Gout

Written by DynoMed.com, Indianapolis, IN

An ancient disease, gout is a chronic type of inflammatory arthritis that causes immediate attacks of pain, tenderness, redness, warmth and swelling in some joints. Usually, the joints in the big toe are affected, but gout can also affect the instep, ankles, heels, knees, wrists, fingers and elbows.

Once believed to be the result of gluttony, gout is now known to affect people from all walks of life and often the disease is inherited. Less than one in ten women will develop gout. About 500,000 people have gout in the United States, with most being men between the ages of 30 and 60.  Gout accounts for about 5 percent of all cases of arthritis.

Causes of Gout
Gout is caused when there is over production of uric acid in normal purine metabolism in the body. Genetics can play a role in who develops gout. It can also occur as a complication of other conditions.  Some people inherit the inability to process uric acid and lose it in the urine. High blood levels of uric acid in turn causes sodium monourate crystals to collect in the joint fluid and joint coverings leading to gout, a painful stiff swollen joint.

Contributing factors and causes of gout include:

There are many reasons why an episode of gout will appear, including drinking too much alcohol or eating certain kinds of food rich in purines such as seafood, beans, sweetbreads, gravies and anchovies.

Other potential triggers of gout include:

• Surgery
• Stress
• Crash diets
• Sudden, severe illness
• Chemotherapy
• Joint injury
• High blood pressure
• Excessive exercise.

Symptoms of Gout
Gout is said by some experts to be one of the most painful of all types of arthritis. Incidents of gout often develop very quickly and sometimes the first incident will be at night. These painful incidents of gout include swelling in the joints that lasts for about a week without treatment. The skin may be red and shiny around the affected joints.

Lumps (tophi) may be found under the skin around the elbows, heels or ears. The uric acid crystals cause these lumps and can also cause kidney stones to develop.
A few people will only experience one gout attack. However, for most people the gout attacks will keep coming back every few months and will be worse in intensity. If the disease is left untreated, it may result in crippling damage to the joints.

Gout is easily identified through a physical examination and diagnostic tests.  Your doctor will take a sample of the joint fluid and look for the presence of uric acid crystals. He or she may also take a blood test to measure the amount of uric acid in your body.

Treatment of Gout
Through the use of certain kinds of medications, a proper diet and exercise, gout sufferers will be able to successfully treat their condition.

Uric acid levels in the body can be controlled through medications, thus reducing the number of gout attacks. Doctors will usually prescribe a medication called allopurinol that stops the over production of uric acid. If the kidneys are not excreting enough uric acid, your doctor may prescribe a different kind of medication such as probenecid or sulfinpyrazone.

Doctors have been using a drug called colchicine for centuries to treat gout attacks. Colchicine relieves pain while limiting the inflammation of the joint. Often the drug provides relief quickly but there are some side effects such as nausea, vomiting and abdominal pain.

Nonsalicylate NSAIDS (nonsteroidal anti-inflammatory drugs) such as ibuprofen may be used for pain relief. Aspirin should not be used because it can actually make symptoms of gout worse.

Talk to your doctor or nutritionist about starting a proper diet. There are certain foods that you should stay away from and be sure to limit your alcohol intake as wine and beer have been shown to make symptoms worse.  

A combination of exercise, rest and relaxation is important in achieving an optimum level of health and wellness. Your doctor or physical therapist will help you create an exercise plan such as swimming or walking that will help you maintain a healthy lifestyle.