Introduction to gout

What is gout? Who gets it?

Gout is a type of painful, inflammatory (red, swollen) arthritis. It’s caused by buildup of a salt called uric acid in the joints and other places in the body. It’s the most common type of inflammatory arthritis in men over 40, and is common in men even in their 20’s and 30’s.  Women commonly get gout as well, but most often women get it after menopause. There are an estimated 8.3 million people with gout in the U.S. at this time – almost 4% of the population!

Why is gout important to recognize?

Since painful gout episodes (attacks), especially when they first start, only last a week or less, why is it so important to see your healthcare provider about gout? There are many reasons. First of all, gout attacks can be extremely painful, and worth treating for that reason alone. Second, gout is a chronic and progressive medical problem, meaning it will usually get worse over time if left untreated.  Third, there are complications of gout that can be prevented with treatment, such as “lumps” of uric acid just under the skin (called “tophi”), kidney stones, and even joint damage. Finally, gout is very treatable, and the vast majority of patients can be made “attack-free” if they take their medicine regularly.

What are clues you might have gout?

The most common way for gout to start is with severe pain in the base of the big toe, with heat, redness, swelling, and tenderness. First attacks usually last 3-7 days, can improve with anti-inflammatory medications (e.g. ibuprofen over-the-counter), but later on attacks tend to get closer together and get more severe. Other joints that can be attacked by gout commonly are the mid-foot, ankle, knee and elbow.

Do any other conditions tend to “travel” with gout?

Gout is frequently associated with other conditions. They include coronary artery disease, hypertension, obesity, high cholesterol/triglycerides, and abnormal kidney function. If you have any of these conditions, your healthcare provider will need to consider them when making a decision about the best medications for your gout.

What will your healthcare provider need to know to make a diagnosis of gout, and to develop a treatment plan for you?

A blood test of the uric acid level can help make a diagnosis of gout. When any question remains about the diagnosis, getting fluid from an inflamed joint and having it evaluated for uric acid crystals will allow a definite diagnosis of gout. Knowing your blood chemistry and your other medical problems will be helpful in designing a treatment plan. In some cases, a joint x-ray will show damage in a pattern that suggests gout.

What are some misconceptions about gout?

One misconception is that getting gout attacks is “your fault” because of what you ate or drank. This is only a part of the story—gout is a genetic disease, and while certain foods can set off attacks, this is only likely if you have a genetic tendency towards having gout. You do have to watch your diet, but likely medication will be needed as part of the treatment. Another misconception is that once your healthcare starts treatment for your gout, that it’s not important to let the doctor know when you get attacks.  It is important—because if you are still having attacks despite treatment, your healthcare provider can modify your treatment and make attacks much less frequent.

How is gout treated?

There are two very separate parts of gout treatment. First is treatment of the attack of gout, when your joint is inflamed and painful. The second is prevention of future attacks.

What are the options for treating an attack of gout?

Four options exist:

1) Anti-inflammatory medications (such as ibuprofen and naproxen)

2) Colchicine (usually 2 tabs and then 1 tab an hour later)

3) Steroid medications (e.g. prednisone) by mouth

4) Steroid injections by local joint injection

The choice and dose of medication will depend on your other medical issues, if any.

What can be done to prevent future attacks of gout?

Everyone with gout needs to address lifestyle issues including weight loss if indicated and decreasing intake of foods that can increase uric acid (red meat, shellfish, organ meats, high fructose corn syrup and alcohol – especially beer). For most patients, diet alone won’t stop gout (but still can help), and they will need prescription medication. Most commonly your healthcare provider will use medications that decrease production of uric acid in your body (allopurinol or febuxostat). Occasionally, a drug which increases uric acid excretion in the urine (probenecid) is used. Any medication used to lower uric acid can make gout attacks more frequent in the early months of treatment, so your healthcare provider may add a medication such as colchicine early on in treatment to help prevent those attacks. Down the road, your gout attacks are extremely likely to decrease and ultimately stop completely if you stay on your medication.  Gout can be “cured” if you stay on your medication!