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Gout

(Arthritis, Gouty; Gouty Arthritis)

Definition

Gout occurs when uric acid crystals build up in the joints. This causes the joints to be inflamed, causing pain.

Causes

Gout typically occurs if you have high levels of uric acid in your blood. A high level of uric acid in the blood is identified by the term hyperuricemia. However, you could also have normal uric levels and still have gout.
The uric acid can then form crystals in the joints causing the pain and inflammation.
The liver metabolizes uric acid, and the kidneys get rid of it through the urine. Levels of uric acid build up when:
  • Too much uric acid is produced
  • Not enough uric acid is eliminated
If you have gout and hyperuricemia, your body doesn't eliminate enough uric acid.

Risk Factors

Gout is more common in men over the age of 30 years, but gout can occur in men and women at any age. Other factors that may increase your risk of gout include:
  • Obesity , sudden weight gain, or rapid weight loss
  • Family members with history of gout
  • Kidney disease
  • Diabetes mellitus
  • High blood pressure
  • Certain types of cancer
  • Certain medications, such as:
    • Low-dose aspirin
    • Diuretics
    • Cyclosporin, an antirejection drug
    • Chemotherapy drugs used to treat cancer
Certain foods and beverages may also increase your chances of gout.
  • Foods high in purines, such as organ meats, shellfish, some vegetables, and gravies.
  • High-fructose drinks, such as sugar-sweetened sodas and orange juice
  • Excess alcohol, especially beer
  • Binge drinking alcohol

Symptoms

Acute Gout

Symptoms may include:
  • Sudden onset of severe pain in an inflamed joint, usually starting in the big toe
  • Joints that are red, hot, swollen, and very tender
  • Increased pain 24-48 hours after the onset of symptoms
Gout of the Big Toe
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Copyright © Nucleus Medical Media, Inc.

Recurrent Gout

Most people with gout have another attack. This attack may affect many different joints. With recurrent gout, tophi can form. Tophi are chalky deposits of uric acid that commonly occur in the elbows and earlobes.
Gout can also lead to other health problems, such as:

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. A sample of fluid from the affected joint will be taken. This fluid will be tested for uric acid crystals.
Other tests may include:
  • Blood and urine tests—to measure the level of uric acid in your blood and to assess kidney function
  • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones; used to check for joint destruction

Treatment

Treatment depends on whether the gout is acute or recurrent.

Acute Gout

In general, the sooner treatment begins for an acute attack, the more effective it is. Treatment depends on:
  • Number of joints affected
  • Previous responses to treatment
  • Overall health
General Measures
Putting an ice pack on the joint may ease the pain. Keeping the weight of clothes or bed covers off the joint can also help.
Medications
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroids—may be given orally or as an injection into the affected joint
  • Colchicine

Recurrent Gout

General Measures
  • Consume a low-purine diet.
  • Avoid alcohol.
  • If you're overweight, lose weight gradually. Rapid weight loss can cause a gout attack.
  • Ask your doctor if any of your medications can cause high uric acid levels.
  • Drink a lot of fluids throughout the day.
Medications
If you have recurrent gout, or you have kidney stones, tophi, or reduced kidney function, you may be given medications:
  • To lower the production of uric acid
  • To increase the excretion of uric acid by the kidneys
  • To convert uric acid into a different byproduct

Prevention

To help reduce your chance of getting gout:
  • Eat a low-purine diet.
  • Limit how much alcohol you drink. Avoid binge drinking.
  • Drink a lot of fluids.
  • Lose weight gradually.

RESOURCES

Arthritis Foundation http://www.arthritis.org

American Arthritis Society http://www.americanarthritis.org

CANADIAN RESOURCES

Arthritis Society of Canada http://www.arthritis.ca

Canadian Arthritis Network http://www.arthritisnetwork.ca

References

Gout. American College of Rheumatology website. Available at: http://www.rheumatology.org/Practice/Clinical/Patients/Diseases%5FAnd%5FConditions/Gout . Updated September 2012. Accessed July 12, 2013.

Gout. Arthritis Foundation website. Available at: http://www.arthritis.org/conditions-treatments/disease-center/gout . Accessed July 12, 2013.

Gout. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 13, 2013. Accessed July 12, 2013.

Gout - treatment of acute attack. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 6, 2013. Accessed July 12, 2013.

Gout overview. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/gout.html . Updated March 2010. Accessed July 12, 2013.

Questions and answers about gout. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Gout/default.asp . Accessed July 12, 2013.

Rott KT, Agudelo CA. Gout. JAMA . 2003;289:2857-2860.

Terkeltaub RA. Clinical practice. Gout. N Engl J Med . 2003;349:1647-1655.

What is gout? National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Gout/gout%5Fff.pdf . Accessed July 12, 2013.

1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Man CY, Cheung IT, Cameron PA, Rainer TH. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute gout-like arthritis: a double-blind, randomized, controlled trial. Ann Emerg Med . 2007;49:670-677. Epub 2007 Feb 5.

1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA . 2010;304(20):2270-2278.

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