Understanding Gout: Causes, Symptoms, Diagnosis and Treatment

Gout is a common and painful form of arthritis caused by excess uric acid in the bloodstream. Crystals of uric acid deposit in the joints, leading to inflammation and abrupt gout attacks. While not curable, gout can be effectively managed with medication and lifestyle changes. This article provides an overview of gout - who gets it, what causes it, how it's diagnosed, and the latest treatments to prevent flair-ups.

Introduction

Gout afflicts over 8 million adults in the United States. It occurs when uric acid builds up in the blood. Uric acid comes from the natural breakdown of purines, which are found in foods like red meat, seafood, and beer. Normally, uric acid dissolves in the blood and passes through the kidneys into the urine. But in gout, uric acid accumulates and crystallizes in joints, tendons, and surrounding tissues. These needle-like crystals cause severe inflammatory arthritis in joints, often the big toe, knee, or ankle. Attacks of swelling, redness, and intense pain can flare up suddenly and last for days or weeks. While gout cannot be cured, medications and lifestyle changes can prevent recurring gout episodes.

What Causes Gout?

Gout develops when the body produces too much uric acid or cannot properly excrete uric acid via the kidneys. Common causes include:

• Diet - Foods high in purines like red meat, seafood, and alcohol raise blood uric acid levels. Being overweight also increases gout risk.
• Genetics - A family history of gout points to inherited traits that make the kidneys less efficient at eliminating uric acid.
• Medical conditions - Some conditions like diabetes, metabolic syndrome, and kidney disease hamper the kidneys' ability to remove uric acid. Certain cancers and chemotherapy drugs can also increase uric acid production.
• Medications - Diuretics, aspirin, some arthritis medications, and cyclosporine used to prevent organ transplant rejection can all influence uric acid levels.

Gout usually occurs in combination with both genetic and lifestyle triggers. Men develop gout more often than women, especially women before menopause.

Recognizing Gout Symptoms

The most common gout symptoms include:

• Intense pain, swelling, warmth, and redness rapidly building up in a joint, often the big toe.
• Joint stiffness and decreased range of motion in the affected area
• Shiny, tight, stretched skin over the joint as inflammation develops
• Hard nodules or lumps under the skin around joints
• Recurring gout attacks followed by symptom-free periods
• Chronic gout pain and inflammation in multiple joints, especially ankles, knees, wrists, fingers, and elbows

Untreated gout can lead to bone erosion and joint damage. Seek medical advice for any unexplained joint pain. An accurate diagnosis is key to prevent recurrent gout attacks.

Diagnosing Gout

To diagnose gout, a doctor will review medical history and perform a physical exam looking for signs of swollen, tender joints. Diagnostic tests may include:

• Joint fluid analysis - Extracting fluid with a needle to examine for urate crystals under a microscope.
• Blood work - Testing blood uric acid levels, although levels may be normal during an acute gout attack.
• X-rays - Imaging helps rule out other potential causes of arthritis.
• Ultrasound - Allows visual detection of urate crystals in tissues.

Accurately differentiating gout from septic arthritis, which requires urgent treatment, is critical before starting any gout medication.

Treating Gout Flare-Ups

Gout attacks are extremely painful. Treatment focuses on relieving symptoms. Options include:

• NSAIDs - Anti-inflammatory drugs like indomethacin provide relief for most people without other health conditions.
• Colchicine - Relieves pain and inflammation if started early in a gout attack. Use is limited by side effects.
• Corticosteroids - Used short-term for people unable to take NSAIDs or colchicine. Local injections often work best.
• ACTH - Adrenocorticotropic hormone injections may help in difficult gout cases unresponsive to other therapies.

Wait for a gout diagnosis before starting medication. Applying ice packs to the painful joint can provide some relief.

Preventing Further Gout Attacks

Preventing future gout attacks involves medications that lower uric acid levels in the blood. Common options include:

• Allopurinol - The most commonly prescribed gout medication, it blocks production of uric acid.
• Febuxostat - A urate-lowering alternative to allopurinol, without interactions with kidney function.
• Probenecid - Helps kidneys remove excess uric acid in urine. Often used when allopurinol cannot be tolerated.
• Pegloticase - Used for chronic gout when other medications have failed.

Lifestyle measures like weight loss, exercise, limited alcohol intake, and avoiding trigger foods also help prevent recurrent gout flares.

Conclusion

Gout results from excess uric acid buildup in tissues. It causes extremely painful and disabling arthritis attacks. While not curable, gout is highly manageable with modern treatments. Medications can safely reduce uric acid levels and limit gout episodes. Avoiding dietary triggers and maintaining a healthy lifestyle are also key. Diagnosing gout quickly and starting proper medication early on provides the best outcomes. Most patients can successfully prevent debilitating gout flare-ups with a combined treatment approach.

References

Arthritis Foundation. What is Gout?

MedlinePlus. Gout.

Johns Hopkins Arthritis Center. Gout.

Mayo Clinic. Gout.