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Gout: Causes, Symptoms and Treatment

Also called "gouty arthritis," gout is a painful form of arthritis caused by too much uric acid in the blood.

gout
Gout can affect the ankles, heels and toes.
Credit: Alice Day | shutterstock

Gout is characterized by painful flare-ups that may be concentrated in the big toe (a symptom known as podagra), as well as swelling and pain in the ankles, knees, feet, wrists or elbows. Flare-ups can last days or weeks, and commonly occur at night. Left untreated, gout can cause permanent damage to joints and kidneys, according to the National Institutes of Health.

Gout is most commonly seen in men (particularly those between the ages of 40 and 50), people with a family history of gout, those who are overweight, patients with kidney problems, people who have had organ transplants and those who drink too much alcohol, according to the National Institutes of Arthritis and Musculoskeletal and Skin Diseases.

Causes

Uric acid is a waste product created during the normal breakdown of purines, naturally-occurring substances found in foods and drinks, such as liver, anchovies, mackerel, dried beans, beer and wine, according to the NIH.

Uric acid is normally cleaned out of the blood by the kidneys, and passes out of the body along with urine. However, high levels of uric acid can accumulate in the body, either when the kidneys excrete too little uric acid or when the body produces too much uric acid. This condition is known as hyperuricemia.

According to the Mayo Clinic, the high concentration of uric acid in the blood will eventually convert the acid into urate crystals, which can then accumulate around the joints and soft tissues. Deposits of the needle-like urate crystals are responsible for the inflammation and the painful symptoms of gout.

Test and diagnosis

While gout has painful and distinctive symptoms during flare-ups, its symptoms can be vague during other times, according to the NIAMS. Your doctor may extract a sample of joint fluid so it can be examined under a microscope for any presence of urate crystals.

Certain joint infections can produce symptoms similar to gout. If an infection is suspected, your doctor may culture the joint fluid to see if any bacteria are present.

Blood tests can reveal the concentration of uric acid in the blood and further confirm the diagnosis. However, according to the Mayo Clinic, blood tests can be misleading, because some gout patients do not have an unusual level of uric acid in their blood, and some people with high levels of uric acid do not go on to develop gout.

 

Treatments and Prevention

The painful symptoms of gout can be alleviated by nonsteroidal anti-inflammatory drugs (NSAIDs), which can reduce both pain and inflammation around the joints, according to the University of Maryland. Depending on the severity of the flare-ups, patients can be treated with over-the-counter NSAIDs such as ibuprofen (such as Advil or Motrin), or naproxen (such as Aleve) or with prescription-strength painkillers such as indomethacin (available under the trade name Indocin).

Corticosteriods, such as prednisone, can be injected directly into the affected joints for relief within a few hours, according to Mayo Clinic. However, despite their effectiveness, cortosteroids must be used sparingly, because they can weaken cartilage and bones, and therefore create even more joint problems down the line.

Another pain reliever commonly used to reduce gout pain is colchicine. It is most effective when taken within the first 12 hours of symptoms, according to NIAMS. Once the flare-up subsides, the doctor may prescribe low, daily doses of colchicine to ward off future attacks.

Aside from painkillers, other drugs may help treat the underlying uric acid imbalance. Medication that limits uric acid production, such as allopurinol (also known as Zyloprim and Aloprim) and febuxostat (Uloric), may lower the blood's uric acid level. Another drug called probenecid (Probalan) can reduce gout attacks by improving the kidneys' ability to eliminate uric acid.

Beyond medications, patients can also control the frequency of flare-ups through exercise and diet adjustments. Because uric acid is created during the digestion and breakdown of purines, patients can reduce the concentration of uric acid in the blood by avoiding high-purine foods such as anchovies, asparagus, dried beans and peas, mushrooms and organ meats (such as livers and kidneys). The Mayo Clinic also suggests that patients should drink more water and less alcohol, because alcohol can raise the level of uric acid in the blood.

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