Gout

Gout is a type of arthritis that causes sudden, severe attacks of pain, swelling, redness, warmth and tenderness in the joints. It usually affects the joint of the big toe but can occur in feet, ankles, knees, hands and wrists. Gout occurs when a substance called uric acid builds up in the body and forms needle-like crystals in the joints. The first symptoms of gout often occur in the middle of the night or upon rising in the morning. Wearing shoes and moving the joint or standing may be difficult and painful. Gout accounts for about 5 percent of all cases of arthritis.

Gout is caused by a buildup of uric acid that occurs when the body has difficulty breaking down protein substances called purines which are found naturally in foods. Sometimes this happens because the kidneys are not getting rid of uric acid properly, and sometimes it occurs because the body produces too much uric acid. Eating too much of certain foods such as salmon, liver, herring or sardines and drinking too much alcohol may trigger an episode of gout.

Gout occurs most often in men over age 40, but it can affect persons of any age. Women are more susceptible after menopause. Gout is more common in people who are overweight. A family history of gout may increase a person's risk of developing the disease. Certain medical conditions, such as untreated high blood pressure, diabetes and high cholesterol, also may increase a person's risk of developing gout. Exposure to lead in the environment also may be a risk factor.

In some families, inherited factors play a role in a person’s risk for developing arthritis. If a parent or other close relative has been diagnosed with arthritis, it is important to share this history with a health care provider. Early diagnosis and treatment is the key to successful management of arthritis.

There is no sure way to prevent gout. However, if diagnosed early, the disabling effects of gout can be prevented with medications, proper diet, weight loss, limiting or avoiding alcohol and drinking plenty of fluids.

The diagnosis of gout is based on personal and family history and examination by a physician or other health care professional. Blood tests are used to determine uric acid levels. X-rays may be done to look for abnormal changes in bones and joints. The doctor also may test joint fluid to check for uric acid crystals.

With proper treatment, most people with gout are able to control their symptoms. High doses of non-steroidal anti-inflammatory drugs (NSAIDs) and injections of corticosteroid drugs into the affected joint(s) are the most common treatments. Patients usually improve within a few hours of treatment, and the attack goes away completely within a few days. Colchicine may be used if NSAIDs do not control the symptoms but tends to cause more side effects.

Successfully dealing with arthritis pain and disability requires self-management skills. It is important for patients to learn about their disease and to take part in their own care. Working with health care professionals allows a person to share in decision making and gain a sense of control.
Self-management techniques include arthritis education, exercise programs, relaxation and stress management, eating well-balanced meals and maintaining proper weight, taking care of joints and using assistive devices to rest joints and relieve pressure.

• Exercise can help increase independence, improve mood, decrease pain, increase flexibility, improve blood flow, maintain proper weight and promote general physical fitness. Exercise in a warm water pool is an excellent choice. Physical/occupational therapy can help restore joint movement and increase strength. A therapist can help design an exercise program to meet a person's specific needs.
• Rest also is important. Arthritis may cause tiredness and muscle weakness. A rest or short nap that does not interfere with nighttime sleep may help. Relaxation techniques can be useful in controlling pain. Some people find stress reduction and biofeedback helpful.
• Assistive devices can be used to reduce stress on certain joints. For example, braces or canes may help reduce stress on the knees. Jar grippers or other gadgets may help reduce stress on the small joints of the hands.

Research shows that patients who take part in their own care report less pain and make fewer doctor visits as well as enjoy a better quality of life.

If gout is not treated, other conditions may arise. Tophi (soft tissue swellings caused by uric acid crystals) may form on the toes, fingers, hands or elbows. Permanent changes in the joint may occur, and kidney disease or kidney stones may develop. Seek medical care immediately if a fever is present and a joint is hot and inflamed. This may be a sign of an infection. A doctor should be seen if a person experiences intense, sudden pain in a joint, even if the pain goes away in one or two days.