Gout

What is gout?

Gout is a type of arthritis caused by having too much uric acid in your body. The uric acid may not cause symptoms for years, but after a time too much of it can cause painful joint inflammation (arthritis). Usually gout first affects the joint between the foot and the big toe. Later attacks may affect other joints of the foot and leg. Less often, the arms and hands have gout.

In addition to the arthritis, gout causes tophi. Tophi are lumps of uric acid crystals just under the skin. Common places to have tophi are the outer edge of the ear, on or near the elbow, the fingers and toes, and around the Achilles tendon near the ankle.

Gout can also cause kidney stones made of uric acid.

Most people who have gout are middle-aged men, but it can occur at any age. It is less common in women.

How does it occur?

Gout usually happens because too much uric acid is in your blood. Uric acid is a chemical your body makes when it breaks down substances called purines. Purines are found in all of your body's tissues. They are also in many foods. Normally, uric acid dissolves in the blood and passes through the kidneys and out of the body in the urine. If the level of uric acid builds up in the blood, sharp uric acid crystals may form in the joints. The crystals cause pain and swelling.

Most cases of gout happen because your kidneys do not get rid of enough uric acid. The specific problem with the kidneys is usually not found.

Gout may also happen because your body is making too much uric acid. There are different reasons this may happen:

• You may eat a lot of purine-rich foods, such as seafood and meat, especially red meat and organ meats like liver.
• You may drink a lot of alcohol.
• You may have inherited a tendency to make too much uric acid.
• You may have a disease such as cancer or a red blood cell problem.

Some conditions, such as dehydration, can cause high levels of uric acid. Diuretic medicine (also called water pills), which is often used to treat high blood pressure, can increase the level of uric acid. Other medicines can also affect the level of uric acid in the blood.

Uric acid levels in men start to go up after puberty. Women's uric acid levels usually do not go up until after menopause. For this reason women are protected from gout until several years after menopause. Usually the uric acid levels have to be high for many years before you start having gout.

People who have recently had a serious illness or surgery have an increased chance of having an attack of gout.

Some people have gout even though they have normal uric acid levels.

What are the symptoms?

Many people have high uric acid blood levels for years and never have any symptoms. Only 10 to 20% of people with high levels of uric acid develop symptoms in their joints. Symptoms may include:

• sudden, severe pain, especially of just 1 joint at a time
• redness of a joint
• swelling of a joint.

Sudden attacks sometimes happen with illness, injury, or drinking too much alcohol. The symptoms may last for days to weeks. The symptoms of pain, redness, and swelling usually happen months or years before either tophi or kidney stones develop.

The tophi do not cause any symptoms unless they open and drain. They are usually not painful. Depending on where they are on the body, they may limit movement of a joint.

The symptoms of uric acid kidney stones are like those of other kidney stones. They can cause severe abdominal pain and sometimes nausea, vomiting, fever, or blood in the urine. The stones may block urine flow, which can damage the kidneys if it is not treated.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and your family and personal medical history. He or she will examine you and ask about all of the medicines you are taking. Your provider will suspect that you have gout if:

• Your first toe joint is inflamed.
• You have a blood test that shows a high level of uric acid in your blood.
• You have tophi.
• You start taking the drug colchicine and your arthritis symptoms get better. (Colchicine, an anti-inflammatory drug, is effective only for gouty arthritis.)

To confirm the diagnosis, your provider may take a sample of fluid from an affected joint for lab tests. If there are uric acid crystals in the fluid, you have gout.

How is it treated?

Usually, if you have high uric acid levels but no symptoms, you will not need treatment. In special cases (for example, if you have a family history of gout or kidney stones), you may be treated for gout even though you do not have any symptoms.

If you have symptoms of gout, the goals of treatment are:

• Stop the pain.
• Try to keep the problem from coming back by controlling uric acid levels.
• Prevent serious problems such as kidney damage.

Anti-inflammatory medicines are used to treat the arthritis, such as:

• ibuprofen or naproxen
• steroid drugs, such as prednisone
• colchicine.

Anti-inflammatory medicines are sometimes taken daily to prevent recurrent attacks of gouty arthritis.

• Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen and naproxen, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.
• Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.

Aspirin is not usually recommended because it may keep the kidneys from getting rid of the uric acid.

Your healthcare provider may prescribe narcotic medicine, such as hydrocodone, to help relieve the pain.

If the gouty arthritis becomes a frequent problem, other medicines may also be prescribed to lower the amount of uric acid in your body. Examples of these medicines are allopurinol, febuxostat, and probenecid. The medicines can help keep uric acid crystals from forming in the joints. This can help prevent painful attacks of gouty arthritis and damage to the joints.

How long will the effects last?

The sooner treatment is started, the sooner the symptoms stop. You may start feeling better 1 to 2 days after you start treatment. If gout is not treated, it could last a few days to several weeks.

You could have another attack of gout, but usually not for at least 6 months to 2 years. It could be years before you have gout again, or you may never have another attack.

How can I take care of myself and help prevent gout?

To treat symptoms of gout:

• Make the changes in your diet, the fluids you drink, and alcohol use as recommended by your healthcare provider.
• Take medicine as prescribed by your provider.
• A warm washcloth or heating pad set on the lowest setting may help lessen pain. You can put heat on the painful joint for 15 to 30 minutes 3 to 4 times a day. Be careful not to fall asleep with a heating pad on. It could cause a burn.
• Acetaminophen or nonprescription anti-inflammatory medicine such as ibuprofen or naproxen may help lessen your pain. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.

There is no sure way to prevent gout. However, you can take these steps to lessen the chance that you will have high uric acid levels:

• Eat a diet low in purines. Purine-containing foods that you should avoid include meat—especially red meat and organ meats such as sweetbreads, liver, and kidney—shrimp, anchovies, sardines, and dried legumes (beans).
• Don’t drink a lot of alcohol. Don’t drink more than 2 ounces of alcohol a day. It’s best not to drink any alcohol.
• Unless your healthcare provider has restricted how much fluid you can have, drink lots of nonalcoholic fluids.

Call your healthcare provider right away if during a gout attack:

• You start to have pain in your belly or back.
• Your pain is not controlled with pain medicine.
• You have nausea and vomiting.
• You start to have pain in other joints also.
• Your urine looks bloody or is the color of tea.
• You have bloody, black, or tarry looking bowel movements. This can happen when your stomach or intestines are irritated by medicines used to treat gout.
• You have a fever higher than 101.5° F (38.6° C).
• You have any other symptoms that worry you.