Gout is a form of arthritis that often occurs on the joint of the big toe. It occurs suddenly with the affected joint getting very red, swollen, and painful. While the toe is frequently affected because it is the furthest body tissue from the heart and is therefore the coolest part of the body, gout can actually affect other joints as well. Other affected areas include the ankle, heel, knee, wrist, fingers, elbow, and instep.
Gout occurs when higher than normal uric acid develops in the blood. Uric acid is a substance that occurs naturally in the body from the breakdown of cells as well as in response to certain foods that contain high levels of purines. When the body cannot eliminate enough uric acid through the kidneys the level can increase and in some patients cause symptoms of gout. The higher levels of uric acid can then cause urate crystals to form in a joint and this produces the symptoms of gout. Because uric acid is eliminated by the kidneys, sometimes uric acid crystals can form in the kidney and cause kidney stones.
Attacks can last for 3 to 10 days. Generally the pain is the most intense in the first 12 to 24 hours and then it gradually will lessen. People who experience frequent gout attacks may have each attack last longer and occur more frequently.
Certain people are more at risk for developing gout. Men are more likely to be affected by gout and can experience attacks in their 30’s to 50’s, whereas women in general are less likely to be affected. Gout before menopause in women is not common. Genetics play a role in determining who could suffer from gout. A family history of gout attacks puts a person at a much higher risk having an attack. Other factors such as obesity, diabetes, and uncontrolled high blood pressure/heart disease play a role. Some medications can cause gout in some patients. These include thiazide diuretics, aspirin, cyclosporine, niacin, and levodopa.
Several foods high in a substance known as purines can increase uric acid and cause gout. These can include some meats, seafood such as scallops, alcohol (especially red wine and beer), and fructose sweetened drinks. Other foods high in purines include asparagus, mushrooms, and dried beans/peas. These vegetables, however, are less likely to cause an increase in uric acid levels.
Normal uric acid levels in the blood are 2.4 to 6mg/dl for women and 3.4 to 7mg/dl in men. This range may vary slightly between different labs. It is important to note that some patients can have elevated uric acid levels and have no gout attacks, as well as some people may have gout attacks with normal uric acid levels. Any swelling or redness in an affected body part accompanied by a fever is usually not gout and should be evaluated for a possible infection instead. There is also another health issue called pseudo gout with similar symptoms but a different cause. Pseudo gout is caused from calcium phosphate crystals instead and has a completely different treatment.
Gout can be diagnosed by examination by a physician and usually confirmed with a blood test or by the provider drawing a sample of fluid from the affected joint to examine for the urate crystals. People who suffer from gout can help prevent attacks by trying to avoid foods high in purines as well as maintaining adequate fluid intake daily, about 2 to 4 liters. Limiting or avoiding consumption of alcohol as well as beef, bacon, pork, scallops, sardines, and gravy. Low carbohydrate diets can worsen uric acid levels. Patients should try to keep an ideal body weight, and low fat dairy products are good to consume.
There are several drugs that can treat acute attacks of gout as well as some that can hopefully prevent attacks. During an acute attack, the symptoms can be treated with NSAIDS (non-steroidal anti-inflammatory), such as naproxen, ibuprofen, celecoxib, or indomethacin. Colchicine, a potent but different anti-inflammatory is often used as well as occasional steroids like prednisone or methylprednisolone for patients who can’t take NSAIDS. For people who continue to have elevated uric acid levels, other drugs called xanthine-oxidase inhibitors are used. Xanthine-oxidase inhibitors help to block uric acid production; these are allopurinol and febuxostat (Uloric). Interestingly enough, these two drugs are generally not used during acute attacks of gout because they often can worsen the symptoms of gout. Occasionally an older remedy called probenecid is utilized. This drug removes uric acid through the kidneys, but can cause kidney stones so it is not used frequently any longer.
Gout attacks can happen once or become a chronic health condition for some people. Chronic gout attacks can actually cause the urate crystals to form tophi, which are nodules in various areas of the body. These to can become inflamed and aggravated with each gout attack.
Chronic gout can be debilitating and cause permanent damage to the joint. Luckily with the proper preventative treatment, diet, healthy weight/blood pressure/blood sugar, and hydration, many gout attacks can be minimized or prevented.