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Gout, also known as gouty arthritis, is a form of inflammatory arthritis affecting people who have high levels of uric acid in the blood. This uric acid can form needle-like crystals in a joint, causing acute tenderness, pain, redness, warmth, and swelling. Oftentimes, the joint at the base of the big toe is affected first. The global prevalence is about 0.08%. Four percent of adults in the U.S. are affected, and men experience gout at a rate three times that of women.

What is Gout?

Causes of Gout

Gout is caused by an elevated level of uric acid in the body. Uric acid is produced when the body breaks down purines, which are found in many foods as well as in human cells. Under normal circumstances, blood carries uric acid to the kidneys, where it is eliminated in the urine. When the body produces too much uric acid and/or the kidneys can’t process a normal amount, the excess uric acid can form crystal structures in the joint. Gout can be triggered by a number of health-related issues, but often lifestyle factors play a key role.

Lifestyle factors:

  • Diet rich in high purine foods, especially red meat
  • Excess alcohol consumption, especially beer
  • Dehydration
  • Drinking sweet sodas
  • Crash diets
  • Obesity
  • Gastric bypass surgery

Health-Related Factors

  • Genetics
  • Gender - men are more at risk (until the age of 60)
  • Medical trauma, such as joint injury, surgery, severe illness or infection
  • Medications, such as cyclosporine or certain diuretics and immunosuppressant
  • Chemotherapy
  • High cholester
  • High blood pressure
  • Diabe
  • Heart disease

 Symptoms of Gout

The first symptom experienced is often acute pain and swelling in the big toe, usually occurring overnight and increasing in intensity over the course of the next day. Symptoms typically decrease within a few days and are completely gone in a week to ten days. Other lower joints of the body can also be affected. Symptoms progress in four stages:

  • Asymptomatic hyperuricemia – uric acid levels are elevated and crystals are forming in the joint, prior to experiencing any symptoms
  • Acute attack – characterized by pain, swelling, tenderness, redness, and warmth in the affected joint
  • Interval gout – the period between attacks when joints can still be damaged by low-level inflammation
  • Chronic gout – develops over time when uric acid levels remain high, causing more frequent and longer lasting attacks, possible joint damage, and/or loss of mobility

Symptoms of Gout

Diagnosis of Gout

A diagnosis of gout begins with a review of the reported symptoms, family medical history, physical examination, blood test, and ruling out other causes. Bone and soft tissue are often examined using x-ray, MRI, CT scan, or ultrasound, but the surest diagnosis is made by extracting fluid from the joint and testing for uric acid crystals.

Complications of Gout

●joint damage

●loss of mobility

●tophi –lumps of painless crystals that form under the skin around the joints

● kidney stones

●increased risk of heart disease

●increased risk of stroke

Complications of Gout

Treatment of Gout

The successful treatment of gout involves both taking medications and making changes in one’s lifestyle.

Medications:

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) - prescribed to reduce pain and swelling (examples include aspirin and ibuprofen)
  • Corticosteroids  to reduce pain and swelling (such as prednisone) taken either orally or injected, or ACTH, a synthetic drug that prompts the body to make its own corticosteroids
  • Colchicine – to reduce pain and swelling, a plant-based medicine used for centuries
  • Uric Acid Level-Reducing Drugs – prescribed to prevent attacks and to prevent gout from advancing to the chronic stage (initiated after an attack is over as it can actually prolong an existing attack)

Lifestyle Changes:

  • Eating a heart-healthy diet
  • Losing and/or maintaining a healthy weight
  • Being physically active

Prognosis of Gout

With proper medication and lifestyle adjustments, most people can prevent gout from advancing to the chronic stage, coping with occasional symptoms and leading relatively normal lives.

Resources:

  • Ann Rheum Dis. 2014 Aug;73(8):1470-6. doi: 10.1136/annrheumdis-2013-204647. Epub 2014 Mar 3
  • www.arthritis.org

Rheumatology, Gout

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