Gout – Overview
A common and complex form of arthritis that can affect anyone is known as gout. It’s classified by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.
An attack of gout can happen suddenly; often waking up in the middle of the night with the sensation that big toe is on fire. The joint which is affected is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.
Symptoms may come and go for gout, but there are ways to manage symptoms and prevent flares.
Gout – Symptoms
The signs and symptoms of gout almost happens suddenly every time, and often at night. They include:
- Intense joint pain. The large joint of the big toe is usually affected by the gout, but it can occur in any joint. The ankles, knees, elbows, wrists and fingers are other commonly affected joints. Within the first four to 12 hours after it starts is when the pain is likely to become most severe.
- Lingering discomfort. After the most severe pain finishes, some joint discomfort may last for a period of a few days to a few weeks. Later attacks are likely to last for a longer period and more joints may be affected.
- Inflammation and redness. The joint or joints which are affected become swollen, tender, warm and red.
- Limited range of motion. As gout progresses, moving joints normally may not be done.
If a sudden, intense pain in a joint is experienced, call the doctor. Worsening pain and joint damage may be caused when the gout is left untreated.
Medical care should be sought immediately if having a fever and a joint is hot and inflamed, which can be a sign of infection.
Urate crystals accumulate in the joint when gout happens, causing the inflammation and intense pain of a gout attack. When having high levels of uric acid in blood, urate crystal can be formed.
Uric acid is produced by the body when it breaks down purines which are substances that are found naturally in the body.
Certain foods contain purines, such as steak, organ meats and seafood. Higher levels of uric acid are also promoted by other foods, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
Normally, blood dissolves uric acid and passes through the kidneys into the urine. But sometimes either the body develops too much uric acid or too little uric acid is excreted by the kidneys. When this happens, uric acid can build up and sharp, needlelike urate crystals are formed in a joint or surrounding tissue that cause pain, inflammation and swelling.
Gout – Risk factors
Gout is likely to be developed if having high levels of uric acid in the body. Factors that increase the uric acid level in the body may include:
- Diet. A diet rich in meat and seafood should be eaten and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increases the risk of gout. Risk of gout is increase if alcohol is consumed, especially of beer.
- Obesity. If overweight, more uric acid is produced by the body and the kidneys have a more difficult time eliminating uric acid.
- Medical conditions. The risk of gout is increased with certain diseases and conditions which include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
- Certain medications. The usage of thiazide diuretics which is commonly used to treat hypertension and low-dose aspirin also can increase uric acid levels. Also uric acid levels are increased with the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
- Family history of gout. If other members of the family have had gout, it is more likely to develop the disease.
- Age and sex. More often in men gout happens, primarily because women tend to have lower uric acid levels. After menopause, however, uric acid levels of women approach those of men. Men are also more likely to develop gout earlier which can be usually between the ages of around 30 and 50 whereas signs and symptoms are generally developed in women after menopause.
- Recent surgery or trauma. Recent surgery or trauma when experienced has been related with an increased risk of developing a gout attack.
Gout – Complications
More-severe conditions can be developed in people with gout, such as:
- Recurrent gout. Gout signs and symptoms may never be experienced by some people again while others may experience gout several times each year. Gout attacks in people with recurrent gout may be prevented with the help of medication. If not treated, erosion and destruction of a joint can be caused.
- Advanced gout. Deposits of urate crystals may be caused by untreated gout to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas can develop tophi such as fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but swollen and tender during gout attacks may happen.
- Kidney stones. Kidney stones may be caused when urate crystals collect in the urinary tract of people with gout. The risk of kidney stones may be reduced with the help of medications.
Gout – Prevention
During symptom-free periods, below dietary guidelines may help to protect against future gout attacks:
- Plenty of fluids to consumed. Stay well-hydrated, including plenty of water. Many sweetened beverages being consumed should be limited, especially those sweetened with high-fructose corn syrup.
- Limit or avoid alcohol. Doctor should be consulted about whether any amount or type of alcohol is safe. Recent evidence recommends that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
- Get protein from low-fat dairy products. The best-bet protein sources are low-fat dairy products which may actually have a protective effect against gout.
- Limit intake of meat, fish and poultry. A small amount may be tolerable, but close attention is to be paid to what types and how much of it seems to cause problems.
- Maintain a desirable body weight. Portions should be chosen that allow maintaining a healthy weight. Uric acid levels in body may be decreased with weight loss. But fasting or rapid weight loss should be avoided, since doing so may temporarily raise uric acid levels.
Gout – Diagnosis
Diagnosing gout can be done with the help of tests that may include:
- Joint fluid test. A needle to draw fluid from the affected joint may be used by the doctor. When the fluid is examined under a microscope, urate crystals may be visible.
- Blood test. A blood test may be recommended by the doctor to measure the levels of uric acid and creatinine in blood. Blood test results can mislead, though. High uric acid levels may be present in some people but they never experience gout. And signs and symptoms of gout are present in some people, but don’t have unusual levels of uric acid in their blood.
- X-ray imaging. To rule out other causes of joint inflammation, x-rays of joint may be helpful.
- Ultrasound. Urate crystals can be detected with musculoskeletal ultrasound in a joint or in a tophus. This technique is used more in Europe than in the United States.
- Dual energy CT scan. The presence of urate crystals in a joint is detected in this type of imaging, even when it is not acutely inflamed. This test is not used generally in clinical practice because of the expense and is not widely available.
Gout – Treatment
Medications are usually involved in treatment for gout. Medications that are being chosen will be based on current health and preferences.
Acute attacks can be treated with gout medications and prevent future attacks. Risk of complications from gout can also be reduced by medications, such as the development of tophi from urate crystal deposits.
Medications to treat gout attacks
Drugs used for treating acute attacks and prevent future attacks may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter options are included in NSAIDs such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin) or celecoxib (Celebrex).
A higher dose may be prescribed by the doctor to stop an acute attack, followed by a lower daily dose to prevent future attacks.
Stomach pain, bleeding and ulcers are risks of NSAIDs.
- Colchicine. Colchicine (Colcrys, Mitigare) may be recommended by the doctor which is a type of pain reliever that effectively reduces gout pain. The effectiveness of the drug may be offset, however, by side effects such as nausea, vomiting and diarrhea, especially if taken in large doses.
After an acute gout attack resolves, a low daily dose of colchicine to prevent future attacks may be prescribed by the doctor.
- Corticosteroids. Inflammation and pain of gout may be controlled by orticosteroid medications, such as the drug prednisone. Corticosteroids may be in the form of pill, or they can be injected into the joint.
People who can’t take NSAIDs or colchicine use corticosteroids generally. Mood changes, increased blood sugar levels and elevated blood pressure are included in the side effects of corticosteroids.
Medications to prevent gout complications
If several gout attacks each year are experienced, or if gout attacks are less frequent but particularly painful, medication may be recommended by the doctor to reduce the risk of gout-related complications. If already having evidence of damage from gout on joint X-rays, or having tophi, chronic kidney disease or kidney stones, medications to lower body’s level of uric acid may be recommended. Options include:
- Medications that block uric acid production. Drugs called xanthine oxidase inhibitors (XOIs), including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), limit the amount of uric acid made by the body and may lower the blood’s uric acid level and risk of gout is reduced.
A rash and low blood counts are side effects of allopurinol. Rash, nausea, reduced liver function are side effects of febuxostat and an increased risk of heart-related death.
- Medication that improves uric acid removal. These drugs, known as uricosurics, include probenecid (Probalan) and lesinurad (Zurampic). Uricosuric drugs improve the kidneys’ ability to remove uric acid from the body. Uric acid levels may be lowered and risk of gout is reduced, but the level of uric acid in the urine is increased. A rash, stomach pain and kidney stones are included in side effects. Lesinurad can be taken only along with an XOI.
Gout – Lifestyle and home remedies
The most effective way to treat acute gout is often medications and can prevent recurrent attacks of gout. However, certain lifestyle changes also are important, such as:
- Alcoholic beverages and drinks sweetened with fruit sugar (fructose) should be limited. Instead, plenty of nonalcoholic beverages, especially water should be consumed.
- Intake of foods high in purines should be limited, such as red meat, organ meats and seafood.
- Exercising frequently and losing weight. Body kept at a healthy weight reduces the risk of gout.
Gout – Alternative medicine
If gout treatments aren’t working as well as it was thought, trying an alternative approach may be of interest. Before trying such a treatment, doctor should be consulted to weigh the benefits and risks and learn whether the treatment might interfere with the gout medication.
Because a lot of research is not there on alternative therapies for gout, however, in some cases the risks aren’t known.
Certain foods have been studied for their potential to reduce uric acid levels, including:
- Coffee. An association is found in studies between coffee drinking both regular and decaffeinated coffee and lower uric acid levels, though no study has demonstrated how or why coffee may have such an effect.
The available evidence isn’t enough to encourage noncoffee drinkers to start, but clues may be given to researchers to new ways of treating gout in the future.
- Vitamin C. Vitamin C contained supplements may reduce the levels of uric acid in the blood. However, no studies have demonstrated that the frequency or severity of gout attacks is affected by vitamin C.
Doctor should be consulted about what a reasonable dose of vitamin C may be. And don’t forget that vitamin C intake can be increased by eating more vegetables and fruits, especially oranges.
- Cherries. Lower levels of uric acid have been reported in cherries, as well as the number of gout attacks reduced. However, to confirm this more research is required. Eating more cherries and drinking cherry extract may be a safe way to supplement the gout treatment, but doctor should be consulted first.
Other complementary and alternative medicine treatments may help to cope until the gout pain subsides or effect of the medications start. For instance, relaxation techniques, such as deep-breathing exercises and meditation, may help in taking mind off the pain.
Gout – Preparing for appointment
An appointment should be made with the doctor if having symptoms that are common to gout. After an initial examination, a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist) might be referred by the doctor.
Below is some information to help in getting ready for appointment, and what to expect from the doctor.
- Symptoms should be written down, including when they started and how often they occur.
- Important personal information should be noted such as any recent changes or major stressors in life.
- A list of key medical information should be made, including any other conditions for which being treated and the names of any medications, vitamins or supplements being taken. The doctor will also want to know if having any family history of gout.
- A family member or friend along should be taken along, if possible. Sometimes it can be difficult to remember all the information provided during an appointment. Someone accompanying may remember something that is missed or forgot.
- Questions to ask the doctor should be written down. List of questions should be created in advance to help to make the most of the time with doctor.
If any additional questions occur during medical appointments, ask without hesitation.
A number of questions is likely to be asked by the doctor. Being ready to answer them may reserve time to go over any points that are wanted to be discussed in-depth. The doctor may ask:
- The symptoms?
- First experiencing these symptoms?
- Symptoms come and go? How often?
- Anything in particular triggering the symptoms, such as certain foods or physical or emotional stress?
- Being treated for any other medical conditions?
- Medications currently being taken, including over-the-counter and prescription drugs as well as vitamins and supplements?
- Any of the first-degree relatives such as a parent or sibling having a history of gout?
- Consumption in a typical day?
- Drinking alcohol? If so, how much and how often?