Gout is considered one of the most painful types of arthritis. Along with pain, gout can cause swelling, redness, heat and stiffness in joints. There are other types of arthritis which can mimic gout symptoms, making it very important to get an accurate diagnosis so that proper treatment can begin. There are 10 things you should know about gout.
1 - Gout is accurately diagnosed through the identification of characteristic crystals.
Gout attacks develop when excess uric acid accumulates in the body and crystals are deposited in the affected joints. The big toe is often the first joint affected. A microscopic examination of joint fluid reveals the presence of monosodium urate crystals. Tophi, deposits of uric acid under the skin, also can develop, especially in advanced gout.
2 - Blood uric acid levels can be misleading.
During a gout attack, blood uric acid levels can be low or temporarily normal. Also, blood uric acid levels are often high (known as hyperuricemia) in people who do not have gout.
3 - Though the big toe is the most common joint affected by gout, ankles, heels, insteps, wrists, and knees can also be affected.
It's important to understand the stages of gout so you recognize when gout symptoms are affecting one of your joints:
- asymptomatic hyperuricemia - high level of blood uric acid without any symptoms of gout
- acute intermittent gout - one joint is painful, swollen, and hot, which without treatment may last 2 weeks or less (even less with treatment)
- chronic tophaceous gout - affected joint is uncomfortable and swollen much of the time; more than one joint may become involved; crystals begin to form tophi; kidney stones may develop
4 - Uric acid results from the breakdown of purines. Purines are part of all human tissue and found in many foods.
Excess uric acid can be caused by either an over-production of uric acid by the body or the under-elimination of uric acid by the kidneys. About 10 percent of people with hyperuricemia (high blood levels of uric acid) produce too much uric acid. More than 90 percent of people who have gout do not excrete enough uric acid in their urine.
5 - There are certain triggers which can cause a gout attack.
Among the potential triggers of gout attacks are:
- Medications which affect kidney function
- Loop and thiazide diuretics which alter kidney function
- Cyclosporine which is given to organ transplant recipients
- Low-dose aspirin can raise blood uric acid levels
- Urate-lowering drugs, such as allopurinol and probenecid (the sharp fall in uric acid can be a trigger)
- Obesity, hypertension (high blood pressure), hyperlipidemia (high blood fats), and diabetes
- Alcohol consumption
- Joint injury, surgical stress, acute medical illness
- Fad diets, fasting, and dehydration
- Lead exposure
- Body temperature (gout tends to form in colder body parts)
6 - For gout to be treated successfully, there are four goals of treatment.
To attain a successful treatment outcome for gout:
- acute attacks must be stopped
- pain and inflammation must be relieved quickly
- future attacks must be prevented
- tophi, kidney stones, and renal disease must be prevented
7 - Treating an acute gout attack can involve resting the affected joint and taking prescribed medications.
NSAIDs, and especially indomethacin, are commonly prescribed during an acute gout attack to control inflammation. Colchicine, a preferred treatment for acute gouty arthritis and most effective if given early in the attack, can provide pain relief within 48 hours. Prednisone or ACTH (adrenocorticotropic hormone) can be given to patients who cannot take NSAIDs or colchicine.
8 - To prevent future attacks, diet and lifestyle changes, along with urate-lowering medications, can be helpful.
Allopurinol is usually prescribed for people who over-produce uric acid and have tophi. Allopurinol blocks production of uric acid. Probenecid helps kidneys eliminate uric acid and is prescribed to patients with good kidney function, no history of kidney stones, who are willing to drink 2 liters of fluids on a daily basis. People who have chronic gout typically require lifetime treatment with drugs in order to lower uric acid levels. In 2010, Krystexxa was FDA-approved as a gout treatment option.
9 - Prevalence statistics from the Arthritis Foundation indicate that 2.1 million Americans are affected by gout.
Gout actually accounts for 5 percent of all arthritis cases. Men who are 40-59 years old are the most likely group to develop gout. Women also can develop gout but usually not until after menopause. Gout is uncommon in children and young adults.
10 - Unless gout is properly managed it can affect the patient's life and work productivity.
One published study concluded that gout had a significant impact on work absence and work productivity. In the study, employees with gout had 4.56 more annual absence days than people without gout.
Gout. American College of Rheumatology. 6/2006.
Gout. Arthritis Foundation. 8/26/2007.
What is Gout? NIAMS. 3/2007.
Questions and Answers About Gout. NIAMS. 12/2006.
The Impact of Gout on Work Absence and Productivity. Value in Health. July/Aug 2007.