Gout

What is gout?

Gout is a form of arthritis that causes painful inflammation. Gout impacts the joints, typically one at a time and most often the big toe. The instances of pain and swelling occur at random during flares. The time between flares are remissions, which can last any length of time. Gout has no cure, but it does have effective treatments that help lessen the symptoms.

Gout is becoming more of a common affliction for people. However, unlike other forms of arthritis, you can take preventative measures to decrease your chance of having gout.

What causes gout?

Gout occurs when the body has a buildup of uric acid. The excess uric acid crystallizes near joints, which causes the pain and inflammation in those areas. The body produces uric acid to break down purines. However, sometimes the body produces too much of the acid, causing an excess. In other cases, the kidneys do not excrete enough uric acid to balance the amount of acid. Sometimes the combination of malfunctions can also lead to the buildup.

Not everyone with uric acid processing issues will develop gout. Many people who have hyperuricemia, or high levels of uric acid in the blood, do not develop gout in their life.

What are symptoms of gout?

There are different symptoms of gout, depending on the type of the condition the person has. Some people live with high levels of uric acid in their systems yet have asymptomatic gout. In these cases, the person does not experience any pain or other symptoms brought on by gout. There are slight differences in the symptoms between acute and chronic gout that can affect how long and to what degree the symptoms appear.

In general, symptoms of gout last anywhere from 3 to 10 days. During periods of remission, the person will not experience any symptoms. There are no signals of a gout flare, for the pain rapidly sets in.

• Acute Gout: Acute gout occurs over a shorter period of time, and the person experiences the symptoms for shorter bursts of pain. The pain usually starts in the big toe but can also be in the ankles and knees and is centralized in the joint. The pain is quickly onset and intense for the initial hours of the gout attack and mellows over time. The painful joint can appear red on the outside of the skin, indicating the flareup. Acute gout will make the impacted joint inflamed, tender, and hot to the touch. This can cause discomfort for the person as the area is very sensitive.
• Chronic Gout: Many of the symptoms of acute gout apply to chronic gout, too. The differences for chronic gout are the long-term symptoms. After repeated gout attacks, joints take time to recover, leaving the person with a limited range of motion due to lingering pain. If gout impacts multiple joints, the person’s mobility may decrease. Chronic gout attacks can leave the skin surrounding the joints feeling itchy and dry.

Are there any risk factors for gout?

Many people will develop gout, but there are several lifestyle and biological factors that make certain types of people more likely to have gout.

• Diet: Diets high in purine-rich foods can contribute to gout. Foods high in purine include fish, like anchovies, scallops, haddock, and mussels. Bacon, turkey, and organ meats have a high level of purines while meats such as beef, duck, chicken, and pork have moderate levels. Additionally, all alcohol contains purines. A diet containing these foods in high amounts can lead to gout.
• Family history: A person is more likely to develop gout if a person in their family also has it.
• Age and sex: The risk of gout is higher on average for males. Males are also more likely to develop gout at a younger age (30-50 years old) than women. Women tend to develop gout only post-menopause since their uric acid levels rise.
• Weight: Obesity can lead to gout since an overweight body has a harder time processing uric acid.
• Medications: Certain medications, mainly diuretics, low-dose aspirin, and anti-rejection medication following an organ transplant, contribute to gout. These medications can increase uric acid levels.
• Medical conditions: High blood pressure and several chronic conditions can put a person at risk for gout. Examples of chronic conditions include diabetes and kidney disease. Chronic illnesses compromise the body’s ability to properly excrete uric acid.

When Should You See a Doctor for Gout?

You should seek medical assistance when you have painful inflammation in your joints. The sooner a doctor can diagnose gout, the better the treatment will be.

How Is Gout Diagnosed?

Doctors will use a combination of examinations and tests to diagnose gout. A doctor would ask for these tests if a review of the patient’s medical history and description of symptoms points to gout.

• Physical examination: A doctor would be able to see the inflammation and redness if the patient sees the doctor during an active flare. The joint will still have lingering swelling and tenderness in remission, so a doctor will listen to your symptoms and gather information from the impacted joint.
• Joint fluid test: The best way to confirm if a person has gout is with a joint fluid test, which determines how much uric acid is present at the joint. To collect a fluid sample, a doctor will aspirate the joint with a needle and check the sample under a microscope to detect the uric acid.
• X-ray: An x-ray can help eliminate other possible causes of the joint inflammation and give the doctor a better understanding of the joint’s condition.

How Is Gout Treated?

The doctor and patient will work to prescribe medication and lifestyle modifications to best treat gout for the individual. There are no standard treatments that work for all individuals. Part of the reason is that gout medications either manage the pain and inflammation or lower the uric acid levels, but not both. The frequency and severity of a person’s gout attacks will help in deciding which type of medication will work best. Doctors also need to help the patient choose medications to help prevent any damage caused by gout that can lead to more serious conditions in the future.

What medications are used for gout?

Certain medications are used to both treat flares and manage levels of uric acids. Flares are treated with the following medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Some common NSAIDs are available over the counter like ibuprofen and naproxen sodium, and stronger ones are available with prescription. These medications help with pain management. However, NSAIDs can damage your stomach, causing ulcers and bleeding.
• Colchicine: Another pain management drug, colchicine effectively reduces pain from gout. It does have side effects nausea and vomiting.
• Corticosteroids: People with gout can take corticosteroids as a pill or an injection into the joint to resolve pain. As with the other medications, corticosteroids have side effects that impact mood and blood sugar levels.

Doctors commonly prescribe the following medications to manage uric acid levels:

• Block uric acid: Both allopurinol and febuxostat are drugs that can help the body block uric acid production. People taking either drug may experience symptoms like rash, fever, nausea, and kidney problems.
• Remove uric acid: A drug like probenecid aids the kidney in uric acid excretion. Patients on this drug may experience stomach pain and kidney stones.

What are common lifestyle changes to manage gout?

While medications are the most effective way to treat gout, people with gout can also make lifestyle changes to manage gout and its effects. The biggest change a person can make is adjusting their diet. By cutting out foods and drinks that lead to an increase in uric acid levels, people can more effectively keep future gout attacks away.

People can also be more active. Sticking to a light exercise routine can help you stay in control of your weight as well as keep your joints mobile and healthy. A stronger body will help your system process uric acid and reduce the chance of a gout attack.

What is the outlook for people living with gout?

People with gout can utilize management strategies to keep the negative effects of gout at bay. Medications and lifestyle changes can help people with gout return to their normal life with a lessened fear of a gout attack. Gout can lead to more serious conditions like tophi and kidney stones. However, making a treatment plan with your doctor can help with this.

How Is gout different from pseudogout?

While gout and pseudogout are both forms of arthritis, they have different causes and impacts. Gout occurs when excess uric acid crystallizes in the joints. Pseudogout, however, is caused by a buildup of calcium pyrophosphate in the joints. Symptoms of gout and pseudogout are similar, but pseudogout tends to affect the knees instead of the big toe.

The only definitive way to tell the two apart is to have a doctor use a joint fluid test to determine which kind of crystal building is causing the pain. The doctor will then consult with the patient on how to treat either form of arthritis. Gout has preventative and pain management treatments while pseudogout only has attack management medications.