Gout

ExitCare ImageGout is an inflammatory arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a chemical that is normally present in the blood. When the level of uric acid in the blood is too high it can form crystals that deposit in your joints and tissues. 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, destroying bone and 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. Certain foods you eat, such as meats and fish, contain high amounts of purines. Causes of an elevated uric acid level include:

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

  • Diseases that cause increased uric acid production (such as obesity, psoriasis, and certain cancers).

  • Excessive alcohol use.

  • Diet, especially diets rich in meat and seafood.

  • Medicines, including certain cancer-fighting medicines (chemotherapy), water pills (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 attacks.

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. In some cases, tests may be recommended. The tests may include:

  • Blood tests.

  • Urine tests.

  • X-rays.

  • Joint fluid exam. This exam requires a needle to remove fluid from the joint (arthrocentesis). Using a microscope, gout is confirmed when uric acid crystals are seen in the joint fluid.

TREATMENT

There are two 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.

  • Treatment to Prevent Attacks.

  • If you suffer from frequent gout attacks, your caregiver may advise preventive medicine. These medicines are started after the acute attack subsides. 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 preventive 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. Your caregiver may make several adjustments to your medicine dose before these medicines are effective.

  • Discuss dietary treatment with your caregiver or dietitian. Alcohol and drinks high in sugar and fructose and foods such as meat, poultry, and seafood can increase uric acid levels. Your caregiver or dietician can advise you on drinks and foods that should be limited.

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).

  • Apply warm or cold treatments to painful joints. Use of warm or cold treatments depends on which works best for you.

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

  • Drink enough fluids to keep your urine clear or pale yellow. This helps your body get rid of uric acid. Limit alcohol, sugary drinks, and fructose drinks.

  • Follow your 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. Discuss the use of coffee, vitamin C, and cherries with your caregiver or dietician. These may be helpful in lowering uric acid levels.

  • Maintain a healthy body weight.

SEEK MEDICAL CARE IF:

  • 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 or a fever.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

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