Gout
Learn about Gout pain and swelling of joints, especially in the legs, ankle, foot and big toes.
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What is Gout?
Ever woken up in the middle of the night with your big toe feeling as though it’s on fire? It feels hot, it’s tender and swollen and you experience pain at the slightest touch? You may be experiencing an acute attack of gout (or gouty arthritis) a form of arthritis that’s characterized by sudden, severe attacks of pain, redness and tenderness in joints. Men are more prone to gout. Women become increasingly susceptible to gout after menopause.
Diagnosing Gout
The signs and symptoms of gout are almost always acute, occurring suddenly (often at night) and without warning. Gout is suspected when a history of repeated attacks of painful arthritis at the base of the toes is reported. Ankles and knees are also commonly involved joints affected by gout. Gout usually attacks one joint at a time, while other arthritis conditions, such as systemic lupus and rheumatoid arthritis, usually attack multiple joints at the same time.
Symptoms of gout include:
- Intense joint pain. If untreated, the joint pain typically lasts five to 10 days and then stops. The discomfort subsides gradually over one to two weeks, leaving the joint apparently normal and pain-free.
- Inflammation and redness at the joint. The affected joint or joints become swollen, tender and red.
Patients can also develop fever with the acute gout attacks. The most reliable test for gout is finding uric acid crystals in the joint fluid obtained by joint aspiration – a common office procedure performed under local anesthesia. Fluid is withdrawn from the inflamed joint, using a syringe and needle. The joint fluid is then analyzed for uric acid crystals and for infection.
Other means to help diagnose gout may include:
- X-rays can sometimes be helpful, and may show tophi crystal deposits and bone damage as a result of repeated inflammations. X-rays can also be helpful for monitoring the effects of chronic gout on the joints.
- Blood test. This is used to measure the uric acid level in your blood, although some people have high uric acid levels, but never experience gout and vice versa.
What Causes Gout?
Intense joint inflammation occurs when white blood cells engulf the uric acid crystals and release chemicals – causing pain, heat, and redness of the joint tissues. Gout occurs when there is an overload of uric acid in the body. Your body produces uric acid when it breaks down purines, substances that are found naturally in your body, as well as in certain foods, such as organ meats, anchovies, herring, asparagus and mushrooms.
The kidneys usually regulate the levels of uric acid in the body, when this process is compromised, gout can occur. Chronic gout can lead to deposits of hard lumps of uric acid in and around the joints (most commonly found around the fingers, at the tips of the elbows, and around the big toe) and can also lead to decreased kidney function, and kidney stones.
Some people may only develop elevated blood uric acid levels (hyperuricemia) without having arthritis or kidney problems. Tiny fluid-filled sacs (bursae) can be deposited around the joints – inciting inflammation in the bursae leading to joint pain and swelling – and a condition called bursitis. In rare instances, gout leads to a more chronic condition that mimics rheumatoid arthritis.
Risk factors for developing gout include:
- Obesity
- Excessive weight gain
- Moderate to heavy alcohol intake
- High blood pressure (hypertension)
- Diabetes
- High levels of fat and cholesterol in the blood
- Narrowing of the arteries (arteriosclerosis)
- Abnormal kidney function
- Family history of gout
Certain drugs, such as thiazide diuretics, low-dose aspirin, niacin, cyclosporine, tuberculosis medications (pyrazinamide and ethambutol), and others can also cause elevated uric acid levels in the blood and lead to gout. Interestingly, a recent study demonstrated an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.
If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage. Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection .
Help for Gout
Conventional treatment
Pain relievers such as Tylenol or other more potent analgesics are used to manage pain. Anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs (NSAIDS) are used to decrease joint inflammation, but common side effects of NSAIDS include irritation of the gastrointestinal system, stomach ulcers and intestinal problems , and even intestinal bleeding. Corticosteroids, such as prednisone, given in short courses, are powerful anti-inflammatory agents for treating acute gout; yet long-term chronic use of corticosteroids is discouraged because of serious long-term side effects. Probenecid (Benemid) and sulfinpyrazone (Anturane) are medications that are commonly used to decrease uric acid blood levels by increasing the excretion of uric acid into the urine. Since these drugs can cause kidney stones patients with a history of kidney stones should seek other options. Allopurinol (Zyloprim) lowers the blood uric acid level by preventing uric acid production, but medication is used with caution in patients with poor kidney function, as they are at a particular risk of developing side effects, including rash and liver damage.
Self-care treatment
Natural pain relievers can help to ease pain and reduce swelling. Preventing acute gout attacks is just as important as treating the condition. Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption, and medications to reduce hyperuricemia. Home techniques that can alleviate the symptoms of acute gout include resting and elevating the inflamed joint. Ice pack applications can be helpful to reduce pain and decrease inflammation.
More Information on Gout
Scientists recently reported that high animal protein slightly increased the risk for gout. Others found that dietary calcium intake may protect patients from getting gout attacks. The optimal regimens for the treatment of acute gout attacks and chronic gout conditions still require further long-term studies. Research scientists will continue to develop less toxic and more effective medications to battle this "scourge of the ages."
No specific dietary changes are proved to reduce your risk of gout. However, these tips may prove helpful:
Don’t:
- Eat large amounts of red meat and seafood.
- Consume alcoholic beverages regularly or in excess. Alcohol can inhibit the excretion of uric acid. If you’re having a gout attack, it’s best to avoid alcohol completely.
- Eat organ meats (liver, brains, kidney and sweetbreads), anchovies, herring and mackerel – they are particularly high in purines.
Do:
- Eat more low-fat dairy products.
- Eat more complex carbohydrates, such as whole-grain breads
- Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.
- Drink plenty of liquids. Fluids help dilute uric acid in your blood and urine, so be sure you get enough water and other fluids every day.
- Get enough Vitamin C. A sensible amount of vitamin C is recommended – as high doses of vitamin C may increase your body’s uric acid levels. Talk to your doctor about what a reasonable dose of vitamin C may be. And don’t forget that you can increase your vitamin C intake by eating more fruits and vegetables, especially oranges.
- Eat Cherries. Cherries have been associated with lower levels of uric acid in studies, but it isn’t clear if they have any effect on gout signs and symptoms. Adding cherries and other dark-colored fruits, such as blackberries, blueberries, purple grapes and raspberries, to your diet may be a safe way to supplement your gout treatment, but discuss it with your doctor first.
