Overview

Gout is a disease caused by the buildup of uric acid in the joints. It results from an elevated blood level of uric acid (hyperuricemia), which occurs when the liver produces more uric acid than the body can excrete in the urine, or when a diet high in rich foods (e.g., red meat, cream sauces, red wine) produces more uric acid than the kidneys can filter from the blood.

Over time, uric acid in the blood crystallizes and settles in the joint spaces, causing swelling, inflammation, stiffness, and pain.

Gout usually affects the first metatarsal phalangeal joint of the big toe (hallux) or the ankle joints.

Incidence and Prevalence

According to the National Institutes of Health (NIH), gout affects approximately 2.1 million people in the United States. The disease is more common in men between the ages of 40 and 50, and in women, incidence increases after menopause. The condition is rare in children and young adults.

Causes and Risk Factors

Gout is caused by the buildup of uric acid in the joints. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, approximately 18% of people who develop gout have a family history of the condition. Diseases and conditions that increase the risk include diabetes, obesity, kidney disease, and sickle cell anemia.

Regularly drinking alcohol interferes with the removal of uric acid from the body and can increase the risk for developing gout. Other risk factors include the following:

• Exposure to lead in the environment
• High dietary intake of rich foods that contain purine (e.g., cream sauces, red meat, sardines, liver, scallops)
• Medications that may interfere with the body's ability to remove uric acid (e.g., aspirin, diuretics, levodopa [used to treat Parkinson's disease])

Cyclosporine (e.g., Gengraf®), which is a medication used to suppress the body's immune system and prevent rejection after organ transplant, also increases the risk for developing gout.

Signs and Symptoms

Gout usually develops in the joint of the first toe (i.e., the big toe, or hallux). It also can affect the ankle or knee. Common symptoms include the following:

• Inflammation
• Pain
• Redness
• Stiffness
• Swelling

Touching or moving the toe may be intensely painful and patients often say that having as much as a bed sheet over the toe increases the pain. Symptoms of gout develop quickly (sometimes in 1 day) and typically occur in only one joint at a time. Rarely, symptoms develop in two or three joints simultaneously. If widespread symptoms occur, the condition is probably not gout. If left untreated, gout can damage joints and cause disability.

Diagnosis

Diagnosis of gout may involve inserting a needle into the affected joint and drawing a sample of the fluid that lubricates the joint (called synovial fluid). The fluid is then analyzed under a microscope to determine if uric acid crystals are present. To rule out joint infection, the fluid also is examined for the presence of bacteria.

Patients with gout may have elevated blood levels of uric acid (hyperuricemia), but this condition may not be present during an acute attack. The reason for this is that during an acute attack, uric acid is released from the bloodstream and finds its way into the joint(s). Therefore, when blood is drawn to check uric acid levels, these levels are usually normal or low.

Aspiration can be a painful procedure, so if acute gout is suspected, many physicians diagnose the condition through other signs and symptoms and prescribe short-term non-steroidal anti-inflammatory drugs (NSAIDs).

Treatment

The goal of treatment is to decrease the amount of uric acid in the joints, which helps to reduce symptoms and prevent further attacks. If left untreated, affected joints may be damaged, causing disability. Acute gout often is treated with nonsteroidal anti-inflammatories (NSAIDs) such as naproxen (e.g., Anaprox®, Naprosyn®) and indomethacin (e.g., Indocin®), usually for 3–7 days. Due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.

If gout attacks occur frequently, long-term, daily gout medication may be prescribed. Colchicine and probenecid (Benemid®) may be used alone or in combination (e.g., Colbenemid®) when other medications do not relieve symptoms. These medications are most effective when taken within 12 hours of the onset of symptoms. Side effects include abdominal pain, diarrhea, nausea, and vomiting. Corticosteroids (e.g., prednisone) also may be taken orally or injected into the affected joint. These medications usually resolve symptoms in about a week.

Prevention

Prevention is the best defense against gout. Medication (e.g., small doses of NSAIDs, colchicine, allopurinol [Zyloprim®], probenecid) may prevent continued accumulation of uric acid in the joints and further attacks. Avoiding alcohol and rich foods that are high in purine (e.g., scallops, sardines, red meat, sweetbreads, gravy, cream sauces) also may help to prevent the condition.

Other preventative measures include the following:

• Drink plenty of fluids (especially water)
• Exercise regularly
• Maintain a healthy diet and healthy body weight
• See a physician regularly

Original article.