All About Gout

What is gout? 

Once called the “disease of kings,” gout has long been associated with portly men – especially those who could afford to overindulge in rich foods and alcohol. But, in truth, gout can be a royal pain for both men and women, regardless of wealth or body size.

Gout occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee, before becoming chronic. In its chronic stage, gout can affect many joints, including those of the hands. Other problems related to gout can include the formation of tophi, or lumps of crystals under the skin, in the joints and in bone; kidney stones; and impaired kidney function.

Who gets gout? 

Gout affects an estimated 2.1 million Americans. Men in their 40s and 50s are most likely to develop gout. But by age 60, gout affects men and women roughly equally. After age 80 more women than men have gout.

High uric acid levels (hyperuricemia), which can lead to gout, occur for one of two reasons: the body produces too much uric acid or the body is not efficient at excreting uric acid in the urine. For more than 90 percent of people with gout, the cause is the latter. There are certain inborn errors of metabolism that can cause hyperuricemia, but these genetic disorders account for a very small fraction of people with gout.

Diagnosing and treating gout

Because the joint inflammation of gout can resemble that of a joint infection or other form of arthritis, diagnosing gout requires removing a small amount of fluid with a syringe from the joint and examining it under a microscope for uric acid crystals.

When a diagnosis is made, your doctor can recommend a gout treatment plan to stop acute attacks, rapidly relieve pain and inflammation, avert future attacks and prevent the development of tophi, kidney stones and kidney disease.

Gout treatment will likely involve anti-inflammatory medications – such as corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine – to relieve acute pain and inflammation as well as urate-lowering drugs – such as allopurinol (Aloprim, Zyloprim) or probenecid (Benemid, Probalan) – to control urate levels and prevent future attacks.

Other gout treatment strategies include:

* Avoiding foods high in purines, such as organ meats, anchovies, shellfish, bacon and gravies, and increasing intake of dairy foods

* Avoiding alcohol, which increases the production of urate and impairs excretion

* Losing weight to reduce blood urate levels

* Avoiding medications that contribute to hyperuricemia, including diuretics

With appropriate treatment, gout is one of the most controllable forms of arthritis.