that if left untreated, may get worse over time and cause joint damage. By recognizing the symptoms early and seeking a physician’s care, you can reduce the chances of gout reaching later stages.

  • Acute Gouty Arthritis: Urate crystals in the joint cause inflammation, resulting in a sudden onset of severe pain and swelling. An acute gout attack can last a week or longer. Commonly, the gout attack will affect the big toe joint, but other joints, such as the knee, may be involved.
  • Intercritical and Recurrent Gout: After the pain of an acute flare has gone away, gout can enter a stage during which the disease is inactive. In this stage, urate crystals can continue to be deposited in tissues with resulting damage. Subsequent gout attacks may not occur for months or even years; however, as the disease progresses, attacks can recur more frequently, last longer, and be felt in multiple joints.
  • Chronic Tophaceous Gout: This is the most destructive stage of the disease and occurs after many years of recurrent gout attacks. Having chronic gout means the disease has caused permanent damage to the affected joints, producing persistent inflammation, joint deformity, and extensive deposits of crystallized uric acid (tophi). Tophi can be found on the ears or joints, and can damage surrounding tissues to cause deformities.

How is gout diagnosed?

If you have symptoms of gout, your doctor may refer you to a rheumatologist. Your rheumatologist will ask you a number of questions about your symptoms, medical history, family history, medications, and diet. After speaking with you, your physician will use one or more of the following tests to help diagnose gout:

  • Joint fluid analysis: Using a needle, joint fluid is removed from the inflamed, painful joint. The joint fluid is then examined under a microscope to see if there are urate crystals present. This is a definitive way of diagnosing gout.
  • Blood tests: Your blood can be tested to measure levels of uric acid. This is not a definitive diagnostic test because some people have high uric acid levels without experiencing gout, and others have normal uric acid levels with symptoms of gout.
  • Imaging: X-ray imaging of the joints can sometimes show gout-related joint damage. Ultrasound is another imaging tool for evaluating the soft tissue and bone to detect urate crystals. In some instances, MRI may be used to identify tophi, inflammation, or joint injury, and dual imaging CT scans can find urate deposits.

How is gout treated?

Gout treatment involves managing the flare up and treating the underlying problem to prevent future episodes. The initial treatment goal is to reduce pain and inflammation quickly and safely.

Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and/or corticosteroids may be used. Specific treatment of gout varies based on co-existing medical conditions and other medications you are taking.

After treating the pain and inflammation of a gout flare up, it is important to decrease your uric acid levels to prevent future gout attacks and joint damage. Your rheumatologist will work with you to find a balance of medications and lifestyle changes to help lower your uric acid levels.

Lifestyle changes

Medications can be effective for treating gout pain and lowering your uric acid levels, but lifestyle changes are also important. Diet modifications and maintaining a healthy weight can lower uric acid levels in your blood.

Foods to avoid or limit

Avoiding or limiting the following foods can reduce your chances of triggering a gout attack:

Meats

red meat, organ meats (such as liver and sweetbreads)

Alcohol

particularly beer but also spirits and wine

Seafood

shellfish and other fish with high purine content (such as sardines)

Other

sugary drinks or foods high in fructose

Foods and supplements that are encouraged

Consuming the following foods or supplements, in addition to keeping well hydrated, may decrease your risk of having a gout attack:

  • Low fat or non fat dairy products
  • Vegetables
  • Cherries, cherry juice concentrate
  • Vitamin C

Can gout be prevented?

The best way to minimize your risk of developing gout and complications from gout is by following a healthy lifestyle: stay well hydrated, maintain a healthy body weight, and eat a low-purine diet.