Gout is a form of arthritis that occurs when uric acid crystals build up in the joints. This causes the joints to be inflamed, causing pain. It most often affects the joint of the big toe but can affect other joints as well.
Gout may occur in a single attack or become a recurrent problem. During acute attacks, gout can cause pain, swelling, and redness in the affected joint. Periods between acute attacks are usually symptom-free.
Over time, gout can cause permanent damage to the affected joints and the kidneys. Gout can also create a collection of crystals under the skin called tophi. The tophi are visible lumps under the skin that can show up anywhere in the body and become tender during acute attacks.
Fortunately, these long-term factors are less likely to occur with proper treatment. The earlier gout is detected and treated, the better it can be managed.
Causes of Gout
Gout is caused by the build-up of uric acid crystals in and around a joint. Crystals often form because of high levels of uric acid in the blood.
Uric acid is created and released into the blood during the breakdown of a substance in food called purines. The uric acid is then filtered out of the blood through the kidneys and passes out of the body through urine. Higher than normal levels of uric acid in the blood may be caused by:
- Impaired ability to clear the uric acid in the kidneys, which may occur with kidney damage or disease
- Increased production of uric acid, which may be caused by one or more of the following:
- Excess consumption of foods high in purines like steak, seafood and organ meats
- Consumption of foods that encourage high uric acid levels, such as alcohol or sugary drinks
- Certain medications, such as diuretics, salicylate containing medications (like aspirin), niacin or levodopa
- Medical conditions such as high blood pressure, hypothyroidism, Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome
Gout is more common in men over 30 years old, and usually doesn't usually affect women until after menopause.
The risk for gout increases if other family members have gout.
Other factors that may increase your chance of gout include:
- Obesity — poor eating habits can lead to an increase of uric acid in the blood
- Eating a diet high in foods with purines, such as seafood, shellfish or red meat
- Excess intake of alcohol
- Drinking high-fructose beverages, such as sugar-sweetened sodas and orange juice
Serious illness, such as a heart attack or stroke, can trigger a gout attack. Other illnesses that may increase the risk for developing gout include:
- High blood pressure
- Vascular diseases that affect blood vessels
- Kidney disease
- Thyroid disorders
- Organ transplantation
- Diuretics — often used to treat high blood pressure
- Salicylates and medications made from salicylic acid, such as aspirin
- Levodopa — used in the treatment of Parkinson’s disease
- Cyclosporine — used to help control rejection of transplanted organs
The symptoms of gout usually come on suddenly and severely. They're referred to as gout attacks, which can happen one time or several times. A single gout attack usually only affects only one joint, but recurrent attacks may affect more than one joint.
The big toe is the most common site of gout. Other sites include the ankle, heel, foot instep, wrist, elbow or fingers.
Attack symptoms often develop rapidly overnight and worsen over the next 24-48 hours. Common symptoms in the joint include:
- Severe pain and sensitivity of the joint
- Extreme tenderness
- Recurrent attacks can lead to permanent joint damage, especially if gout remains untreated. Uric acids can build up and create deposits called tophi. They can lead to:
- Hard lumps under the skin near or around joints
- Hard lumps at the rim of the ear, fingertips, cornea of eye, aorta, spine or around the brain
- High levels of uric acid in the body can also lead to complications in other areas of the body, such as the kidneys
Gout of the Big Toe
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Gout may be suspected based on symptoms and medical history. Because there are several joint disorders with similar symptoms, your doctor may do other tests to rule these out.
A standard test for gout is arthrocentesis. A needle is inserted into a joint or tophus and a fluid sample is removed. The fluid is evaluated under a microscope to look for uric acid crystals. Uric acid crystals are present in nearly all cases of gout.
Blood tests may also be done to measure the level of uric acid crystals in the blood. Blood tests are also useful to rule out other joint conditions.
Imaging tests evaluate the joint and surrounding structures. These may include:
- MRI scan
There is no cure for gout, but most symptoms and attacks can be managed with a combination of lifestyle changes and medications. The earlier gout is detected and treated, the better it can be controlled.
The goals of treatment for gout include:
- Managing symptoms of an acute attack
- Decreasing the risk of recurrence by managing uric acid levels
- Preventing complications, such as joint or kidney damage, which can occur with recurrent attacks
Treatment options can vary by individual. Working with a healthcare team is important to help find the treatments that works best for each person.
Treatment may include the following:
- Lifestyle changes
- Alternative and complementary therapies
There are no specific guidelines to help prevent gout, but there are ways to reduce the risk of acute attacks and maintain joint health. Managing certain risk factors may help. Steps include:
- Maintain a healthy weight. Obesity is linked to increased uric acid levels. Eat more vegetables, low- or non-fat dairy and mono- and polyunsaturated fats.
- Exercise regularly. Moderate exercise helps with weight control and overall well-being. Talk to your doctor about which exercises will benefit you the most. Avoid intense exercises that strain muscles and joints.
- Drink alcohol in moderation. Excess alcohol consumption is associated with gout. Moderate alcohol intake means two drinks or less per day for men and one drink or less per day for women.
- Avoid foods that contain high amounts of purines. These include red meats, seafood and foods high in salt.
Talk to your doctor about adding sweet cherries and/or vitamin C supplements to your diet. These may help reduce uric acid levels.
Keep in mind that supplements and herbal medications may interact with medications you currently take. Talk to your doctor or pharmacist about medications and supplements you may be taking to learn about possible problems.
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Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.