Gout

Definition
Gout is a disorder that causes recurring attacks of painful arthritis (inflammation of a joint).

Causes/associated factors
A condition known as hyperuricemia causes gout. Here's how it develops. Purines, compounds that form naturally in your body and can also be found in certain foods, produce uric acid when they're broken down in your body. This waste product normally dissolves in your blood and is eliminated from your body through urination. If too much uric acid builds up in your blood, however, you may develop hyperuricemia. Eventually, uric acid crystals can form and be deposited in the joints.
The exact cause of hyperuricemia is unknown, but it may be due to an increased production of uric acid in the body or a reduction in the amount of uric acid that's eliminated. Another factor may be the consumption of alcohol or foods high in purine, such as shellfish, organ meats, anchovies, sardines, yeast, beans, dried peas, oatmeal and asparagus.

Ten to 20 percent of people who have gout also develop uric acid kidney stones.

Various factors may increase the risk of developing gout, including being male, obese and/or older than age 30. Having a family history of gout also increases the risk. Other risk factors may include:

diabetes
high blood pressure
vascular disease (involving the blood vessels, veins or arteries), such as artherosclerosis
kidney failure
certain endocrine diseases (affecting glands that produce hormones), such as thyroid problems (the gland that helps, in part, regulate the body's metabolism)
certain skin conditions, such as psoriasis (a chronic skin disease marked by patches of raised, red bumps covered with white, flaking scales on the scalp, knees, elbows or buttocks)
certain blood conditions, such as anemia (a condition marked by a decreased number of red blood cells or hemoglobin, a protein in red blood cells that contains iron) and sickle cell anemia (a specific type of anemia in which the hemoglobin is defective, causing the red blood cells to become shaped like a sickle or crescent)
lead poisoning or exposure
Attacks of gout may be precipitated by factors such as:

physical or emotional stress
surgery or trauma
heavy alcohol use
excessive dietary intake of purines
dehydration
fasting, starvation or extremely low-calorie diets
use of certain drugs, such as some diuretics (medications that help the body get rid of fluid through increased urine secretion), antibiotics, low-dose aspirin, niacin and cyclosporin (a medication to prevent organ rejection after a transplant)

Signs/symptoms
When hyperuricemia causes deposits of uric acid crystals in your joints, you may experience a sudden gout attack. These attacks can develop in just 24 hours and often happen at night. The affected joints will become red, painful, swollen and warm. You may have a difficult time using them. You may even get a moderate fever or the chills. Gout usually affects one joint at a time, often the big toe. Other joints can be involved, such as the elbows, knees, ankles, feet, elbows, wrists or hands.
Gout attacks normally last about a week and go away on their own. Other attacks typically follow within the next few months or years. With time, the attacks may occur more often and last longer. Even if the pain goes away, it's important to consult your doctor to prevent damage to your joints.


Diagnosis
The doctor will ask questions about your medical history and do a physical exam. A diagnosis can usually be made after identifying uric acid crystals from fluid removed from the affected joint, which can often be done right in your doctor's office. Blood tests may show elevated uric acid levels, but this is not necessarily an indicator of gout because many people with hyperuricemia never develop gout. Uric acid levels may even be normal during a gout attack. Sometimes X-rays are helpful in diagnosing crystal deposits and bone damage from inflammation.

Treatment
Although there is no cure for gout, the condition can usually be controlled through medication, diet and lifestyle changes. The goal of treatment is to treat sudden attacks, prevent future attacks and joint damage, and control uric acid levels.
During an attack, elevate the affected joint and get plenty of rest. Splinting of the affected joint may also provide some pain relief and protect the area from other trauma. Your doctor may also recommend certain medications to provide pain relief and reduce inflammation, or others to help prevent recurrences. Medications often used during acute attacks include nonsteroidal anti-inflammatories (such as indomethacin, naproxen or ibuprofen), the drug colchicine, and steroidal anti-inflammatories such as oral prednisone or the injection of a corticosteroid into the affected joint. For those who need long-term therapy after an acute attack, urate-lowering drugs (such as allopurinol) and drugs that increase the excretion of uric acid through the kidneys (such as probenecid or sulfinpyrazone) may be considered.


Complications
Gout may become chronic, with persistent pain in your joints and the development of tophi (deposits of uric acid crystals that produce lumps on your fingers, hands, wrists, elbows, ankles, knees, feet or outer ears). Gout may also lead to kidney stones and kidney damage. To prevent complications, seek an early diagnosis and begin treatment as soon as possible.

Pregnancy-specific information
Gout is uncommon in women of childbearing age. Remember to tell your doctor if you have gout. Some medications used to treat the condition may be harmful to the developing fetus. Do not take any medications without your doctor's approval.

Senior-specific information
Older adults have a higher risk of side effects from gout medications. Be sure you understand the potential side effects of any medication your doctor prescribes. Follow the doctor's instructions carefully, and report any new symptoms right away.

Prevention
To help prevent gout attacks, consider the following suggestions:
Avoid or limit alcohol and foods high in purine, such as shellfish, organ meats, anchovies, sardines, yeast, beans, dried peas, oatmeal and asparagus.
Maintain a normal body weight. If you're overweight, keep in mind that it's best to lose weight gradually. Avoid fasting or extremely low-calorie diets.
Drink at least eight to 10 glasses of water a day to flush out uric acid.
Exercise regularly.
Discuss all medication use with your doctor. Your doctor may recommend avoiding aspirin, which prevents uric acid from being eliminated by the body.
Keep all follow-up appointments with your doctor, especially if you're on chronic medication therapy.
It's also helpful to keep a diary of your responses to treatment and self-care measures to track what works best for you.