Gout
Gout is an inflammatory type of arthritis that more commonly affects men.
Causes
When uric acid levels get high, they can form crystals, which lodge in and around the joints, causing a gout attack. But not everyone with high uric acid levels develop painful gout.
People are more likely to develop gout if they:
- Are male.
- Have family members who have gout.
- Take certain drugs (e.g., water pills, aspirin, cyclosporine, niacin, levodopa).
- Have another type of inflammatory arthritis, such as rheumatoid arthritis or psoriatic arthritis.
- Drink more than two alcoholic drinks or two beers a day.
- Eat a lot of high-purine foods, such as:
- Liver, kidney, sweetbreads and other organ meats.
- Red meats (beef, lamb, pork).
- Select seafood (anchovies, sardines, mackerel, herring, mussels, scallops, trout, haddock, and tuna)
- Broths, consommés, gravies.
- Caviar, roe.
- Dried peas and beans. - Have high blood pressure; kidneys or thyroid gland that don’t work properly; or a condition that causes cells to turn over quickly (e.g., psoriasis).
- Drink a lot of sugary drinks.
- Are obese.
- Had gastric bypass or transplant surgery
Gout causes sudden and severe joint pain that usually starts in the big toe. But other joints and areas around the joints can be affected, such as the ankle, knee and foot. It’s the most common type of inflammatory arthritis. Men are three times more likely than women to develop gout. It tends to affect men after age 40 and women after menopause. Gout symptoms can be confused with another type of arthritis called calcium pyrophosphate deposition (CPPD). However, the crystals that irritate the joint in this condition are calcium phosphate crystals, not uric acid.
Symptoms
There are four stages of gout:
1. Before the first gout attack:
There are no symptoms, but uric acid levels are high and crystals are forming in the joints. This is called “asymptomatic hyperuricemia.”
2. Acute Gout:
Uric acid levels spike or crystals in the joint move around. The attack (flare) may be caused by an injury (like stubbing the toe), alcohol, drugs an infection or illness. The pain usually strikes at night and gets worse over the next 8–12 hours. The symptoms ease after a few days and likely go away in 10 days. Some people never experience a second attack, but many people will have a second attack within a year.
3. Interval Gout:
This is the time between attacks. Although there’s no pain, the gout isn’t gone. Low-level inflammation may be damaging joints.
4. Chronic Gout:
Gout attacks happen more often for people who have high uric acid levels for 10 years or more. Pain comes and goes more frequently.
Gout Facts
Gout affects about 8 million adults.
Three out of four people with gout are men.
Gout tends to affect men between the ages 40 and 50.
Percentage of gout patients have a second attack within a year of diagnosis.
Diagnosis
A medical history, physical examination and blood tests are used to diagnose gout. The doctor needs to know:
- How severe the pain is.
- How quickly it started.
- How long it has been happening.
- Which joints are affected.
The doctor will need to rule out other reasons for the joint pain and inflammation such as an infection, injury or other type of arthritis. The doctor may also take an X-ray, do an ultrasound or order a magnetic resonance imaging scan (MRI) to examine soft tissue and bone. The doctor might also remove fluid from the painful joint and examine it under a microscope for uric acid crystals or bacteria indicating an infection.
Health Effects
Treatment
Treating an Acute Gout Attack
Here are the steps for getting the pain and swelling of a gout attack under control as quickly as possible:
- Call your doctor and make an appointment.
- Ice and elevate the joint.
- Drink plenty of fluids (no alcohol or sweet sodas).
- Reduce stress, which can worsen the attack.
- Ask friends and family to help you with daily tasks to ease stress on joints.
Medications for Acute Gout Attack
Here are the medications that your doctor may prescribe at the first sign of an attack:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to relieve the pain and swelling of an acute gout episode. They can shorten the attack, especially if taken in the first 24 hours.
- Corticosteroids – These drugs can be taken by mouth or injected into an inflamed joint to quickly relieve the pain and swelling of an acute attack. Corticosteroids usually start working within 24 hours after they are taken.
- Colchicine - This anti-inflammatory medicine works best if taken within the first 24 hours of a gout attack.
Reducing Uric Acid Levels
The doctor will wait until the acute attack ends before starting medications to reduce your uric acid levels. Sometimes, these drugs can cause an attack at first because uric acid levels drop and crystals in the joints shift. But sticking with the treatment plan is the best way to prevent future attacks. The doctor may prescribe a low, but regular dose of colchicine along with one of the medications below to prevent attacks.
Medications for Reducing Uric Acid Levels
The doctor will wait until the acute attack ends before starting medications to reduce your uric acid levels. Sometimes, these drugs can cause an attack at first because uric acid levels drop and crystals in the joints shift. But sticking with the treatment plan is the best way to prevent future attacks. The doctor may prescribe a low, but regular dose of colchicine along with one of the medications below to prevent attacks.
- Allopurinol (Zyloprim) reduces how much uric acid the body produces. It is often prescribed at a low daily dose at first, with the which is increased slowly over time if uric acid levels remain high. This drug comes in pill form.
- Febuxostat (Uloric) reduces how much uric acid the body produces. Like allopurinol, it’s started at a lower dose, which may be increased if uric acid levels remain high. This drug comes in pill form.
- Probenecid acts on the kidneys to help the body eliminate uric acid. The medication is taken twice daily and may be combined with febuxostat to boost effectiveness. This drug comes in pill form.
- Pegloticase (Krystexxa) is used when standard medications are unable to lower the uric acid level. It reduces uric acid quickly and to lower levels than other medications. The drug is administered every two weeks by intravenous (IV) infusion.
All drugs come with risks. To learn more about these drugs and their side effects, visit the drug guide.
Diet
Drink lots of water and avoid alcohol, beer, high-purine foods and sugary drinks to help reduce uric acid buildup.
Self Care
Adopting healthy lifestyle habits is a key part of an effective gout treatment plan. Eat a healthy diet, avoid or limit high-purine foods, do regular exercise and lose excess weight to lower your risk of repeated gout attacks.
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