Gout is an acute arthritic condition caused by an increase of uric acid in the blood. This results in urate crystals forming in one or two joints, often in the lower extremity and commonly in the big toe. The pain comes on suddenly, causing intense pain, stiffness, and swelling. Unless it is treated correctly the condition will continue to recur until it becomes chronic.
The most common sign is night time attack of swelling, tenderness and sharp pain. Gout can also attack the foot, ankle or knees and can last weeks when not treated correctly. Sometimes called gouty arthritis, it is suspected when the patient reports a history of painful arthritis at the base of the toes. Often one joint is only affected while other systemic arthritic conditions such as lupus and rheumatoid arthritis will attack multiple joints simultaneously. (1)
The most reliable test is to find uric acid crystals in the joint fluid. This means the doctor will use arthrocentesis, or a joint aspiration, to pull out fluid from the affected joint. It is a common office practice performed under local anesthesia. The fluid is sent to the lab for viewing under a polarized microscope. Sometimes when patients have a classic history and symptoms, they will be treated and presumed to have Gout without having an arthrocentesis. But a firm diagnosis is preferable since other conditions can mimic Gout, such is pseudogout, psoriatic arthritis, rheumatoid arthritis and an infected joint.
Gout has four distinct stages of the condition. In the initial stage the individual has no symptoms but there is a build up of uric acid in the blood stream. During the acute phase an individual has complaints of pain, swelling and soreness in a joint. Intercritical stage occurs between flare-ups of Gout in the chronic stage is when the crystals are deposited in the tendons and ligaments of the joints, the skin becomes swollen and seeps white pus. The goal of treatment is to prevent a chronic stage of the disease.
It is critical to stop the acute inflammation and address the long-term management. Initial treatments will involve medications to reduce inflammation and pain. Often times non-steroidal anti-inflammatory are taken orally for three to four days. At this time indomethacin is the treatment of choice. Corticosteroids may be used if the individual is unable to tolerate non-steroidal anti-inflammatory medications.
Long-term treatment is also initiated once the acute stage is over. Prevention of further attacks involves maintaining adequate fluid, reducing weight, dietary changes, reduction in alcohol consumption and medications to lower the uric acid level in the blood. Uric acid is a metabolic byproducts of purines. These are chemicals which are in high concentration in red meat, shellfish and organ meats. (2)
Research has reported that meat in general increases the risk of a subsequent attack of gout while dairy products appear to reduce the risk. Total amount of alcohol intake is also strongly associated with an increased risk as our soft drinks high in fructose. Maintaining an adequate fluid intake will also help to prevent the risk of kidney stone formation in patients who are at high risk for Gout. Because alcohol has a diuretic effect it has two major pathways that worse than Gout – by slowing the excretion of uric acid as well as causing dehydration.
Medications may also be used to block the production of uric acid in the body if all else is not successful. Allopurinol is the drug of choice used for long-term treatment in older patients and those who have high levels of excreted uric acid.
Long-term treatment and prevention for Gout is essential for the long-term health of the individual. Over time gout will cause permanent damage to the joints it affects resulting in decreased motion, increased pain and impaired function.
(1) National Institute of Arthritis and Musculoskeletal and Skin Diseases: Fast Facts: What is Gout