Gout

Gout is an inflammatory condition (arthritis) caused by a buildup of uric acid crystals in the joints. Uric acid is a chemical that is normally present in the blood. Under some circumstances, uric acid can form into crystals in your joints. This causes joint redness, soreness, and swelling (inflammation). Repeat attacks are common. Over time, uric acid crystals can form into masses (tophi) near a joint, causing disfigurement. Gout is treatable and often preventable.

CAUSES

The disease begins with elevated levels of uric acid in the blood. Uric acid is produced by your body when it breaks down a naturally found substance called purines. This also happens when you eat certain foods such as meats and fish. Causes of an elevated uric acid level include:

  • Being passed down from parent to child (heredity).

  • Diseases that cause increased uric acid production (obesity, psoriasis, some cancers).

  • Excessive alcohol use.

  • Diet, especially diets rich in meat and seafood.

  • Medicines, including certain cancer-fighting drugs (chemotherapy), diuretics, and aspirin.

  • Chronic kidney disease. The kidneys are no longer able to remove uric acid well.

  • Problems with metabolism.

Conditions strongly associated with gout include:

  • Obesity.

  • High blood pressure.

  • High cholesterol.

  • Diabetes.

Not everyone with elevated uric acid levels gets gout. It is not understood why some people get gout and others do not. Surgery, joint injury, and eating too much of certain foods are some of the factors that can lead to gout.

SYMPTOMS

  • An attack of gout comes on quickly. It causes intense pain with redness, swelling, and warmth in a joint.

  • Fever can occur.

  • Often, only one joint is involved. Certain joints are more commonly involved:

  • Base of the big toe.

  • Knee.

  • Ankle.

  • Wrist.

  • Finger.

Without treatment, an attack usually goes away in a few days to weeks. Between attacks, you usually will not have symptoms, which is different from many other forms of arthritis.

DIAGNOSIS

Your caregiver will suspect gout based on your symptoms and exam. Removal of fluid from the joint (arthrocentesis) is done to check for uric acid crystals. Your caregiver will give you a medicine that numbs the area (local anesthetic) and use a needle to remove joint fluid for exam. Gout is confirmed when uric acid crystals are seen in joint fluid, using a special microscope. Sometimes, blood, urine, and X-ray tests are also used.

TREATMENT

There are 2 phases to gout treatment: treating the sudden onset (acute) attack and preventing attacks (prophylaxis).

Treatment of an Acute Attack

  • Medicines are used. These include anti-inflammatory medicines or steroid medicines.

  • An injection of steroid medicine into the affected joint is sometimes necessary.

  • The painful joint is rested. Movement can worsen the arthritis.

  • You may use warm or cold treatments on painful joints, depending which works best for you.

  • Discuss the use of coffee, vitamin C, or cherries with your caregiver. These may be helpful treatment options.

Treatment to Prevent Attacks

After the acute attack subsides, your caregiver may advise prophylactic medicine. These medicines either help your kidneys eliminate uric acid from your body or decrease your uric acid production. You may need to stay on these medicines for a very long time.

The early phase of treatment with prophylactic medicine can be associated with an increase in acute gout attacks. For this reason, during the first few months of treatment, your caregiver may also advise you to take medicines usually used for acute gout treatment. Be sure you understand your caregiver's directions.

You should also discuss dietary treatment with your caregiver. Certain foods such as meats and fish can increase uric acid levels. Other foods such as dairy can decrease levels. Your caregiver can give you a list of foods to avoid.

HOME CARE INSTRUCTIONS

  • Do not take aspirin to relieve pain. This raises uric acid levels.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

  • Rest the joint as much as possible. When in bed, keep sheets and blankets off painful areas.

  • Keep the affected joint raised (elevated).

  • Use crutches if the painful joint is in your leg.

  • Drink enough water and fluids to keep your urine clear or pale yellow. This helps your body get rid of uric acid. Do not drink alcoholic beverages. They slow the passage of uric acid.

  • Follow your caregiver's dietary instructions. Pay careful attention to the amount of protein you eat. Your daily diet should emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk products.

  • Maintain a healthy body weight.

SEEK MEDICAL CARE IF:

  • You have an oral temperature above 102° F (38.9° C).

  • You develop diarrhea, vomiting, or any side effects from medicines.

  • You do not feel better in 24 hours, or you are getting worse.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your joint becomes suddenly more tender and you have:

  • Chills.

  • An oral temperature above 102° F (38.9° C), not controlled by medicine.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.