Get a Grip on Gout
Do you wake up at night with pain and swelling in the big toe? It could be gout.

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Picture of a man Get a Grip on Gout

Gout has been a cause of pain and suffering for thousands of years. It is most common in men over 50, but also occurs in women, especially after menopause, and in people with kidney disease.

What causes gout?
Gout is a form of arthritis. It is caused by hard crystals that build up inside the joints. The crystals form when there is too much uric acid in the blood. Uric acid is made from purine, found in certain foods and in our own cells. Foods that contain a high concentration of purines include meats, seafood, and dried peas and beans. High levels of purines are also found in beer and wine.

With gout, the body either makes too much uric acid or the kidneys do not eliminate enough of it. Uric acid then builds up in the blood. Over time, the uric acid collects around joints and forms needle-shaped crystals inside the joint. The crystals cause intense pain and swelling, the hallmarks of an acute gout attack.

What raises your risk?

  • Family history.
  • Obesity.
  • High blood pressure, psoriasis, and diabetes.
  • Alcohol use. Your doctor may advise that you not drink at all if you have gout attacks.
  • Diet. Eating too many foods rich in purine can cause or make gout worse in some people.
  • Kidney disease.
  • Taking certain medications. Diuretics (water pills) and some other medicines can raise your risk for gout.
  • Recent surgery, illness, injury, or infection.

What are the symptoms?

  • Sudden, intense pain in the joints.
  • A joint may become red, hot, and swollen. The big toe joint is the most commonly affected joint. But gout can also affect ankles, heels, knees, elbows, wrists, and fingers.
  • Nodules under the skin, called tophi.

How is gout diagnosed?
Your doctor will ask you about your symptoms and do a physical exam. He or she may take a sample of fluid from the affected joint and look for uric acid crystals in the sample. A blood test to measure uric acid may also be done.

How is gout treated?
Your doctor may suggest that you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, which can be bought without a prescription. He or she may prescribe another NSAID, such as indomethacin. These medications can help relieve pain and inflammation.

NSAIDs may have serious side effects. But used for the short period of time during an acute attack, they are generally well-tolerated. Ask your doctor if they are right for you.

Another drug doctors may prescribe for gout is colchicine. While it may work well, it frequently causes nausea, vomiting, and diarrhea.

Corticosteroids may also be prescribed to be taken orally or injected into the affected joint. Prednisone is the most common corticosteroid that is used for gout. There is usually improvement within a few hours of treatment.

If you've suffered from multiple gout attacks or have developed tophi or kidney stones, your doctor may treat you with probenecid or allopurinol on a daily basis. These drugs reduce the uric acid in the blood, lower the frequency of attacks, and prevent the buildup of tophi.

A note about NSAIDs
NSAIDs (nonsteroidal anti-inflammatory drugs) are commonly taken to reduce pain and swelling, although they are not for everyone. Ibuprofen, naproxen, and aspirin are all NSAIDs. Talk to your doctor about whether taking NSAIDs is safe for you, especially if you:

  • Have stomach bleeding or peptic ulcers
  • Have liver or kidney disease or a bleeding disorder
  • Drink more than three alcoholic drinks each day
  • Have high blood pressure or kidney, liver, or heart disease
  • Take medicine for high blood pressure, aspirin to protect your heart, or any sort of blood thinning drugs

Do not give aspirin to anyone younger than 20. It has been linked to Reye's syndrome, a serious illness. Do not give ibuprofen or naproxen to children without first talking to your doctor.

Always read instruction labels carefully to understand all precautions.

By Louis Neipris, MD, Staff Writer
Created on 02/07/2002
Updated on 05/16/2011
Sources:
  • Arthritis Foundation. Gout.
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout.
  • Keith MP, Gilliland WR. Updates in the management of gout. American Journal of Medicine. 2007;120(3):221-224.
Copyright © OptumHealth.
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