By National Institute of Arthritis and Musculoskeletal and Skin Diseases
Gout, one of the most painful forms of arthritis. Gout is caused by having higher-than-normal levels of uric acid in your body. Gout occurs when the bodily waste product uric acid is deposited crystals in the joints or soft tissues. These uric acid crystals cause inflammatory arthritis in the joints, which in turn leads to intermittent swelling, redness, heat, pain, and stiffness.
Gout attacks often follow eating foods like shellfish, liver, dried beans, peas, anchovies, or gravy. Using alcohol, being overweight, and certain medications may also make gout worse. In older people, some blood pressure medicines can also increase your elderly mom or dad's chance of a gout attack.
Gout is most often a problem in the big toe, but it can affect other joints, including the ankle, elbow, knee, wrist, hand, or other toes. Swelling may cause the skin to pull tightly around the joint and make the area red or purple and very tender. Your doctor might suggest blood tests and x-rays. He or she might also take a sample of fluid from your aging parent's joint while you are having an attack.
Signs of Gout
- Presence of uric acid crystals in joint fluid
- More than one attack of acute arthritis
- Arthritis that develops in a day, producing a swollen, red, and warm joint
- Attacks of arthritis in only one joint, often the toe, ankle, or knee
What Causes Gout?
Many people with gout have a family history of the disease. Estimates range from 20 to 80 percent.
Gout is more common in men than in women.
Being overweight increases the risk of developing gout because there is more tissue available for turnover or breakdown, which leads to excess uric acid production.
- Alcohol Consumption
Drinking too much alcohol interferes with the removal of uric acid from the body.
Eating too many foods that are rich in purines can cause or aggravate gout.
- Lead Exposure
In some cases, exposure to lead in the environment can cause gout.
- Other Health Problems
Renal insufficiency, high blood pressure, hypothyroidism (underactive thyroid gland), psoriasis, hemlytic anemia, or some cancers can raise a person's risk.
Medications may put people at risk for developing hyperuricemia and gout are: Diuretics, Salicylate-containing drugs, such as aspirin, Niacin, a vitamin also known as nicotinic acid, Cyclosporine, a medication that suppresses the body's immune system and Levodopa, a medicine used in the treatment of Parkinson's disease.
Treatments for Gout
With proper treatment, most people who have gout are able to control their symptoms and live productive lives. Gout can be treated with one or a combination of therapies. The goals of treatment are to ease the pain associated with acute attacks, to prevent future attacks, and to avoid the formation of tophi and kidney stones. Successful treatment can reduce discomfort caused by the symptoms of gout, as well as long-term damage to the affected joints. Treatment will help to prevent disability due to gout.
The most common treatments for an acute attack of gout are nonsteroidal anti-inflammatory drugs (NSAIDs) taken orally (by mouth), or corticosteroids, which are taken orally or injected into the affected joint. NSAIDs reduce the inflammation caused by deposits of uric acid crystals, but have no effect on the amount of uric acid in the body.
Corticosteroids are strong anti-inflammatory hormones. The most commonly prescribed corticosteroid is prednisone. Patients often begin to improve within a few hours of treatment with a corticosteroid, and the attack usually goes away completely within a week or so.
When NSAIDs or corticosteroids do not control symptoms, the doctor may consider using colchicine. This drug is most effective when taken within the first 12 hours of an acute attack.
The doctor also may consider prescribing medicine such as allopurinol, probenecid, or febuxostat to treat hyperuricemia and reduce the frequency of sudden attacks and the development of tophi.
People who have other medical problems, such as high blood pressure or high blood triglycerides (fats), may find that the drugs they take for those conditions can also be useful for gout. Both losartan, a blood pressure medication, and fenofibrate, a triglyceride-lowering drug, also help reduce blood levels of uric acid.
The doctor may also recommend losing weight, for those who are overweight; limiting alcohol consumption; and avoiding or limiting high-purine foods, which can increase uric acid levels.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, and the dissemination of information on research progress in these diseases.