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Doc Talk Doc Talk: Prevention and treatment of gout

  • Published Tuesday, Dec. 18, 2012, at 2:44 a.m.

Just about everyone has heard of someone who has had an attack of gout, but what exactly is it?

Gout is a condition that causes severe pain in a joint due to deposits of urate crystals (uric acid) into a joint. This is due to high levels of uric acid in the blood. Gout can affect any joint in the body, but most commonly the big toe, feet, ankles, fingers, elbows, wrists or knees.

So who is at risk for gout? It affects men much more often than women and is more common as people age. Several conditions are associated with gout, including obesity, medications that increase uric acid levels (especially diuretics), high blood pressure, recent surgery and fasting. Also associated with gout are excessive consumption of red meat, seafood and soda, and excessive consumption of alcohol on a regular basis.

Symptoms of gout include sudden swelling, redness and severe pain in a joint. The pain is usually the worst at the beginning of the attack and generally decreases over a period of days to weeks. Gout typically affects one joint at a time, but can occasionally affect more than one. A second attack typically occurs within a couple of years. If untreated, gout can begin to occur frequently and cause severe deformities of joints and damage to the bones. Gout can also lead to the complication of kidney stones, as the uric acid crystals can be formed into stones within the kidneys.

How is gout diagnosed? The best way is the use of a needle to obtain fluid from the affected joint to check for urate crystals. However, this is not always necessary and is frequently not done because of limitations of a clinic or to avoid patient discomfort. Gout can be diagnosed by symptoms and by checking blood levels for uric acid.

How is gout treated? Medications that reduce pain and inflammation (NSAIDS) such as naproxen, ibuprofen and indomethacin are the best options and work better the sooner they are started. Aspirin is not generally recommended because it has the ability to raise uric acid levels in the blood. Colchicine is a prescription drug that can be used for treatment and can be taken on a regular basis to prevent gout. Steroids can be used to treat patients who can’t take NSAIDS or colchicine. Other medications that can help prevent gout are allopurinol, febuxostat and probenecid.

Dietary changes, such as limiting consumption of high-fructose corn syrup (soda and sweets), red meat, seafood and alcohol, can help control gout.

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