Gout is a painful and sometimes disabling form of arthritis that starts with intense episodes of painful swelling, often in the feet. It has long been incorrectly linked to overindulgence in food and wine. Gout occurs when excess uric acid accumulates in the joints and surrounding tissue, causing uric acid crystals. Uric acid results from the breakdown of substances known as purines, which are found in all body tissues and in some foods. Certain foods, like shellfish and alcohol, may trigger attacks. Other forms of arthritis resemble gout, so careful diagnosis is important.
The most common gout symptoms (known collectively as podagra) are pain, warmth, swelling and extreme tenderness in a joint. While it often starts in the big toe, other joints such as ankles or knees can also be affected.
- Pain that starts during the night and is so intense that even the touch of a sheet on the joint causes intense discomfort.
- A quick rise in discomfort level that continues through the night but eases over the next few days.
- Red or purplish skin around the joint that seems to be infected.
- Peeling, itchy skin around the joint as the gout attack subsides.
- Limited movement in the affected joint.
- Non-acute symptoms including nodules on the hands, elbows or ears.
Some people (especially older adults) do not experience an acute episode but instead suffer from chronic gout, which is less painful.
Those most likely to develop gout are:
- Middle-aged men
- Post-menopausal women
- Individuals with high levels of uric acid
- People who are overweight
Foods that can increase the risk for gout include red meats, organ meats, shellfish, anchovies, alcohol and sugary soft drinks. Taking medications such as water pills and having medical conditions like diabetes and kidney problems also elevate the risk.
Although an excess buildup of uric acid is not typically known until an attack of gout occurs, there are some steps that can help prevent or reduce the severity of future gout attacks.
- If you have been prescribed medication for gout, take it according to instructions. (Some people remain on the medicine throughout their lives.)
- Maintain a healthy weight or lose weight if needed.
- Make recommended adjustments in your food and alcohol consumption according to your doctor’s assessment.
The best way to determine if you have gout is for your rheumatologist to draw fluid from the joint with a needle and have the fluid analyzed for the presence of urate crystals. The doctor will also look for:
- More than one attack of acute arthritis
- Arthritis that develops in one day, producing a swollen, red, warm joint
- An arthritis attack in a single joint
Careful diagnosis is important, as signs of gout mimic symptoms of other conditions.
Treating gout can be complicated by factors like existing conditions and other medications. A variety of medicines are used to treat gout. A drug known as colchicine can be effective, but only if given early in the attack. It can cause nausea, vomiting and other unwelcome side effects, but these are less in lower doses. Another choice is non-steroidal anti-inflammatory drugs (NSAIDs) that can help decrease inflammation and pain. Examples are indomethacin and naproxen, which are given in high doses for a limited time. Some people who cannot take NSAIDs take corticosteroids orally or by injection into the muscle. Some patients get relief by resting the affected joint and applying cold compresses.
Those who experience repeated gout attacks should talk with their doctor about ways to normalize their levels of blood uric acid. These medications do not control the painful chronic attacks of gout. An example is probenecid, which helps the kidneys eliminate uric acid. Your WellStar rheumatologist can help you choose the right medications and manage possible side effects, such as short-term flares. The right treatment plan can vary considerably from one patient to the next. Gout is often associated with hypertension and heart and kidney disease.
It’s likely that you will be advised to stop drinking alcohol and to restrict certain foods such as fatty meats, some seafood and high-fructose beverages.
Living with gout presents challenges, especially during attacks and, for some people, due to the chronic arthritis that can be part of the disease. It’s important to work in partnership with your rheumatologist and other health care providers. Outcomes are improved when patients comply with their medication regimes and make recommended lifestyle changes like controlling weight and avoiding alcohol.