- acute gout
- gouty arthritis
- acute gouty arthritis
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.
What is going on in the body?
Gout results from an excess of uric acid in the body. The excess uric acid is deposited in one or more joints, causing arthritis.
What are the causes and risks of the disease?
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:
Foods high in purines include:
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 purines
high blood pressure
high levels of cholesterol, triglycerides, and other lipids in the blood
sickle 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.
What can be done to prevent the disease?
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.
How is the disease diagnosed?
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.
Long Term Effects
What are the long-term effects of the disease?
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.
What are the risks to others?
Gout is not contagious and poses no risk to others.
What are the treatments for the disease?
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:
What are the side effects of the treatments?
Colchicine, NSAIDs, and allopurinol may cause nausea, vomiting, diarrhea, abdominal distress, and allergic reactions.
What happens after treatment for the disease?
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.
How is the disease monitored?
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.