Gout is a form of arthritis that causes severe pain and swelling in the joints. It most commonly affects the big toe, but may also affect the heel, ankle,hand, wrist, or elbow. Gout usually comes on suddenly, goes away after 5-10days, and can keep recurring. It is different from other forms of arthritis because it occurs when there are high levels of uric acid circulating in the blood, which can cause urate crystals to settle in the tissues of the joints.
Normally the kidneys filter uric acid out of the blood and excrete it in theurine. Sometimes, however, the body produces too much uric acid or the kidneys aren't efficient enough at filtering it, and it builds up in the bloodstream. A person's susceptibility to gout may be inherited, or result from being overweight and eating a rich diet. In some cases, another disease (such as lymphoma, leukemia, or hemolytic anemia) may be the underlying cause.
An excess of uric acid doesn't always cause gout. However, over years, sharpurate crystals build up in the joints. Often, an infection, surgery, a stubbed toe, a heavy drinking binge, or some other event can lead to inflammation--the redness, swelling, and pain that are the hallmarks of a gout attack.
Often, the attack begins in the middle of the night. The pain can be so excruciating that the sufferer cannot bear weight on the joint or tolerate the pressure of bedcovers. The inflamed skin over the joint may be red, shiny, and dry, and there may be mild fever. These symptoms may go away in about a week and disappear for months or years. However, over time, attacks of gout recur more and more frequently, last longer, and affect more joints. Eventually, stone-like deposits may build up in the joints, ligaments, and tendons, leadingto permanent joint deformity and decreased motion. An excess of uric acid canalso cause kidney stones.
Gout affects an estimated one million Americans. It most commonly afflicts men (800,000 men versus 200,000 women). Uric acid levels tend to increase in men at puberty, and, because it takes 20 years of high levels to cause gout symptoms, men commonly develop gout in their late 30s or early 40s. Womentend to develop gout later in life, starting in their 60s. According to somemedical experts, estrogen protects against gout, and when estrogen levels fall during menopause, urate crystals can begin to build. Excess body weight, regular excessive alcohol intake, the use of blood pressure medications calleddiuretics, and high levels of certain fatty substances in the blood can all increase risk of gout.
Usually, doctors can diagnose gout based on the physical examination and medical history. They can also administer a test that measures the level of uricacid in the blood. The most definitive way to diagnose gout is to take a sample of fluid from the joint and test it for urate crystals.
Temporary attacks of gout can be treated with nonsteroidal anti-inflammatorydrugs (NSAIDs) such as naproxen sodium (Aleve), ibuprofen (Advil), or indomethacin (Indocin). In some cases, these drugs can aggravate a peptic ulcer or existing kidney disease and cannot be used. Doctors sometimes also usecolchicine (Colbenemid). Corticosteroids such as prednisone (Deltasone) and adrenocorticotropic hormone (Acthar) may be given orally or may be injected directly into the joint for more concentrated effect. While all of these drugshave potential side effects, they are used for only about 48 hours and are not likely to cause major problems. Aspirin and closely related drugs (salicylates) should be avoided because they can worsen gout.
Once an acute attack has been successfully treated, doctors try to prevent future attacks and long-term joint damage by lowering uric acid levels in the blood. Uricosuric drugs, such as probenecid (Benemid) and sulfinpyrazone (Anturane), lower the levels of urate in the blood by increasing its removal fromthe body (excretion) through the urine. These drugs may promote formation ofkidney stones and may not work for all patients, especially those with kidneydisease. Allopurinol (Zyloprim), blocks the production of urate in the body,and can also dissolve kidney stones. Once people begin taking these medications they must take them for life or the gout will continue to return.
Gout cannot be cured but usually it can be managed successfully. In some cases, however, medicines alone do not dissolve the uric acid deposits and they must be removed surgically. In addition to taking pain medications as prescribed by their doctors, people having gout attacks are encouraged to rest and toincrease the amount of fluids that they drink.
For centuries, gout has been known as a "rich man's disease," implying overindulgence in food and drink. While this is perhaps a little oversimplified, lifestyle factors clearly influence a person's risk of developing gout. Since obesity and excessive alcohol intake are associated with gout, losing weight and limiting alcohol intake can help reduce risk. Dehydration may also promotethe formation of urate crystals, so people taking diuretics or "water pills"may be better off switching to another blood pressure medication, and everyone should be sure to drink at least six to eight glasses of water each day. It may also be helpful to avoid foods high in purine, such as organ meats, sardines, anchovies, red meat, gravies, beans, beer, and wine.