Gout is a painful joint condition that affects thousands of people each year and can lead to more serious medical issues if untreated. Kelly Weselman, M.D., FACR, with WellStar Medical Group Rheumatology, shares the answers to the questions she is most frequently asked by her patients.
What is Gout?
HIgh levels of uric acid in the blood can lead to deposition of uric acid crystals in the joints. Those crystals cause intense inflammation in the joint leading to pain, swelling and redness. This type of inflammation in a joint is called gouty arthritis or gout. Gout “attacks” usually start in one joint and most commonly affect the big toe but can also affect the ankles and knees. Attacks usually get better after 1-2 weeks without any treatment. Over time, if the disease goes on untreated, attacks can occur more frequently and can involve many joints including the hands. Gout can cause long term pain and deformities including “tophi” (nodular deposits of urate) and even bony erosions.
Are certain people more likely to develop gout?
Gout can run in families. It occurs more commonly in people with kidney problems and is more common among people who are overweight and have high blood pressure. Gout can be associated with drinking alcoholic beverages and with specific medications. Each of these risk factors can also worsen gout “attacks” in someone who has already developed the disease.
How is gout diagnosed?
The only way to diagnose gout beyond a doubt is to see the specific crystals in a
sample of fluid taken out of a joint. While the procedure sounds painful, it can be done with minimal discomfort in a physician’s office. It is important to make a clear diagnosis to make sure the treatment is both safe and effective as joint infections and other types of arthritis can be mistakenly identified as gout.
A blood test known as a serum uric acid can be high in persons with gout but it can also be normal during flares of the arthritis. Additionally, high levels of uric acid in the blood do not necessarily mean someone has gout. In addition, x-rays of the joints may be useful as gout can cause specific changes in the joints in patients with multiple attacks over time.
How is gout treated?
Treatment of gout can stop the painful attacks when they occur and prevent future attacks. Acute or immediate treatment is aimed at reducing pain and the inflammation that causes it. Physicians may prescribe drugs such as steroids or non-steroidal antiinflammatories such as ibuprofen or naproxen. In some cases, more specialized medicines such as colchicine may be used. Make sure to talk with your physician before taking any of these medicines though as they can have side effects and are not indicated for every patient.
Chronic or long-term treatments are designed to prevent future attacks and to prevent permanent joint damage. Medications such as colchicine, probenecid and allopurinol can be helpful. These medicines either lower the bodies production of uric acid or help the body eliminate it in the patient’s urine. There are newer medicines for patients who have side effects to these well-established therapies. The most important long term treatment is to maintain your ideal body weight, control your blood pressure and minimize alcohol intake.
High blood pressure must be controlled with medications that will not worsen gout and all other medications should be reviewed. Other dietary factors that may worsen gout include eating too much shellfish, red meats and various types of beans. Dairy products may be helpful in preventing gout. Additionally, many people report improvement with eating cherries or taking vitamin C. Before making any changes to your diet or medications, be sure to talk with your physician.
What else should I know about gout?
Gout can also lead to kidney disease if it is severe and untreated. The good news is gout is treatable once diagnosed. There are several available treatment options that can control the disease and improve its symptoms. If you think you have gout - talk to your physician.
About Dr. Weselman
Kelly Weselman, M.D., FACR, is a rheumatologist with WellStar Medical Group Rheumatology. Dr. Weselman earned her Bachelor of Science in Biology from the College of William and Mary in Williamsburg, Va. She earned her Doctorate of Medicine from Baylor College of Medicine in Houston, Texas where she also completed her internship and residency in internal medicine. Dr. Weselman completed her fellowship in rheumatology at Emory University School of Medicine in Atlanta.
Dr. Weselman is a fellow of the American College of Rheumatology and a member of the Georgia Society of Rheumatology, American College of Physicians and American Medical Association. She is board certified in rheumatology and internal medicine.
WellStar Medical Group Rheumatology
4480 North Cooper Lake Road
Smyrna, GA 30082