Gout is a form of arthritis (joint inflammation) that is caused by increased uric acid in the bloodstream. Uric acid is a chemical produced by the normal breakdown of cells.
Gout results from an excess of uric acid in the body. The excess uric acid is deposited in one or more joints, causing arthritis.
Gout can cause a sudden onset of severe joint pain with the following characteristics: The pain is usually described as excruciating, throbbing, or crushing.The pain usually starts during the night.Generally, only the main joint of one or both of the big toes is involved.Usually, only one or two joints are affected at a time.It typically lasts for two or three days but may last up to several weeks, and then stops.It recurs occasionally
Although gout is most commonly seen in the great toes, it may also affect the joints of the other toes, fingers, hands, knees, or feet. Less commonly, the hips, shoulders, elbows, and wrists can be involved.
Other symptoms of gout can include: joint swellingredness over and around the jointfevera lump over the joint that contains uric acid in the form of a chalky material. Occasionally this material will drain from the deposit. tjoint stiffness
Gout is caused by an excess of uric acid in the bloodstream. Uric acid accumulates in the body and may form crystals in the joints under the following conditions: if the person has a defect in body chemistry that causes overproduction of uric acid. if the kidneys have a reduced ability to remove uric acid from the bloodstreamif the person's diet is high in purines, which are broken down into uric acid in the body.
Foods high in purines include: organ meats, such as liver, seafood, and dried beans.
Certain risk factors increase a person's chance of developing gout or having a flare-up of symptoms once he or she has the disease. These factors include the following: a diet high in purinesalcohol consumptionobesityhigh blood pressurehigh levels of cholesterol, triglycerides, and other lipids in the blooddiabeteskidney diseasesickle cell anemia, a blood disorder that causes abnormal red blood cells
Gout occurs in approximately 1 in 100 people. It is more common in men, although women are at increased risk after menopause, the end of normal menstruation.
Some cases of gout can be prevented by controlling conditions that predispose to it, such as obesity or alcohol consumption. Thiazide diuretics also contribute to an elevated uric acid.
Although purines in the diet contribute to the level of uric acid in the bloodstream, it is almost impossible to prevent gout simply by eliminating foods which contain large amounts of purines.
The diagnosis of gout starts with a medical history and physical examination. The healthcare professional may do a joint aspiration, inserting a needle into the joint space to remove some of the joint fluid. The fluid is examined in the laboratory for the presence of uric acid crystals.
Blood tests are also available to check the level of uric acid, but the results may be normal or even low in people with gout. Joint X-rays may be used to rule out any other abnormalities. Usually, if gout is in the acute stage, the joint X-rays will be normal or will show only some swelling.
People with gout can live normal lives, but when the disease is active, it can have a significant effect on quality of life.
Gout can progress to a chronic state with chronic changes in the affected joints. In some cases, an increased amount of uric acid in the urine may cause kidney stones.
The chronic stage is more likely to occur when the disease starts before the age of 30.
Untreated gout can lead to permanent disability.
Gout is not contagious and poses no risk to others.
There are treatments for both the acute phase of gout and for preventing flare-ups of symptoms.
For acute attacks, the anti-inflammatory medication colchicine is used to reduce the pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (i.e., Indocin) and ibuprofen (i.e., Advil, Motrin), may also be useful.
The Natural Medicines Comprehensive Database lists no herbs, vitamins or supplements as being effective for gout.
For some persons, corticosteroids may be the safest and most effective medication. Corticosteroids may be administered by mouth, by intravenous injection, or directly into a joint. Occasionally, pain medications may be prescribed.
After the acute attack has resolved, other medications can be used to minimize recurrences of gout. Allopurinol (i.e., Aloprim, Zyloprim) blocks the body's production of uric acid and probenicid (i.e., Benemid) helps the kidneys eliminate excess uric acid.
A person with gout will also be advised to make the following lifestyle changes: Drink plenty of liquids.Eat a diet low in purines.Limit alcohol intake.Maintain a healthy body weight.Follow effective treatment for conditions such as diabetes, high blood pressure, high cholesterol, kidney disease, and sickle cell anemia.
Colchicine, NSAIDs, and allopurinol may cause nausea, vomiting, diarrhea, abdominal distress, and allergic reactions.
People who have gout can have recurrent episodes throughout their lives. These episodes are not always associated with increases in the uric acid level in the blood.
Early treatment of acute gout attacks is important because it helps improve the quality of life and reduces the chances of long-term deterioriation of the joint.
The healthcare professional will want to know about the number of attacks, the length of each attack, and which joint is involved. The professional will also monitor uric acid levels and any side effects of the medications. Any new or worsening symptoms should be reported to the healthcare professional.
