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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Gout

What is it?

Gout is a systemic disorder (that is, one potentially affecting the entire body), marked by elevated blood levels of uric acid, one of the body's waste products. This buildup in the blood can be caused by over production of uric acid, impaired excretion of it in the urine, or sometimes a combination of both. As it accumulates, uric acid may form crystals in the joints. Thus, gout is often first recognized by inflammation of a single joint. The immune system typically reacts to these crystals as if they were foreign invaders and releases substances that produce inflammation. The affected joint becomes swollen, red, warm, and severely painful. Often the first episode of gout affects the base of the big toe (this joint is eventually affected in 90 percent of patients).

Although symptoms gradually subside within a week, subsequent attacks are likely. These generally strike with no warning, occur with increasing frequency, and affect a number of joints, including the knees, elbows, wrists, and those of the hands and feet. Significantly elevated uric acid levels in the blood, if untreated, may result in kidney stones or deposition of uric acid in the kidneys, possibly causing kidney failure. About 90 percent of those affected with gout are adult men. In women, the disorder usually strikes after menopause.

What Causes It?

  • Genetic factors are often involved; one in four gout sufferers has a family history of the disorder.
  • A kidney malfunction may result in a buildup of uric acid and thus an attack of gout.
  • Low doses of aspirin, certain antibiotics, diuretics, and alcohol may raise uric acid levels.
  • Foods high in purines (like liver, anchovies, kidneys, and sweetbreads) may raise uric acid levels.
  • Obesity and high blood pressure are risk factors.
  • Trauma and surgery may also be associated with an acute gout attack.
  • Chemotherapy may raise uric acid levels as it rapidly destroys cells.

Prevention

  • There is no way to prevent gout, but after the first attack, the risk of recurrences can be minimized.
  • Daily doses of colchicine can reduce the frequency of episodes.
  • Control your weight, but do not fast; fasting may raise uric acid levels.
  • Avoid excessive alcohol consumption.
  • If possible, medications that raise uric acid should be changed to others that do not.
  • Several medications, including allopurinol (which blocks uric acid formation) and the drugs probeneid and sulfinpyrazone (which increase uric acid excretion in the urine), reduce uric acid levels.

Diagnosis

  • To confirm the diagnosis, fluid from the affected joint will be removed and analyzed for the presence of uric acid crystals and to rule out an infection.
  • Blood samples will be taken and measured for uric acid levels. However, the blood uric acid level may be normal during a gouty attack, and an elevated uric acid level by itself does not establish the diagnosis of gout.
  • X-rays are taken to look for permanent joint damage in people with chronic gout.

How to Treat It

  • NSAIDs (nonsteroidal anti-inflammatory drugs) are the treatment of choice for gout.
  • A doctor may prescribe colchicine to relieve pain and decrease swelling during an acute episode. The drug is taken hourly until symptoms subside or side effects (nausea, vomiting, cramps, diarrhea) begin. Colchicine works best when started within minutes or hours of an attack.
  • Your doctor may prescribe more powerful analgesics, including codeine or meperidine, for rapid relief of severe pain.
  • Corticosteroids may be administered in pill form, intravenously, or by direct injections into the joint.
  • Bed rest may be necessary for about 24 hours after symptoms abate, since movement can induce inflammation and trigger another attack. Make a small "tent" of the bedding to keep it from touching the affected area.

When to Call a Doctor

  • Call a doctor if you experience any of the symptoms of gout.