Gout is considered one of the most intensely painful types of arthritis. Gout is characterized by sudden onset of severe pain, tenderness, warmth, redness, and swelling from inflammation of the affected joint. Gout usually affects a single joint and most often the big toe is affected (i.e. podagra). The knee, ankle, foot, hand, wrist, and elbow may also be affected. Shoulders, hips, and spine may eventually be affected by gout, but rarely. Other conditions which mimic gout include:
Causes of Gout:
Gout develops from an accumulation of excess uric acid in the body which causes uric acid crystals to deposit in the joints. Excess uric acid can result from increased uric acid production or decreased elimination of uric acid from the body. Certain purine-rich foods can cause an increase in uric acid levels. Some medications also can cause increased uric acid levels.
Symptoms Associated With Gout:
During an acute episode of gout, the patient may be startled by the suddenness and severity of joint pain and swelling. Often the first gout attack occurs at night. Observation of the foot may reveal red or purple shiny skin around the joint. Typically the gout attack goes away after 5-10 days. Without treatment, gout attacks may occur with more frequency and may last longer. Frequent gout attacks can damage the affected joint.
Diagnosis of Gout:
Proper diagnosis is important. Diagnosis is based on physical findings and diagnostic tests including the identification of characteristic crystals. Fluid is extracted from the affected joint and a microscopic examination revealing monosodium urate crystals would be consistent with the diagnosis of gout. Crystals known as tophi may also be found in deposits under the skin. Blood uric acid levels are less useful or definitive. The blood uric acid level can be normal or low during an attack or can be elevated in people who have never had a gout attack.
Treatment of Gout:
Treatment of gout involves medications and lifestyle modifications. Medications include:
- NSAIDs (nonsteroidal anti-inflammatory drugs) - used to decrease pain and inflammation
- Corticosteroids - for people who cannot take NSAIDs
- Probenecid and sulfinpyrazone - help kidneys eliminate uric acid (sulfinpyrazone is not currently available in the U.S.)
- Allopurinol - blocks production of uric acid
- Colchicine - for acute gout attacks or as a prophylactic
- Krystexxa - a biologic drug that works by breaking down uric acid
- Uloric - lowers serum uric acid levels by blocking an enzyme, xanthine oxidase
Lifestyle modifications are important: they include weight management, abstaining from alcohol, and avoiding meats, seafood and other foods high in purines.
Prevalence of Gout:
Gout is actually a disease with a long history. Benjamin Franklin reportedly suffered terribly from gouty arthritis. According to the Arthritis Foundation, approximately 2.1 million Americans are affected by gout. Though it can affect anyone at any age, gout typically affects men between 40 and 50 years old. Gout is nine times more common in men than women. As for women who have gout, the painful condition usually develops after menopause.
Points of Interest About Gout:
- Gout was once referred to as "the disease of kings" because it was thought to be rooted in overindulgence in the food and drink that only the rich could afford.
- Gout is strongly associated with obesity, hypertension, diabetes, and hyperlipidemia.
- Gout seems to run in families, indicating a genetic aspect.
- Risk factors for gout include: obesity or weight gain, heavy alcohol ingestion, high blood pressure, abnormal kidney function, and hypothyroidism.
- Other events which can precipitate a gout attack include taking certain medications, dehydration, fever, joint injury, and recent surgery.