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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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