Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention
Definition
Gout happens when uric acid crystals build up in the joints. This causes the joints to be inflamed. If the crystals build up in the kidneys,
kidney stones
may result.
Causes
Gout typically occurs if you have high levels of
uric acid
in your blood. A high level of uric acid in the blood is identified by the term hyperuricemia. However, you could also have normal uric levels and still have gout.
The liver metabolizes uric acid, and the kidneys get rid of it through the urine. Levels of uric acid build up when:
- Too much uric acid is produced
- Not enough uric acid is eliminated
If you have gout and hyperuricemia, your body doesn't eliminate enough uric acid. Risk FactorsThese factors increase your chance of developing gout. All causes of hyperuricemia are risk factors for gout.
Risk factors include:
- Obesity, sudden weight gain, or rapid weight loss
- Age: over 40 years old
- Sex: male
- Family members with gout
-
Diuretics, such as
hydrochlorothiazide
-
Certain medications, such as
aspirin
-
High-purine diet (uric acid occurs when purines are broken down), for example:
- Liver and other organ meats
- Dried beans and peas
- Anchovies
- Gravies
- Diet that includes high-fructose drinks, like sugar-sweetened sodas and orange juice
- Alcohol use, especially binge drinking
-
Certain types of
cancer
or
cancer treatments
(such as, cytotoxic drugs)
- Medications (such as, antiseizure, anti-rejection medications)
- Dehydration
- Hypercholesterolemia
- Kidney disease
SymptomsSymptoms include: - Sudden onset of severe pain in an inflamed joint, usually starting in the big toe
- Joints that are red, hot, swollen, and very tender
- Increased pain 24-36 hours after the onset of symptoms
Most people with gout have another attack within two years. This attack may affect many different joints. With recurrent gout, tophi can form. Tophi are chalky deposits of uric acid that commonly occur in the elbows and earlobes. DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam. A sample of fluid from the affected joint will be taken. This fluid will be tested for uric acid crystals.
Other tests may include:
- Blood and urine tests—to measure the level of uric acid in your blood and to assess kidney function
- X-ray—a test that uses radiation to take a picture of structures inside the body, especially bones; used to check for joint destruction
TreatmentTreatment depends on whether the gout is acute or recurrent.
In general, the sooner treatment begins for an acute attack, the more effective it is. Treatment depends on:
- Onset of symptoms
- Number of joints affected
- Previous responses to treatment
- Overall health
Putting a warm pad or an ice pack on the joint may ease the pain. Keeping the weight of clothes or bed covers off the joint can also help. -
Nonsteroidal anti-inflammatory drugs (NSAIDs), for example:
- Indomethacin
- Ibuprofen
- Naproxen
-
Corticosteroids—used if NSAIDs are not effective or not recommended
-
A study found that people given corticosteroid plus acetaminophen had fewer adverse effects than those given NSAID plus
acetaminophen.
- Colchicine—used to prevent gout attacks, but seldom used as a treatment for an acute attack;
Note: This drug has many adverse effects, so it is rarely used first.
- Consume a low-purine diet.
- Avoid alcohol.
- If you're overweight, lose weight gradually. Rapid weight loss can cause a gout attack.
- Ask your doctor if any of your medications can cause high uric acid levels.
- Drink a lot of fluids.
If you have recurrent gouty arthritis or an initial attack with hyperuricemia, you may be given medication:
-
To lower the production of uric acid (such as,
allopurinol)
-
To increase the excretion of uric acid by the kidneys (such as,
probenecid
or
sulfinpyrazone)
In some cases, low-dose
colchicine
may also be used to prevent recurrent attacks.
If you are diagnosed with gout, follow your doctor's
instructions.
Prevention
To reduce your chance of getting gout:
- Eat a low-purine diet.
- Limit how much alcohol you drink. Avoid binge drinking.
- Drink a lot of fluids.
- Lose weight gradually.
-
Talk to your doctor about your risk for
high blood pressure
and
heart attacks. These conditions are associated with gout.
Alan R. Medications for gout. EBSCO Health Library website. Available at:
http://www.ebscohost.com/healthLibrary. Updated August 27, 2010. Accessed September 16, 2010.
Braundwald E, Fauci AS, et al, eds. Complications of hyperuricemia.
Harrison's Principles of Internal Medicine.
15th ed.
New York, NY: McGraw Hill; 2002.
Gout.
The American College of Rheumatology website. Available at:
http://www.rheumatology.org/public/factsheets/gout.asp. Updated June 2006. Accessed June 27, 2008.
Rott KT, Agudelo CA. Gout.
JAMA.
2003;289:2857-2860.
Terkeltaub RA. Clinical practice. Gout.
N Engl J Med.
2003;349:1647-1655.
1/4/2011 DynaMed's Systematic Literature Surveillance
https://dynamed.ebscohost.com/about/about-us: Man CY, Cheung IT, Cameron PA, Rainer TH. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute gout-like arthritis: a double-blind, randomized, controlled trial. Ann Emerg Med.
2007;49:670-677. Epub 2007 Feb 5.
1/4/2011 DynaMed's Systematic Literature Surveillance
https://dynamed.ebscohost.com/about/about-us: Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA.
2010;304(20):2270-2278.
Last reviewed September 2011 by Rosalyn Carson-DeWitt, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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