Gout

Gout is a complex form of arthritis.  It typically causes sudden, severe attacks of pain, swelling, redness, and tenderness in the joints.  The most common joint affected is the base of the big toe.  Most patients will have episodic flares, with little or no symptoms between flares.  There are ways to manage this condition and decrease or even prevent symptoms.  Today we'll talk about the symptoms and causes of gout, and next week we will talk more about the diagnosis and treatment of gout.

What are the symptoms of gout?

• Intense joint pain - The onset of pain is sudden and severe, often waking you up from sleep.  The pain is most severe within the first 4-12 hours, and is often described as feeling like your big toe is on fire.  The most common joint affected is the base of the big toe, but other commonly affected joints include the ankles, knees, elbows, wrists, and fingers.  
• Persistent discomfort - After the initial severe pain, some discomfort may last for days to weeks.  The longer a patient has gout, the longer the persistent discomfort may last, and the more joints may be involved.
• Redness, swelling, tenderness - Affected joints may be so tender that even the weight of the bed sheet may seem intolerable.
• Limited motion of joints - With repeated flares, affected joints may lose the ability to move as easily as they should.

What causes gout?

Gout happens because urate crystals accumulate in your joint which occurs when you have high levels of uric acid in your blood.  Urate crystals are sharp, and needle-like, and when they develop inside a joint, they cause the inflammation and swelling associated with gout.

Uric acid is produced by the body when it breaks down substances called purines.  Uric acid is normally dissolved in your blood and is eliminated by passing into the urine through the kidneys.

    

High levels of uric acid in the blood can be caused by the body either producing too much uric acid, or by the kidneys not getting rid of enough uric acid. 

What are the risk factors for gout?

• Family history - If family members have had gout, you are more likely to develop it.
• Age and sex - Men are more likely to develop gout because women tend to have lower uric acid levels.  However, after menopause, uric acid levels in women increase and approach those of men.  Men are more likely to develop gout when they are younger (between 30-50 years of age), but women are more likely to develop gout after menopause.
• Diet - Eating a diet rich in foods containing high levels of purines will increase uric acid levels.  High purine foods include red meats, organ meats, seafood, and some others.  Other foods that increase levels of uric acid include high-fructose foods or drinks and alcohol, especially beer.
• Obesity - When you are overweight, your body produces more uric acid, and your kidneys have more trouble eliminating it.
• Medical conditions and certain medications - Conditions such as diabetes, untreated high blood pressure, heart disease, and kidney disease increase your risk of gout.  Some medications increase uric acid levels, such as certain diuretics, aspirin, and some others.

We'll talk more about gout next week.  If you have any questions about gout, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor