Patient Articles

Gout

What Is Gout?

Gout is a form of arthritis caused by deposits of uric acid crystals in your body. It is helpful to think of gout as two diseases:

  1. Too much uric acid in the blood that leads to a buildup of crystals
  2. Build up of uric acid crystals that causes gout attacks

Therefore, gout is treated by lowering uric acid levels in the blood and by managing painful attacks when they occur. It is important to know that, once uric acid levels are low enough, gout attacks may not happen again.

What Causes Gout?

When uric acid levels in your blood become too high, uric acid crystals form. Think of too much sugar in a glass of water. When you add too much sugar, it forms crystals at the bottom of the glass. In gout, uric acid crystals deposit in the joints. This causes inflammation and pain.

Uric acid crystals form more often in areas with poor blood flow and in cold temperatures. Since the feet are cooler than other body parts, gout occurs most often in the feet.

What Are the Symptoms?

Painful gout attacks begin suddenly in a single joint, often in the big toe. The joint becomes swollen, red, and tender. Sometimes, people with gout cannot put on a shoe or even bear the weight of a bed sheet on their foot.

Once the first attack goes away, it may not occur again for weeks, months, or even years. In time though, attacks become more frequent. If not treated, ongoing and disabling arthritis develops.

While not a focus of this article, high uric acid may also be one cause of kidney stones.

What Is the Treatment?

Treatment gives you fast relief during a gout attack. Long-term, it lowers harmful uric acid to prevent new attacks.
During a Gout Attack

Medications that reduce pain and inflammation fall into three categories:

  • Colchicine: Colchicine is made from the autumn crocus plant. It has been used to treat gout for centuries and remains a mainstay of gout treatment.
  • Non-steroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs such as naproxen (eg, Aleve®), indomethacin (Indocin®), and celecoxib (Celebrex®) are often effective.
  • Cortisone Derivatives: You can receive these medications as tablets or as injections into a muscle or directly into your inflamed joint. Prednisone is the most widely used cortisone derivative.
  • Your doctor may prescribe methylprednisolone (eg, Medrol®) in a dose pack. Each pack contains a card with six days of medication. On Day 1, you take six tables. Then you take one tablet less each day, as counted out on the card.

It is very important that you begin taking medication as soon as a gout attack begins, best within minutes after you have the first signs. This will prevent the attack from becoming much worse and make you feel better as quickly as possible.

Long-term Uric Acid Medication

When uric acid crystals collect around the joints, they may form lumps called tophi. Tophi can look unsightly and keep you from moving well. They may damage the joints. When gout has become chronic or recurrent, or when tophi form, you may get medications that lower uric acid levels in your body. Over time, these medications may melt away the tophi. They will also control your arthritis and keep you from getting new attacks.

The most common uric acid-lowering medication is allopurinol (eg, Aloprim®). Febuxostat (Uloric®) is a new medication that works much like allopurinol. If you are sensitive to allopurinol, your doctor may prescribe febuxostat for you.

If you take uric acid-lowering medication, it is important to know these facts:

  • When the medication is started, it may make you more vulnerable to gout attacks for a short while. Therefore you must also take another medication (like colchicines) for at least six months to prevent an attack.
  • If you already are taking a uric acid-lowering medication when you get a gout attack, you need to continue taking it. Changing your uric acid-lowering medication during an attack will make you feel even worse.
  • Once you begin taking a uric acid-lowering medication, you will probably have to continue taking it for the rest of your life.
  • Patients with gout have high blood pressure, high cholesterol, and diabetes more often than other people. Controlling these conditions may be important for your health, and in particular your heart. While scientists are still learning more, it may also be important to control gout and high uric acid levels if you have these other conditions, or if you have heart or circulatory diseases.

Diet

What you eat can influence your uric acid levels. For some patients, modifying diet can reduce or eliminate attacks, while for others, changing diet may help, but medications will still be essential. There is a lot of confusion about diet. Discuss your diet with your physician. Here are some general guidelines:

  • Alcoholic beverages: Beer is the biggest problem, as it contains a chemical (guanine) which directly leads to increased uric acid. Wine and hard liquor are much less of a problem.
  • Food sources of uric acid: Liver is one of the worst offenders. Red meats, lobster, shrimp, and other shellfish are also problematic and should be consumed in moderation. Hard cheeses and nuts are also a problem.
  • A surf and turf dinner washed down by some beer is a good recipe for a gout attack. Until your doctor tells you your uric acid levels have responded to treatment and are low enough, staying away from beer, red meats, etc is a good way to reduce your risk of having another attack.
  • Aspirin and other medications: Some medications interfere with how your body eliminates uric acid. Aspirin in low doses can cause an increase in uric acid. Since aspirin is often prescribed for patients for a variety of reasons, it is important to discuss your use of aspirin with your doctor.
  • Other medications may affect the level of uric acid. Diuretics in particular may cause an increase in uric acid. Diuretics are often prescribed for patients with heart problems, such as congestion and heart failure, or for patients with high blood pressure. Any doctor prescribing medications for you for any reason should be advised if you have a history of gout.
  • Resources

    Gout Resources

    Find out more about Gout online at:
    Arthritis Foundation