Gout Causes, Diagnosis, and Treatment

A cause of joint pain and swelling.

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Gout is a condition that causes sudden and severe attacks of pain, redness and swelling of joints. Gout is a condition has been well known for many centuries. Most often it affects a single joint in one episode, often the big toe. About 9 out of 10 affected individuals affected by gout are men over the age of 40. The peak age of attacks is 75 years, but it can occur in young individuals on rare occasions.

Over one millions Americans have a gout attack each year.

What causes gout?
Gout is due to accumulations of uric acid within the fluid of your joints. Uric acid is a waste product of many foods that we eat. In order to properly digest food, and rid our body of waste, we produce substances such as uric acid to transport waste material. Ultimately, uric acid is excreted via the kidneys in urine. However, when the transportation of uric acid is impaired, and uric acid accumulates in the blood stream, the condition called gout may result.

The impairment of uric acid excretion is often due to a hereditary problem, but can also have other causes. When the uric acid level becomes too high for an individual, painful attacks of gouty arthritis, or joint pain, can result. Other symptoms can include kidney stones, and, ultimately, kidney failure. It is interesting to note that the relationship between uric acid levels in the blood stream and gout is unclear.

Some individuals with gout have normal or near normal blood levels of uric acid; other individuals have very high blood levels of uric acid with no symptoms of gout. It appears to be entirely dependent on the individual.

Why are some people more susceptible to gouty attacks?
As stated previously, some individuals have a hereditary condition making them more susceptible to gout; other risk factors also contribute to having a gouty attack.

Among these are obesity and sudden weight gain, abnormal kidney function, excessive intake of alcohol (especially "binge" drinking), and certain types of cancer. Some medications, such as thiazide diuretics to control blood pressure, and foods that are rich in purines can lead to attacks. Purine-rich foods include organ meats (e.g. liver, kidney), herring, anchovies, and to an extent, all meat products.

How is gout diagnosed?
Most often the diagnosis of gout can be made by a description of the symptoms and medical history. Your doctor will want to know about risk factors that may be contributing to the onset of this attack. This may be sufficient to make a diagnosis of gout, especially if you have had a gouty attack before.

The diagnosis can be confirmed through sampling the joint fluid by inserting a small needle into the affected joint; this procedure is performed under local anaesthetic. Under the microscope, joint fluid from an affected joint will be full of tiny uric acid crystals that look like small needles. Blood tests may also be performed to check for uric acid levels (however, as stated above, these need not be elevated in gout, but often are), and kidney tests may be done to check your kidney function.

What is the treatment of a gouty attack?
Initial treatment for a gouty attack is usually with a nonsteroidal anti-inflammatory medications (NSAIDs). These medications, such as over the counter Motrin, or more potent prescription versions, are not always well tolerated by some patients. In those who cannot use NSAIDs, a steroid medication can also be used, either injected or oral. Another medication, colchicine, is very effective in the immediate treatment of a gouty attack, but often causes nausea and stomach upset, so many patients do not tolerate this drug.

Future attacks of gout can be prevented by taking a medication called allopurinol. This medication is started after the gout attack has ended (usually after a few days).

How can I prevent gout?
Individuals often learn what causes their own gout attacks. As previously discussed, certain foods with high concentrations of purines can be avoided. Drinking alcohol should be moderated. Prescription and non-prescription medications should be reviewed with your doctor (it is important that you not discontinue a medication without consulting your doctor, as an untreated condition such as high blood pressure may be worse than a gouty attack). Other common causes of a gouty attacks include dehydration, injury to a joint, surgery, and a febrile illness. Prevention should focus on avoidance of these situations. If surgery is needed, discuss with your doctor whether prophylactic medication to prevent a gouty attack is appropriate.