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By Melissa Tennen, HealthAtoZ writer
Gout is one of the most painful types of arthritis.
Problems with gout involve a chemical compound called purine, which is in all the body's cells and in high concentrations in organ meats, sardines, anchovies, dried peas and beans. As cells divide, the body continually breaks down purine. Extra purine is secreted out of the body through urine in a form called uric acid, which is a natural chemical compound.
Normally uric acid dissolves in the blood and passes through the kidneys into the urine. If production of uric acid increases or the kidneys don't filter out enough from the body, levels of uric acid build up in the blood causing a condition called hyperuricemia. As a result, uric acids may form deposits of needle-like crystals in tissues in the joint spaces between bones. Deposits of uric acid called tophi look like lumps under the skin around joints.
White blood cells, mistaking the crystals for a foreign invader, flood into the joint and surround the crystals, causing inflammation. This is the redness, swelling and pain of a gout attack.
For 75 percent of sufferers, gout first attacks the big toe. Gout may attack the big toe first because it is one of the body's farthest points from the heart with the lowest body temperature, making it easier for crystals to develop. Other joints affected include the ankle, heel, knees, wrists, fingers and elbow.
Attacks can be triggered by stress or dehydration. They may last a few days and improve on their own. However, if left untreated, they can become more frequent and last longer. Early diagnosis and treatment can help control the attacks. No screening exists for the condition.
Risk factors include:
- A family history of gout
- Being male
- Overweight
- A diet rich in purines, including shellfish and organ meat
- Alcohol use which interferes with the removal of uric acid
- Not getting enough fluids, which may encourage the formation of urate crystals
- Hyperlipidemia and diabetes
- Immunosuppressant medications used after organ transplantation
When an attack begins, the doctor may start you on nonsteroidal anti-inflammatory (NSAIDs) medicines such as indomethacin or naproxen, or corticosteriods by mouth or injection into the joint. As an alternative, or in addition to NSAIDs and corticosteroids, you may be given colchicine, which is most effective if taken within 12 hours of attack. Your symptoms should improve within 48 hours of starting treatment. However gout may not improve completely until seven to 10 days later.
To prevent attacks, your doctor may prescribe either NSAIDs or colchicine in small daily doses. If you have frequent attacks of gout, your doctor may prescribe allopurinol or probenecid, which lowers the overall concentration of uric acid in the body.
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External Sources
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The Arthritis Foundation
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American College of Rheumatology
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This article was reviewed and updated June 2007.
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