Understanding Gout: Causes and Management

• Gout is a common and complex form of arthritis that can affect anyone
• It is characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe
• An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire
• Gout is more common in men, older adults, and people who are overweight
• There is no cure for gout, but it can be effectively managed with medication and lifestyle changes

Causes

• Gout occurs when urate crystals accumulate in a joint, causing inflammation and intense pain
• Urate crystals form when there are high levels of uric acid in the blood
• Uric acid is produced when the body breaks down purines
• Purines are found in the body and in certain foods, including red meat, organ meats like liver, and seafood
• Alcoholic beverages, especially beer, and fructose-sweetened beverages can elevate uric acid levels and increase gout risk
• Uric acid typically dissolves in the blood, passing through the kidneys into urine
• An overproduction of uric acid or insufficient excretion by the kidneys leads to buildup
• This buildup results in the formation of sharp, needle-like urate crystals in joints or surrounding tissue, causing pain, inflammation, and swelling

Risk factors

• Risk factors that increase uric acid levels in the body, and consequently the risk of gout:
  • Diet: A diet rich in red meat, organ meats, and seafood, along with beverages sweetened with fructose increases uric acid levels
  • Alcohol consumption: Beer and distilled liquors, especially in men, are associated with an increased risk
  • Weight: Being overweight increases the risk because the body produces more uric acid, and the kidneys struggle to eliminate it
  • Medical conditions: Specific diseases and conditions increase risk, including untreated hypertension, diabetes, obesity, metabolic syndrome, and heart and kidney diseases
  • Medications: Certain medications like thiazide diuretics and low-dose aspirin can elevate uric acid levels
  • Family history: A family history of gout increases the likelihood of developing the disease
  • Age and sex: Gout is more common in men due to lower uric acid levels in women, but after menopause, women's uric acid levels approach those of men

Complications

• Gout can lead to:
  • Recurrent gout: Some individuals may not experience further symptoms, while others have attacks several times a year
  • Advanced gout: Untreated gout can cause urate crystals to form under the skin as nodules called tophi, which can develop in areas like fingers, hands, feet, elbows, or Achilles tendons; these aren't usually painful but can become swollen and tender during attacks
  • Kidney stones: Urate crystals may collect in the urinary tract, causing kidney stones

Symptoms

• Gout signs and symptoms almost always occur suddenly, often at night, and include:
  • Intense joint pain: Gout typically affects the big toe but can occur in any joint, such as ankles, knees, elbows, wrists, and fingers; the pain is usually most severe within the first 4-12 hours
  • Lingering discomfort: After the severe pain subsides, joint discomfort may last from a few days to weeks; later attacks may last longer and affect more joints
  • Inflammation and redness: Affected joints become swollen, tender, and red
  • Limited range of motion: Gout progression can restrict normal joint movement

Diagnosis

• Tests to help diagnose gout may include:
  • Joint fluid test: A needle is used to draw fluid from the affected joint, which is then examined under a microscope to check for urate crystals
  • Blood test: A blood test is done to measure uric acid levels, but results can be misleading; some people with high uric acid levels never experience gout, while others with gout symptoms don't have unusual uric acid levels
  • X-ray imaging: X-rays can help rule out other causes of joint inflammation
  • Ultrasound: Musculoskeletal ultrasound can detect urate crystals in joints or tophi
  • Dual energy CT scan: This imaging type can detect urate crystals in joints, even when they are not inflamed

Treatment

• Gout medications can treat acute attacks and prevent future ones:
  • Medications used to treat acute attacks:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve); stronger NSAIDs are available by prescription
    • Colchicine: This anti-inflammatory drug can effectively reduce gout pain but may cause nausea, vomiting, and diarrhea
    • Corticosteroids: Medications like prednisone can control gout inflammation and pain and can be taken in pill form or injected into the joint
  • Medications to prevent gout complications:
    • Uric acid-lowering medications: Medications like allopurinol (Aloprim, Lopurin) and febuxostat (Uloric) limit the amount of uric acid the body produces; side effects of allopurinol include fever, rash, hepatitis, and kidney problems; febuxostat side effects include rash, nausea, and reduced liver function
    • Medications that improve uric acid removal: Probenecid helps the kidneys remove uric acid from the body more effectively; side effects include rash, stomach pain, and kidney stones

Lifestyle and home remedies

• During a gout attack:
  • Rest the joint: Avoid using the affected joint for a day or two
  • Elevate the joint: Elevating the affected joint will help reduce swelling
  • Apply ice: Apply ice to the inflamed joint for 20-30 minutes at a time, several times a day
  • Drink plenty of fluids: Staying hydrated will help the kidneys function properly and eliminate uric acid
• Lifestyle changes to prevent gout attacks:
  • Limit or avoid alcohol: Consult a doctor about safe alcohol consumption; beer is particularly associated with gout attacks
  • Limit intake of meat, poultry, and fish: Higher intake is associated with an increased risk of gout
  • Maintain a healthy weight: Losing weight can reduce uric acid levels

Prevention

• To prevent gout:
  • Stay well-hydrated: Drink plenty of water
  • Avoid sugary drinks: Limit consumption of sweetened beverages
  • Limit or avoid alcohol: If you drink alcohol, do so in moderation
  • Eat a balanced diet: Choose a diet low in purines and rich in fruits, vegetables, and whole grains
  • Maintain a healthy weight: Weight loss may help lower uric acid levels if overweight or obese