Gout

Gout is a common, painful form of arthritis. It causes swollen, red, hot and stiff joints.

Gout happens when uric acid builds up in your body. Uric acid comes from the breakdown of substances called purines. Purines are in your body's tissues and in foods, such as liver, dried beans and peas, and anchovies. Normally, uric acid dissolves in the blood. It passes through the kidneys and out of the body in urine. But sometimes uric acid can build up and form needle-like crystals. When they form in your joints, it is very painful. The crystals can also cause kidney stones.

Often, gout first attacks your big toe. It can also attack ankles, heels, knees, wrists, fingers, and elbows. At first, gout attacks usually get better in days. Eventually, attacks last longer and happen more often.

You may not be able to prevent gout, but you may be able to avoid things that trigger symptoms. Taking medicines to lower uric acid can prevent progression of gout.

Gout is caused by having higher-than-normal level of uric acid in your body. This may occur if:

  • Your body makes too much uric acid
  • Your body has a hard time getting rid of uric acid

If too much uric acid builds up in the fluid around the joints (synovial fluid), uric acid crystals form. These crystals cause the joint to swell and become inflamed.

The exact cause is unknown. Gout may run in families. The problem is more common in men, in women after menopause, and people who drink alcohol. As people become older, gout becomes more common.

The condition may also develop in people with:

  • Diabetes
  • Kidney disease
  • Obesity
  • Sickle cell anemia and other anemias
  • Leukemia and other blood cancers

Gout may occur after taking medicines that interfere with the removal of uric acid from the body. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have a higher level of uric acid in the blood.

Symptoms of acute gout:

  • Only one or a few joints are affected. The big toe, knee, or ankle joints are most often affected.
  • The pain starts suddenly, often during the night. Pain is often described as throbbing, crushing, or excruciating.
  • The joint appears warm and red. It is usually very tender and swollen (it hurts to put a sheet or blanket over it).
  • There may be a fever.
  • The attack may go away in a few days, but may return from time to time. Additional attacks often last longer.

People will have no symptoms after a first gout attack. Many people will have another attack in the next 6 to12 months.

Some people may develop chronic gout. This is also called gouty arthritis. This condition can lead to joint damage and loss of motion in the joints. People with chronic gout will have joint pain and other symptoms most of the time.

Tophi are lumps below the skin around joints or other places such as the elbows, fingertips, and ears. Tophi can develop after a person has had gout for many years. These lumps may drain chalky material.

Proper treatment of acute attacks and lowering uric acid to a level less than 6 mg/dL allows people to live a normal life. However, the acute form of the disease may progress to chronic gout if not treated.

Make sure to visit your physician for a proper diagnosis and take medicines for gout as soon as you can if you have a sudden attack.