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    Gout

    Gouty arthritis - acute; Gout - acute; Hyperuricemia; Tophaceous gout; Tophi; Podagra; Gout - chronic; Chronic gout; Acute gout; Acute gouty arthritis

    Gout is atype of arthritis. It occurs when uric acid builds up in blood and causes inflammation in the joints.

    • Acute gout is a painful condition thatoften affects only one joint.
    • Chronic gout is repeated episodes of pain and inflammation. More than one joint may be affected.

    Causes

    Gout is caused by having higher-than-normal levels of uric acid in your body. This may occur if:

    • Your body makes too much uric acid
    • Your body has a hard time getting rid of uric acid

    If too much uric acid builds up in the fluid around the joints (synovial fluid), uric acid crystals form. These crystals cause the joint to swell and become inflamed.

    The exact cause is unknown. Gout may run in families. The problem is more common in men, in women after menopause, andpeople who drink alcohol.

    The condition may also develop in people with:

    • Diabetes
    • Kidney disease
    • Obesity
    • Sickle cell anemia and other anemias
    • Leukemia and other blood cancers

    Gout may occur after taking medicines that interfere with the removal of uric acid from the body. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have higher levels of uric acid in the blood.

    Symptoms

    Symptoms of acute gout:

    • Only one or a few joints are affected. The big toe, knee, or ankle joints are most often affected.
    • The pain starts suddenly, often during the night. Pain is often described as throbbing, crushing, or excruciating.
    • The joint appears warm and red. It is usually very tender and swollen (it hurts toput a sheet or blanket over it).
    • There may be a fever.
    • The attack may go away in a few days, but may return from time to time. Additional attacks often last longer.

    People will have no symptoms after a first gout attack.Many people willhave another attack in the next 6-12 months.

    Some people may develop chronic gout. This is also called gouty arthritis. This condition can lead tojoint damage and loss of motion in the joints. People with chronic gout will have joint pain and other symptoms most of the time.

    Tophi are lumps below the skin around joints or other places such as the finger tipsand ears. Tophi can develop after a person has hadgout for many years. These lumps may drain chalky material.

    Exams and Tests

    Tests that may be done include:

    • Synovial fluid analysis (shows uric acid crystals)
    • Uric acid - blood
    • Joint x-rays (may be normal)
    • Synovial biopsy
    • Uric acid - urine

    Not everyone with high uric acid levels in the blood has gout. A level over 7 mg/dL is high.

    Treatment

    Take medicines for gout as soon as you can if you have a sudden attack.

    Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or indomethacinwhen symptoms begin. Talk to your health care provider about the correct dose. You will need stronger doses for a few days.

    • Your health care provider may prescribe strong painkillers such as codeine, hydrocodone, and oxycodone.
    • A prescription medicine called colchicine helps reduce pain, swelling, and inflammation.
    • Corticosteroids (such as prednisone) can also be very effective. Your doctor may inject the inflamed joint with steroids to relieve the pain.
    • The pain often goes away within 12 hours of starting treatment. Most of the time all pain is gone within 48 hours.

    Your doctor may prescribe medicines you take daily (such as allopurinol or probenecid) to decrease uric acid levels in your blood. You may need these medicines if:

    • You have several attacks during the same year or your attacks are quite severe.
    • You have damage to joints.
    • You have tophi.
    • You have kidney disease or uric acid kidney stones.

    Diet and lifestyle changes may help prevent gouty attacks:

    • Decreasealcohol, especially beer (some wine may behelpful).
    • Lose weight.
    • Exercise daily.
    • Limit your intake of red meat and sugary beverages.
    • Choose healthy foods such as dairy products, vegetables, nuts, legumes, fruits (less sugary ones), and whole grains.
    • Drink coffee and takevitamin C supplements (may help some people).

    Outlook (Prognosis)

    Proper treatment of acute attacks allows people to live a normal life. However, the acute form of the disease may progress to chronic gout.

    Possible Complications

    • Chronic gouty arthritis
    • Kidney stones
    • Deposits in the kidneys, leading to chronic kidney failure

    When to Contact a Medical Professional

    Call your health care provider if you have symptoms of acute gouty arthritis.

    Prevention

    You may not be able to prevent gout but may be able to avoid things that trigger symptoms.

    References

    Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care & Research. 2012;64(10):1431-46.

    Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care & Research. 2012;64(10):1447-61.

    Choi HK. A prescription for lifestyle change in patients with hyperuricemia and gout. Current Opinion in Rheumatology. 2010;22(2):165-72.

    Burns CM, wortmann RL. Clinical features and treatment of Gout. In: Firestein GS, Budd RC, Gabriel SE, et al, eds.Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa: Saunders Elsevier;2012:chap 95.

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    • Uric acid crystals

      illustration

      • Uric acid crystals

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      A Closer Look

      Self Care

        Tests for Gout

          Review Date: 4/20/2013

          Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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