The basics of gout: A crash course

06/24/2014 6:41 AM

08/08/2014 10:25 AM

For those who have ever suffered the excruciating onset of gout, the symptoms are undeniable. For the rest of us, the condition may be something of a mystery. If you know someone who endures gout flare-ups and have wondered what they are dealing with, or if you have sudden onset pain, swelling and redness in your joints, here is a crash course on the condition.

What is gout?

Gout – a complex form of arthritis – is characterized by sudden, severe attacks of pain, redness and tenderness in joints, frequently in the joint at the base of the big toe. Men are more likely to get gout, but women become increasingly susceptible after menopause.

An acute attack of gout can wake you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

What causes gout?

Gout occurs when uric acid (monosodium urate) crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Your body produces uric acid when it breaks down substances that are found naturally in your body, as well as in certain foods, such as organ meats, anchovies, herring, asparagus and mushrooms.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue resulting in pain, inflammation and swelling. You’re more likely to develop gout if you have high levels of uric acid in your body.

Factors that increase the uric acid level in your body include:

• Lifestyle choice. Excessive alcohol use – generally more than two drinks a day for men and more than one for women.
• Certain diseases and medical conditions – includes untreated high blood pressure (hypertension) and chronic conditions such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
• Certain medications – use of thiazide diuretics (commonly used to treat hypertension) and low-dose aspirin. The use of anti-rejection drugs, prescribed for people who have undergone an organ transplant, can also increase risk.
• Family history of gout.

Warning signs

Symptoms are almost always acute, occurring suddenly – often at night – and without warning:

• Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first 12 to 24 hours after it begins.
• Continued discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Inflammation and redness. The affected joint or joints become swollen, tender and red.

When to see a doctor

• If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage.
• Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.
• Recurrent gout can potentially result in long-term joint damage or kidney damage

Treatment

• Rest the affected joint(s).
• Use ice to reduce swelling.
• Take short-term medicines at the first sign of a gout attack, as prescribed by your doctor, such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or oral corticosteroids.
• Your doctor may prescribe long-term medications to help prevent gout attacks for recurrent gout.

Reducing your risk

Manage your weight, get exercise and limit alcohol, meat and seafood.

If you or someone you know is experiencing the symptoms of gout, see a physician.

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