Gout Facts

What is gout?
What is uric acid?
Is gout a common condition?
Where does gout strike?
Why does gout typically affect the big toe?
How long does a gout attack usually last?
How is gout diagnosed?
Who is likely to develop gout?
What are tophi?
How is gout treated?
What medications are available to treat gout?
Do I need to take medication for the rest of my life?
How serious is gout?
How does my weight affect gout?
How do I know if I'm overweight?
Does having kidney stones or a family history of kidney stones cause gout?
How does diabetes impact gout?
How is heart disease and hypertension linked with gout or hyperuricemia?
How can you prevent gout attacks?
What is pseudogout?
Will gout go away on its own?
Will cherries or cherry juice cure my gout?

What is gout?

Gout, a form of arthritis, is a condition caused by an accumulation of sodium urate crystals in the joints. These crystals form when there is an abnormally high level of uric acid in the body. Gout is characterized by sudden and severe episodes of painful, warm and swollen joints.
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What is uric acid?

Uric acid is naturally present in small amounts in the body. It is a waste product that results from the body's normal process of cells dying and releasing purines, as well as the body absorbing purines contained in certain foods. Uric acid is normally dissolved in the blood and passes through the kidneys into the urine. When too much uric acid is produced, or the kidneys are unable to eliminate an adequate amount of uric acid, it may lead to a condition known as hyperuricemia. Hyperuricemia is a precursor to gout, but it is important to note that hyperuricemia does not always result in developing gout.
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Is gout a common condition?

out has the distinction of being one of the most frequently recorded medical illnesses throughout history, as far back as 5 B.C. More than two million people in the United States live with the condition today. Gout also is the most common form of arthritis in men over 40.
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Where does gout strike?

Gout is most often felt in the large joint of the big toe, but it can affect other joints such as the instep, ankle, heel, knee, wrist, finger and elbow. The initial attack generally strikes suddenly and begins at night with the affected joint becoming red and swollen. Ninety percent of patients will suffer a gout attack in their big toe at some time during the course of their disease.
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Why does gout typically affect the big toe?

One explanation is that the big toe is more vulnerable to an attack because of the pressure it receives from walking. Another explanation is the fact that urate crystals form more readily at cooler temperatures. The big toe is cooler than the central part of the body.
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How long does a gout attack usually last?

An initial gout attack can last anywhere from three to 10 days. After experiencing a first attack, approximately 60 percent of patients will experience another attack within the first year, and 78 percent within two years.
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How is gout diagnosed?

A physician will do a physical exam and may take a test to measure the blood's uric acid level. However, to confirm a diagnosis of gout, a physician will need to obtain and analyze fluid from the inflamed joint. In most cases, if a patient has gout, monosodium urate crystals will be present in the fluid. The absence of crystals does not completely rule out a diagnosis of gout, because sometimes the crystals are too small to detect.
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Who is likely to develop gout?

Gout generally affects men over the age of 40. Women typically do not suffer from gout until after menopause. Gout is often hereditary and when it develops in men before the age of 30, it can be especially severe.
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What are tophi?

Tophi are deposits of urate crystals that settle under the skin in the joint space and tendons. While the tophi themselves are relatively painless, acute inflammation can occur around them when crystals are released. Extensive joint destruction and large tophi beneath the skin may lead to deformities in the hands and feet, and to progressive crippling.
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How is gout treated?

The goals of treatment are to ease the pain associated with acute attacks, prevent future attacks and avoid the formation of tophi and kidney stones. The treatment of gout can be approached two ways - management of pain and lifestyle adjustments:

• Management of Pain - Medications are used to treat the pain of acute attacks of gout and to lower uric acid levels.
• Lifestyle Adjustments - Maintain a healthy, balanced diet and healthy body weight. Regular exercise is important, too. Patients are advised to drink lots of water and a minimal amount of alcohol.

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What medications are available to treat gout?

Medications that treat acute attacks are aimed at reducing pain and swelling, and may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), Colchicine, Oral Glucocorticosteriods and Adrenocorticotropic Hormone (ACTH).

Medications to lower uric acid levels and prevent future attacks may include:

• Probenecid and Allopurinol. It is important not to start or stop use of these medications during an attack.

Always check with your physician to determine the best treatment option.

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Do I need to take medication for the rest of my life?

Once a patient has been diagnosed, gout can usually be successfully managed. If a person suffers from recurring and frequent attacks, long-term therapy may be initiated to 1) either lower the uric acid level in the body or 2) increase excretion of uric acid via the kidneys.

Always check with your physician to determine the best treatment option.
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How serious is gout?

Gout is one of the most painful types of arthritis. It is often compared by gout sufferers to the pain level equivalent to childbirth or the fracture of long bones, such as the femur. If left untreated, gout can lead to joint damage and destruction of tissue, and to progressive crippling. Other disorders associated with gout include:

• Impaired kidney function and kidney stones
• Obesity
• Diabetes
• Heart disease

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How does my weight affect gout?

Gout has been associated with obesity and overeating for hundreds of years. An obese person is four times more likely to develop gout than someone with a normal body weight.

According to a 12-year study involving men, weight gain and body fat are strong risk factors for gout in men. Young men who gained weight steadily from their early 20s through to their 40s had a stronger risk of developing gout, even after adjustment for initial weight and other risk factors. "In contrast," said Dr. Hyon Choi, MD, lead author in the study, "men who had lost 10 pounds or more since their early 20s had a 39 percent lower risk of gout compared with men who had maintained the weight gain."

The study points to the importance of maintaining a healthy body weight throughout adulthood to reduce the risk of gout.
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How do I know if I'm overweight?

In 1998, the National Heart Lung Blood Institute released new guidelines for determining overweight and obesity. They developed the Body Mass Index (BMI) as a measurement tool. In simple terms, it is a ratio of height to weight. BMI is a reliable indicator of total body fat, which is related to the risk of disease and death. The score is valid for both men and women but it does have some limitations:

• It may overestimate body fat in athletes and others who have a muscular build.
• It may underestimate body fat in older persons and others who have lost muscle mass.

The BMI Categories are:

• Underweight = <18.5
• Normal weight = 18.5-24.9
• Overweight = 25-29.9
• Obese = BMI of 30 or greater

BMI charts are available online at www.nhlbisupport.com/bmi. Many health clubs and physician's offices also have BMI charts available.

Somewhat less "scientific" methods include the "pinch an inch." Stand straight and, starting around the navel area, use the forefinger and thumb and loosely get hold of some skin. If it's more than an inch you may be overweight.
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Does having kidney stones or a family history of kidney stones cause gout?

Kidney stones do not cause gout, however, 10 to 25 percent of patients with gout will develop a uric acid kidney stone.
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How does diabetes impact gout?

Preliminary research suggests that insulin resistance may play a role in the development of gout. Gout is strongly associated with the consequences of insulin resistance that result in diabetes.
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How is heart disease and hypertension linked with gout or hyperuricemia?

Gout is often associated with cardiac problems, including high blood pressure, coronary artery disease and congestive heart failure. Hyperuricemia has been associated with a higher risk of death from these conditions. Because an elevated uric acid level is strongly associated with cardiovascular disease, studies are underway to determine if hypertension, kidney disease, and obesity are simply associated with elevated uric acid levels or if they actually have a direct causal role in these disorders.
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How can you prevent gout attacks?

If you are at risk for developing gout, start by asking your physician to monitor your uric acid level. They can order a simple blood test to do so.

Consider a diet low in purine-rich foods. Drink plenty of water and avoid or limit alcohol. Review all prescription and nonprescription medications with your physician to see if any of your medications that may increase your risk for hyperuricemia can be adjusted.

Always check with your physician to determine the best treatment option.
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What is pseudogout?

Pseudogout resembles gout, but is neither gout nor a form of gout. It is its own unique condition. In pseudogout, a form of calcium seeps into joints to cause the swelling, heat, redness and pain, commonly associated with a gout attack. The joint most often involved is the knee, but the shoulder, wrist, ankle, elbow and hand also can be affected. Under a microscope, a physician can see the distinctive calcium crystals of pseudogout.
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Will gout go away on its own?

While the symptoms of a gout attack will generally go away within three to 10 days, an attack signals a person has gout. Some people may only experience a few attacks in their lifetime. However, if left untreated there is the possibility that repeated attacks could lead to the formation of tophi, joint deformity and potential crippling.
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Will cherries or cherry juice cure my gout?

Results of a small study (10 women) published in the Journal of Nutrition cited a decrease in uric acid in the body after eating cherries. However, caution should be used in drawing any direct conclusions of cherries as a treatment for gout.

Always check with your physician to determine the best treatment option.
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