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Gout Attack Symptoms, Causes, Treatment, and Diet

What Is Gout?

Gouty arthritis is a painful condition that results from crystals of uric acid depositing in joint tissues, causing attacks of joint inflammation (arthritis).

Gout is one of the most frequently referenced medical disorders in the history of mankind. Gout is the result of an abnormality of the body's ability to process uric acid. Uric acid builds up either because of too much uric acid intake (from rich foods such as chocolate, seafood, or red wine) or the body's inability to process it. The uric acid then crystalizes in the joints - mainly the toes, ankles, hands and wrists - causing the painful inflammation of a gouty attack (gouty arthritis). In severe cases, increased uric acid can cause kidney stones and blockages of the kidney filtration system (tubules), and permanent damage to the kidney or even kidney failure.

Who Is Affected by Gout?

Approximately 6 million people in the United States suffer from attacks of gout.

Gout is more common in men than in women. It is also more common later in life with most patients having attacks after the age of 50. If your parents have gout then you are also at increased risk of getting gout yourself.

What Are the Risk Factors of Gout?

Obesity, weight gain, alcohol intake, high blood pressure, abnormal kidney function, and certain drugs can promote the development of gout.

Risk factors for gout include:

  • Obesity
  • Excessive weight gain
  • Moderate to heavy alcohol intake
  • High blood pressure
  • Abnormal kidney function

Some medications such as diuretics (water pills), and having low thyroid hormones may also be risk factors for getting gouty attacks.

What Are Symptoms of Gout?

Gouty arthritis is characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness.

The large joint at the base of the big toe (first metatarsalphylangeal joint) is the most common site for a gout attack, however, any other joint can be affected. Most commonly other joints affected are the ankles, knees, wrists, fingers, and elbows.

Patients with gout attacks suffer a rapid onset of pain in the affected joint followed by swelling, redness, and severe tenderness. Some experience pain so intense that even the light touch of a bed sheet on the joint is excruciating. These painful attacks can last from hours to several days. In cases of chronic inflammation the attack may last for weeks. Unfortunately, patients with gout are at risk for repeated attacks of gouty arthritis.

Gout (Big Toe)

An elderly man suffers from acute gouty arthritis on his big toe.

The large joint at the base of the big toe (first metatarsalphylangeal joint) is the most common site for a gout attack but other joints commonly affected are the ankles, knees, wrists, fingers, and elbows.

Gout (Fingers)

Severe gout in the fingers results in large, hard deposits of crystals of uric acid. These deposits are called tophi.

Inflamed lumps of tissue may form in the joint with repeated bouts of gout or prolonged cases. These lumps are called tophi.

Gout (Elbow)

Here is an example of gout affecting the elbow.

Some of the larger joints of the body have a fluid-filled sac around them that act as a shock absorber called a bursa. A bursa also helps with the movement mechanics of the joint. If gout causes inflammation and swelling of the bursa it is called bursitis.

What Procedure Is Used to Diagnose Gouty Arthritis?

Using a sterile syringe and needle, fluid is withdrawn from the inflamed joint and then analyzed for uric acid crystals.

Gout is usually diagnosed by a doctor based on the location of the inflamed joint and a history of having similar non-traumatic attacks of pain and swelling. The most reliable (but not always necessary) test for confirming gout is an arthrocentesis. Arthrocentes is a procedure where fluid is withdrawn (aspirated) from an inflamed joint with a needle and syringe, using a sterile technique and a local anesthetic such as lidocaine. The fluid is sent to a lab where it is analyzed for the presence of uric acid crystals.

How Is Gout Diagnosed?

This fluid was obtained from crystal deposits in a patient with gout.

The fluid withdrawn by an arthrocentesis is analyzed in a lab under a microscope for the presence of uric acid crystals. The fluid analysis can also rule out other causes of inflammation including bacterial infections.

What Do Uric Acid Crystals Look Like?

Uric acid crystals from a patient with gout.

Needle-like uric acid crystals are best viewed with a microscope.

How Are Gout Attacks Prevented?

Prevention of gout includes maintaining adequate fluid intake and reducing alcohol consumption.

Staying well hydrated is the best way to prevent gout attacks. Drink plenty of water throughout the day. Proper hydration also decreases the risk of kidney stones or kidney dysfunction as a result of built-up uric acid.

Avoid alcohol or only drink in extreme moderation if you have had gout attacks in the past. Alcohol affects the body's metabolism of uric acid and can cause it to build up (hyperuricemia). If levels of uric acid build up in your system it can precipitate a gout attack in your joints.

Additional Prevention Techniques

Additional prevention methods include weight reduction and dietary changes.

Foods rich in purines such as shellfish or organ meats (liver, kidneys, brains, sweetbreads) can lead to gout attacks. The body converts purines into uric acid, which in turn leads to gout attacks.

Overall weight reduction is also a way to avoid gout attacks. A diet low in fats and calories, combined with a regular exercise regime can help decrease the likelihood of a gout attack.

What Are the Medical Treatments for Gout?

Medical treatment includes pain relievers such as Tylenol, anti-inflammatory medicines, and other medicines specific for gout medications.

Gout is a very painful condition. Pain relievers and anti-inflammatory medications are the mainstay of treatment for gout. Nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine (Colcrys), and corticosteroids are used to decrease joint inflammation.

Other medications such as probenecid (which helps the body excrete excess uric acid) and allopurinol (Zyloprim, Aloprim), (which decreases the amount of uric acid formed by the body) are used for managing the underlying metabolic derangement that causes hyperuricemia and gout. These medicines decrease the elevated levels of uric acid in the blood.

What Does the Future Hold for Gout?

Active research is ongoing in a variety of fields related to gout and hyperuricemia.

Research is ongoing to find new strategies to prevent gout. New drugs are being developed to keep the body from having high uric acid levels and decrease the likelihood of a painful gout attack.

Reviewed by Kirkwood Johnston, MD on 7/14/2016

Gout Attack Symptoms, Causes, Treatment, and Diet

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