Acute Gouty Arthritis Gout

Gout is a form of arthritis,or joint inflammation, that is caused by increased uric acid in thebloodstream. Uric acid is a chemical produced by the normal breakdown of cells.

What is going on in the body?

Gout results from an excess of uric acid in the body. The excess uric acid isdeposited in 1 or more joints, causing arthritis.

What are the causes and risks of the disease?

Gout is caused by an excess of uric acid in the bloodstream. Uricacid accumulates in the body and may form crystals in the joints under the following conditions:

if the person has a defect in metabolism that causes overproduction of uricacid. Metabolism refers to the chemical processes involved in normal bodyfunctions.

if the kidneys have a reduced ability to remove uric acid from thebloodstream

if the person’s diet is high in purines, which are broken down into uric acidin the body. Foods high in purines include organ meats, seafood, and driedbeans.

Certain risk factors increase a person’s chance of developing gout or having aflare-up of symptoms once he or she has the disease. These factors include the following:

a diet high in purines

alcoholconsumption

obesity

high blood pressure

high levels of cholesterol, triglycerides, and other lipids in the blood

diabetes

kidney disease

sickle cell anemia, ablood disorder that causes abnormal red blood cells

Gout occurs in approximately 1 in 5,000 people. It is more common in men, althoughwomen are at increased risk after menopause, the end of normal menstruation.

What are the signs and symptoms of the disease?

Gout can cause a sudden onset of severe joint pain such as the following:

The pain is usually described as excruciating, throbbing, or crushing.

The pain usually starts during the night.

Generally, only the main joint of 1 or both of the big toes is involved.

Usually, only 1 or 2 joints are affected at a time.

It typically lasts for 2 or 3 days and then stops.

It recurs occasionally.

Although gout is most commonly seen in the great toes, it may also affect thejoints of the fingers, hands, feet, or toes. Less commonly, the hips,shoulders, elbows, and wrists can be involved.

Following are other symptoms of gout:

joint swelling

redness over and around the joint

fever

a lump over the joint that has a chalky material draining from it

joint stiffness

How is the disease diagnosed?

The diagnosis of gout starts with a medical history and physical examination. Then thehealthcare provider may do a jointaspiration, inserting a needle into the joint space to remove someof the joint fluid. The fluid is examined in the laboratory for the presence ofuric acid crystals.

There also are blood tests that can be used to check for uric acid, but the results may benormal or even low in people with gout. Joint X-rays may be used to rule out any other abnormalities.Usually, if gout is in the acute stage, the joint X-rays will be normal.

What can be done to prevent the disease?

Some cases of gout can be prevented by controlling conditions that are strongly associated with gout,such as high blood pressureor high cholesterol.

What are the long-term effects of the disease?

People with gout can live normal lives. But when the disease is active, it canhave a significant effect on quality of life. Gout can progress to a chronicstate, and it can lead to kidneystones and chronic changes in the affected joints. The chronicstage is more likely to occur when the disease starts before the age of 30.Untreated gout can lead to permanent disability.

What are the risks to others?

Gout is not contagious and poses no risk to others.

What are the treatments for the disease?

There are treatments for both the acute phase of gout and for preventingflare-ups of symptoms. For acute attacks, the anti-inflammatory medicationcolchicine is used to reduce the pain. Indomethacin and other nonsteroidalanti-inflammatory drugs, or NSAIDs, like ibuprofen, are also useful.Occasionally, painmedications may be prescribed.

After the acute attack has resolved, other medications can be used to minimizeacute attacks of gout. Allopurinol blocks the body’s production of uric acidand probenicid helps the kidneys eliminate excess uric acid.

A person with gout will also be advised to make the followinglifestyle changes:

Drink plenty of liquids.

Eat a diet low in purines.

Limit alcoholintake.

Maintain a healthy body weight.

Follow effective treatment for conditions such as diabetes, high blood pressure, high cholesterol, kidney disease, and sicklecell anemia.

What are the side effects of the treatments?

Colchicine, nonsteroidal anti-inflammatory drugs, also called NSAIDs, andallopurinol may cause nausea, vomiting, diarrhea, abdominaldistress, and allergicreactions.

What happens after treatment for the disease?

People who have gout can have recurrent episodes throughout their lives. Theseepisodes are not always associated with increases in the uric acid level in theblood. Early treatment of acute gout attacksis important. This helps improve the quality of life and reduces the chances ofany chronic changes in the joint.

How is the disease monitored?

The healthcare provider will describe how to monitor the disease. Most willwant to know about the number of attacks, the length of each attack, and whichjoint is involved. The provider will also monitor uric acid levels and any sideeffects of the medications. Any new or worsening symptoms should be reported tothe healthcare provider.