What is Gout?

  • Gout is a disorder that causes sudden attacks of intense pain, swelling, and redness in your joints or soft tissues.
  • In many cases, the first attacks occur in the joints of the big toe, but gout can affect many other joints. It is a type of inflammatory arthritis.
  • Gout can be controlled and treated with medication.

Gout develops when too much uric acid accumulates in your bloodstream. The dissolved uric acid then comes out of the bloodstream and forms microscopic spike-like crystals in joints or soft tissues.

Your body reacts to uric acid crystals as if they were a foreign body or bacteria. White blood cells and other infection fighting cells are sent into the area, which results in inflammation. The affected area will become red, swollen, hot, and very tender and can look just like an infection:

Acute gout attacks can last from 3 to 10 days and without treatment, the attacks slowly get better.

What Gout Affects

The tissues that can be affected by gout include:

  • Joints. Gout frequently involves the joint of the big toe. However, it can affect small joints like those in the finger, as well as large joints, such as the knee and hip.
  • Bursae. Located throughout the body, these thin, slippery sacs with just a slight amount of fluid in them act as cushions between bones and soft tissues. The bursae most commonly inflamed from gout are the boney tip of the elbow (olecranon bursa) and the front of the kneecap (prepatellar bursa).
  • Tendon sheaths. These tunnels protect and provide nutrition to tendons in the hands and feet.
  • Kidneys. High uric acid levels may cause kidney stones and, sometimes, damage the kidneys. About 15 people out of 100 with gout develop kidney stones.

Our Treatment Approach

Sometimes, it is difficult to tell apart a sudden gout attack from an infection or other condition..

Blood Test

A blood test can measure the level of uric acid in your blood. A high uric acid level strongly suggests gout.

Synovial Fluid Analysis

A more accurate test for gout if your symptoms do not improve with initial treatments is a synovial fluid analysis. During this test, synovial fluid is drawn from your inflamed joint. Synovial fluid surrounds and lubricates joints. When you have gout, there is more fluid in the joint and the fluid contains white blood cells. It will also contain uric acid crystals that can be seen with a special microscope.

Treatment

Treatment for gout focuses on relieving pain during acute attacks, preventing future gout attacks, and reducing the risk of developing tophi and permanent joint damage.

Acute Attack Pain Management

Home remedies. Reducing inflammation during an acute gout attack will provide pain relief.

  • Ice. Apply ice to the affected area to reduce swelling. Do not apply ice directly to the skin. Use an ice pack or wrap a towel around the ice. Apply ice for about 20 minutes at a time.
  • Elevate. Frequently raise and keep the affected area above the level of the heart.
  • Rest. Move the affected area as little as possible while symptoms are present.
  • Over-the-counter non-steroidal anti-inflammatory medicines. If the gout attack is mild, anti-inflammatory drugs available without a prescription (ibuprofen, naproxen) may relieve pain.
  • Prescription medications. Your doctor may recommend a prescription-strength non-

Your doctor may also prescribe corticosteroids for acute gout attacks. These are strong anti-inflammatory medications that can be taken either in pill form, intravenously, or injected into the painful joint. Cortisone may improve the severe inflammation very quickly.

Surgical Treatment

People who develop destructive arthritis related to chronic gout may be helped with surgery.

Removal of tophi. In some cases, the large nodules of uric acid around finger or toe joints, tendons, or bursae need to be removed because they remain painfully inflamed. These nodules may also break open and drain or become infected.

Joint fusion. If chronic gout has caused permanent joint destruction, smaller joints may need to be fused together to limit movement and relieve chronic pain.

Joint replacement. This procedure involves removing the painful joint and replacing it with artificial parts. The goal of joint replacement is to provide pain relief, as well as to maintain joint movement. The knee is the most common joint requiring replacement due to gout.

Causes

Gout develops when your body produces too much uric acid or when it does not eliminate enough of it. When the levels of uric acid in your blood are too high, it is called hyperuricemia.

The Role of Uric Acid

Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage.

Risk Factors

Gout affects approximately 2 out of 100 people in the United States. There are several factors gout.

  • Gender and age. Gout is more common in men than in women and hits men at a younger age.
  • Family history. If other members of your family have had gout, you are at greater risk for the disease.
  • Other medical problems. Certain health conditions can cause higher levels of uric acid in the blood. These include high blood pressure, diabetes, kidney disease, and some types of anemias.
  • Medications. Diuretics (water pills) used to treat hypertension and heart disease can increase uric acid levels, and so can aspirin..
  • Lifestyle. Being overweight and drinking too much alcohol can increase your risk for gout.

Symptoms

A gout attack can be sudden and severe. It may wake you up at night with intense pain in your big toe — so intense that you cannot stand to have it touched, even by the sheets. During a gout attack, the affected joint is often red and swollen.

The joint that is affected is typically red and swollen. It may also feel hot.

You may also run a fever which may indicate you have an infection. This requires treatment. Many people with gout are also diabetic and are at greater risk for infection.

It is important to see a doctor if you experience gout symptoms. Gout is a chronic disease that worsens over time. With treatment you may be able to control the disease and prevent joint damage.