Gout is a form of arthritis that causes sudden, severe attacks of pain, tenderness, redness, warmth and swelling (inflammation) in some joints. It usually affects one joint at a time.

The large toe is most often affected, but gout can also affect other joints in the leg (knee, ankle and foot) and, less often, joints in the arm (hand, wrist and elbow). The fingers are rarely involved and the spine is almost never affected.

What are the symptoms of gout?

· Sudden, intense joint pain, which often first occurs in the early morning hours
· Swollen joint that is warm to touch
· Red or purple skin around the joint

What causes gout?

Gout was once incorrectly thought to be a disease of the rich and famous, caused by consuming too much rich food and fine wine. Although diet and excessive drinking contribute to gout, they are not the main cause of the disorder.

Gout results from abnormal deposits of sodium urate crystals in the joint cartilage that are later released into the joint fluid. Uric acid crystals, which are related to sodium urate, also can form in the kidney, causing kidney stones.

Sodium urate is formed from uric acid, a natural chemical in the body. Uric acid comes from the natural breakdown of RNA (ribonucleic acid) and DNA (deoxyribonucleic acid), the genetic material in cells. Some foods contain large amounts of uric acid, especially red meats and organ meats (such as liver and kidneys), some shellfish and anchovies.

Uric acid in normal amounts remains dissolved in the blood, and easily passes through the kidneys and leaves the body as waste. Uric acid in high amounts, however, makes a person more likely to develop gout.

The amount of uric acid in your blood can change depending on what you eat, your overall health, how much alcohol you drink, what medicines you are taking or sudden illness. Not everyone with high levels of uric acid will develop gout. The kidneys' ability to rid the body of uric acid is partly determined by heredity. Yet, just because someone in the family suffers from gout does not mean everyone in that family will have the disease. Often, the effect of heredity is modified by the risk factors mentioned above that affect uric acid, as well as male gender and age. All of these factors increase the risk of gout.

How frequent are gout attacks?

Gout attacks can recur from time to time in the same joint. The initial attack may last several days to two weeks unless treated.

Over time, gout attacks may occur more often, involve more joints, have more severe symptoms and last longer. Repeated attacks can damage the joint.

Some people will have only a single attack. However, approximately 90 percent of patients who have one gout attack will have at least a second attack, although it may not occur for several years after the initial attack. Others may have attacks every few weeks.

Who is affected by gout?

Gout affects more than 1 million Americans, including men usually over age 30, people who are overweight, people who frequently drink alcohol and people who use diuretics ("water pills") to lower blood pressure or to treat heart disease.

When gout affects women, it is usually after menopause, especially in women who are taking certain medications. Less often, younger patients may be affected by gout if they have been taking certain medications for long periods of time, frequently drink alcoholic beverages or have certain genetic disorders.

How is gout diagnosed?

Gout cannot be diagnosed simply from a blood test, because many people have elevated blood uric acid levels but do not have gout. Rather, gout is diagnosed from the fluid of an inflamed joint. The fluid is observed under a microscope for sodium urate crystals.

Fluid is removed from the inflamed joint through a needle during a procedure called arthrocentesis. Removing the fluid may reduce pressure within the joint and thereby reduce pain.

If crystals are not seen, the diagnosis of gout cannot be made with certainty. Occasionally, crystals may not be observed the first time, but may be seen if additional fluid is removed at another time during a subsequent attack.

Since gout can cause chronic joint pain and involve other joints, it is extremely important that an accurate diagnosis be made. Then your physician can prescribe the appropriate treatment.

How is gout treated?

There is no cure for gout, but it can be treated and controlled. Symptoms are often relieved within 24 hours after treatment has begun.

The goals of treatment are to relieve pain and inflammation, and prevent future gout attacks which could lead to permanent joint damage.

The type of treatment prescribed will depend on several factors, including the person's age, type of medications he or she is taking, overall health, medical history and severity of gout attacks.

Gout is mainly treated with the following medications.

Anti-inflammatory drugs

Anti-inflammatory medications are usually continued until the gout attack completely resolves. If side effects from the therapy occur, treatment may be changed to a different medication. Your health care provider will discuss the potential side effects with you.

· Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen are generally prescribed to treat sudden and severe gout attacks. NSAIDs usually reduce inflammation and pain within hours.

· Corticosteroids (also called steroids) may be prescribed for people who cannot take NSAIDs. Steroids also work by decreasing inflammation. Steroids can be injected into the affected joint or given as pills.

· Colchicine can be used either in moderate doses to treat an acute or attack or sometimes in low doses for a long period of time to reduce the risk of recurrent attacks.

Drugs that affect uric acid levels

Some patients may need to take medications that lower the uric acid in the blood. Examples are allopurinol or probenecid.

These drugs are recommended for patients who have had multiple attacks of gout or kidney stones due to uric acid. The goal of lowering the blood uric acid is to slowly dissolve deposits of sodium urate in the joint.

Sudden lowering of the uric acid level may cause an acute attack of gout. To prevent acute attacks in people who are taking uric acid-lowering drugs, colchicine or a NSAID is temporarily prescribed.

In addition, uric acid-lowering therapy (with allopurinol or probenecid) is not started during a gout attack, since sudden lowering of the uric acid can cause a new attack or prolong an existing one.

Side effects of medications

Not all patients will develop side effects from gout medications. How often any side effect occurs varies from patient to patient. The occurrence of side effects depends on the dose, type of medication, concurrent illnesses or other medications the patient may be taking.

Some side effects are more serious than others. Before any medication is prescribed, your health-care provider will discuss with you the potential benefits and risks of taking the medication.

Can gout be treated through diet?

Dietary changes for most people do not play a major role in controlling their uric acid levels. However, limiting certain foods that cause an increased production of uric acid and reducing alcohol intake is often helpful.

Source: 96.