Monday, June 10, 2013

What Is Gout

What Is Gout?

Gout is one of the most painful forms of arthritis. It occurs when too much uric acid builds up in the body. The buildup of uric acid can lead to:
  • Sharp uric acid crystal deposits in joints, often in the big toe
  • Deposits of uric acid (called tophi) that look like lumps under the skin
  • Kidney stones from uric acid crystals in the kidneys.
For many people, the first attack of gout occurs in the big toe. Often, the attack wakes a person from sleep. The toe is very sore, red, warm, and swollen.
Gout can cause:
  • Pain
  • Swelling
  • Redness
  • Heat
  • Stiffness in joints.
In addition to the big toe, gout can affect the:
  • Insteps
  • Ankles
  • Heels
  • Knees
  • Wrists
  • Fingers
  • Elbows.
A gout attack can be brought on by stressful events, alcohol or drugs, or another illness. Early attacks usually get better within 3 to 10 days, even without treatment. The next attack may not occur for months or even years.

What Causes Gout?

Gout is caused by the buildup of too much uric acid in the body. Uric acid comes from the breakdown of substances called purines. Purines are found in all of your body’s tissues. They are also in many foods, such as liver, dried beans and peas, and anchovies.
Normally, uric acid dissolves in the blood. It passes through the kidneys and out of the body in urine. But uric acid can build up in the blood when:
  • The body increases the amount of uric acid it makes.
  • The kidneys do not get rid of enough uric acid.
  • A person eats too many foods high in purines.
When uric acid levels in the blood are high, it is called hyperuricemia. Most people with hyperuricemia do not develop gout. But if excess uric acid crystals form in the body, gout can develop.
You are more likely to have gout if you:
  • Have family members with the disease
  • Are a man
  • Are overweight
  • Drink too much alcohol
  • Eat too many foods rich in purines
  • Have an enzyme defect that makes it hard for the body to break down purines
  • Are exposed to lead in the environment
  • Have had an organ transplant
  • Use some medicines such as diuretics, aspirin, cyclosporine, or levodopa
  • Take the vitamin niacin.

How Is Gout Diagnosed?

Your doctor will ask about your symptoms, medical history, and family history of gout. Signs and symptoms of gout include:
  • Hyperuricemia (high level of uric acid in the blood)
  • Uric acid crystals in joint fluid
  • More than one attack of acute arthritis
  • Arthritis that develops in 1 day, producing a swollen, red, and warm joint
  • Attack of arthritis in only one joint, usually the toe, ankle, or knee.
To confirm a diagnosis of gout, your doctor may draw a sample of fluid from an inflamed joint to look for crystals associated with gout.

How Is Gout Treated?

Doctors use medicines to treat an acute attack of gout, including:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroids, such as prednisone
  • Colchicine, which works best when taken within the first 12 hours of an acute attack.
Sometimes doctors prescribe NSAIDs or colchicine in small daily doses to prevent future attacks. There are also medicines that lower the level of uric acid in the blood.

What Can People With Gout Do to Stay Healthy?

Some things that you can do to stay healthy are:
  • Take the medicines your doctor prescribes as directed.
  • Tell your doctor about all the medicines and vitamins you take.
  • Plan followup visits with your doctor.
  • Maintain a healthy, balanced diet. Avoid foods that are high in purines, and drink plenty of water.
  • Exercise regularly and maintain a healthy body weight. Ask your doctor about how to lose weight safely. Fast or extreme weight loss can increase uric acid levels in the blood.

      High-Purine Foods

  • anchovies
  • asparagus
  • beef kidneys
  • brains
  • dried beans and peas
  • game meats
  • gravy
  • herring
  • liver
  • mackerel
  • mushrooms
  • sardines
  • scallops
  • sweetbreads

What Research Is Being Done on Gout?

Scientists are studying:
  • Which NSAIDs are the most effective treatments for gout
  • Optimal dosages of medications for gout
  • New medicines that safely lower uric acid in the blood and reduce symptoms
  • New therapies that block a chemical called tumor necrosis factor
  • Enzymes that break down purines in the body
  • The role of foods and certain vitamins
  • The role of genetics and environmental factors
  • The interactions of cells involved in acute gout attacks.

Glossary

Corticosteroids. Powerful anti-inflammatory hormones made naturally in the body or man-made for use as medicine. Injections of corticosteroid drugs are sometimes used to treat inflammation in the shoulder, knee, and other joints.

Diuretics. A type of medication that promotes the formation and output of urine. Diuretics are prescribed to treat the accumulation of excess fluid in bodily tissues that can result from diseases of the kidneys, liver, lungs, or heart. They may also be used to treat high blood pressure or glaucoma, a condition in which pressure builds up inside the eye.

Hemolytic anemia. A form of anemia (deficiency of red blood cells) caused by the destruction of the cells rather than the body’s inability to produce them in adequate numbers.

Hyperuricemia. The presence of elevated levels of uric acid in the blood.

Hypothyroidism. A condition in which the thyroid gland (the gland that makes and stores hormones that regulate heart rate, blood pressure, body temperature, and the rate at which food is converted to energy) is underactive. Without treatment, this condition can result in fatigue, weight gain, other serious medical problems, and even death.

NSAIDs. A class of medications, available over the counter or with a prescription, that ease pain and inflammation.

Podagra. Gout in the big toe.

Pseudogout. A condition often mistaken for gout that results from the deposit of calcium phosphate crystals (not uric acid crystals as in gout) in the joints and other tissues. This condition is also called chondrocalcinosis.

Psoriasis. An autoimmune disease characterized by a red scaly rash that is often located over the surfaces of the elbows, knees, and scalp, and around or in the ears, navel, genitals, or buttocks. Approximately 10 to 15 percent of people with psoriasis develop an associated arthritis referred to as psoriatic arthritis.

Purines. Found in the DNA and RNA within the nuclei of cells, purines are part of all human tissue and are found in many foods, especially those high in protein.

Synovial fluid. The slippery fluid produced by the synovium (joint lining) to lubricate the joints.

Tophi. Nodular masses of uric acid crystals that sometimes form in the soft tissue of people with chronic gout. Although tophi are most common around the fingers, elbows, and big toe, they can occur in virtually any part of the body. (The singular is tophus.)

Uric acid. A substance that results from the breakdown of purines, which are part of all human tissue and are found in many foods.

Source: niams.nih.gov