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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 a type of arthritis. It occurs when uric acid builds up in blood and causes inflammation in the joints.

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

Causes

 

Gout is caused by having higher-than-normal level 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, and people who drink alcohol. As people become older, gout becomes more common.

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 a higher level 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 to put 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 will have another attack in the next 6 to12 months.

Some people may develop chronic gout. This is also called gouty arthritis. This condition can lead to joint 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 elbows, fingertips, and ears. Tophi can develop after a person has had gout 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

A uric acid level in the blood over 7 mg/dL is high. But, not everyone with a high uric acid level has gout.

 

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 indomethacin when symptoms begin. Talk to your health care provider about the correct dose. You will need stronger doses for a few days.

  • Your 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 provider 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.

You may need to take daily medicines such as allopurinol (Zyloprim), febuxostat (Uloric) or probenecid (Benemid) to decrease the uric acid level 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:

  • Decrease alcohol, especially beer (some wine may be helpful).
  • 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 take vitamin C supplements (may help some people).

 

Outlook (Prognosis)

 

Proper treatment of acute attacks and lowering uric acid to a level less than 6 mg/dL allows people to live a normal life. However, the acute form of the disease may progress to chronic gout if not treated.

 

Possible Complications

 

Complications may include:

  • 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 you may be able to avoid things that trigger symptoms. Taking medicines to lower uric acid can prevent progression of gout.

 

 

Open References

References

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: Elsevier Saunders; 2012:chap 95.

Choi HK. A prescription for lifestyle change in patients with hyperuricemia and gout. Current Opin Rheumatol . 2010;22(2):165-72. PMID: 20035225 www.ncbi.nlm.nih.gov/pubmed/20035225 .

Edwards NL. Clinical gout. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology . 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 188.

Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) . 2012;64(10):1431-46. PMID: 23024028 www.ncbi.nlm.nih.gov/pubmed/23024028 .

Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken) . 2012;64(10):1447-61. PMID: 23024029 www.ncbi.nlm.nih.gov/pubmed/23024029 .

 
  • Uric acid crystals

    Uric acid crystals - illustration

    These spiked rods are uric acid crystals photographed under polarized light. Increased uric acid blood levels and formation of uric acid crystals in the joints are associated with gout.

    Uric acid crystals

    illustration

  • Tophi gout in hand

    Tophi gout in hand - illustration

    Chronic symptoms such as joint deformity and limitation of motion in affected joints may occur if several attacks of gout occur each year. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. These tophi usually develop only after a patient has suffered from the disease for many years. Deposits also can occur in the kidneys, leading to chronic renal failure.

    Tophi gout in hand

    illustration

    • Uric acid crystals

      Uric acid crystals - illustration

      These spiked rods are uric acid crystals photographed under polarized light. Increased uric acid blood levels and formation of uric acid crystals in the joints are associated with gout.

      Uric acid crystals

      illustration

    • Tophi gout in hand

      Tophi gout in hand - illustration

      Chronic symptoms such as joint deformity and limitation of motion in affected joints may occur if several attacks of gout occur each year. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. These tophi usually develop only after a patient has suffered from the disease for many years. Deposits also can occur in the kidneys, leading to chronic renal failure.

      Tophi gout in hand

      illustration

    A Closer Look

     

    Self Care

     

      Tests for Gout

       
         

        Review Date: 4/28/2015

        Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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