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Gout, a painful and potentially debilitating form of arthritis, has afflicted such famed figures as Benjamin Franklin and Henry VIII. Today it affects roughly two million Americans. This disorder develops after tiny, needle-like crystals of uric acid (a biological waste product) accumulate in joints, causing swelling and extreme sensitivity, sometimes to the point where even the slight touch of a sheet is unbearable. The same crystals may cause kidney stones if they accumulate in the kidneys.

Gout usually affects one joint at a time, most often the big toe, but sometimes a knee, ankle, wrist, foot, or finger. If gout persists for many years, uric acid crystals may collect in the joints or tendons and under the skin, forming whitish deposits known as tophi. About 90 percent of people with gout are men older than 40, and African American men are twice as likely as Caucasian men to be affected. Gout tends not to occur in women until at least 10 years after menopause.

Causes of gout

For many people, gout develops after a combination of factors contributes to the buildup of excessive levels of uric acid in the body. Abnormally high levels of uric acid may result from a diet that is rich in purines, chemicals that are broken down into uric acid by the body. Purines can be found in anchovies, nuts, and organ foods such as liver, kidney, and sweetbreads. Sometimes, for unknown reasons, the body will produce too much uric acid regardless of diet. Gout can also develop when the kidneys excrete too little uric acid, which can happen in people with some types of kidney disease and in those who drink too much alcohol. In addition, obesity or sudden weight gain can cause elevated levels of uric acid. Some medications, particularly diuretics, also contribute to high uric acid levels. People at risk for developing gout include those with a family history of the disease and those with hypertension, hyperlipidemia, or diabetes.

Diagnosing gout

To reach a diagnosis, your doctor will ask you about your diet, your medication use, your alcohol consumption, and whether you have a family history of gout. During a physical exam, your doctor will inspect your inflamed joints and look for tophi on your skin. Your doctor may also use a needle to withdraw a small fluid sample from your affected joint. This fluid will be examined under a microscope to determine whether uric acid crystals are present. Your doctor may also order a blood test to determine your uric acid level, but this test is not definitive because — for a variety of different reasons — many people without gout experience elevated uric acid levels, and even in people with gout, the results may be normal.

Treating gout

Gout is usually treated with a two-prong medication strategy: The first goal is to ease attacks of joint pain and inflammation, while the second, longer-term goal is to decrease blood uric acid level and prevent further attacks.

Usually a doctor begins by prescribing a nonsteroidal anti-inflammatory drug (NSAID) to control pain and inflammation (see "NSAIDs"). Avoid taking aspirin, as it may raise your uric acid level. If you cannot tolerate an NSAID or if these drugs are ineffective, your doctor may suggest a corticosteroid. Much less often, oral colchicine is prescribed, but be aware that this drug tends to cause unpleasant side effects (nausea, vomiting, cramps, diarrhea) and is not well tolerated in about 80 percent of people.

For people with attacks that respond poorly to therapy, involve multiple joints, or occur frequently, or when kidney stones or tophi are present, a second type of drug may be prescribed to prevent future gout attacks. It's important to keep taking this drug even after you feel better. The first choice is usually allopurinol (Aloprim, Zyloprim), which decreases your body's production of uric acid. Other options include probenecid (Benemid) and sulfinpyrazone (Anturane), which help the kidneys to eliminate uric acid. An investigational medication, febuxostat, is not yet approved by the FDA, but has shown promise as a potential new treatment for gout.

You can help prevent further attacks by avoiding diuretics (if your doctors agree), limiting your alcohol intake, drinking plenty of water, and maintaining a healthy weight. You may also want to reduce your consumption of foods that seem to trigger gout attacks, such as meat and certain types of seafood and vegetables — although many people find that dietary restrictions have few benefits.

Source: from Harvard Health Publications, Copyright © 2008 Harvard University. All rights reserved. Harvard Medical School does not endorse products.
Used with permission of StayWell.
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