GOUT

General Information

DEFINITION--Recurrent attacks of joint inflammation caused by deposits of uric-acid crystals in the joints, especially the base of the big toe. Gout is a form of arthritis.

BODY PARTS INVOLVED--Joints: base of the big toe; may also involve the elbow, knee, hand, foot, ankle, arm or shoulder.

SEX OR AGE MOST AFFECTED--Adults of both sexes, but 20 times more frequent in men than women.

SIGNS & SYMPTOMS

• Sudden onset of severe pain in the inflamed joint, usually at the base of the big toe or larger joints.
• Involved joints are red, hot, swollen and very tender. Skin over the joint is red and shiny.
• Fever (sometimes).

CAUSES--A high level of uric acid in the blood due to increased production of uric acid or decreased elimination of uric acid by the kidneys. Not all people with excess uric acid levels develop gout.

RISK INCREASES WITH

• Use of diuretic drugs (water pills) such as furosemide and hydrochlorothiazide.
• Use of some antibiotics.
• Some blood diseases, such as polycythemia and leukemia.
• Men over 60.
• Family history of gout.
• Obesity.
• Many disorders including thyroid problems, kidney disease, anemia, hyperlipidemia, high blood pressure, diabetes and vascular disease.
• Trauma, surgery, radiation treatment.
• Eating large amounts of anchovies, sardines, sweetbreads, kidney or liver.

HOW TO PREVENT--Avoidance of risk factors where possible.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory studies such as blood levels of uric acid and studies of the fluid in the joint; x-ray (usually normal in the first year of the disease); bone scan (sometimes).
• Therapeutic trial with antigout medications.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.

POSSIBLE COMPLICATIONS--

If untreated, may cause:

• Crippled, deformed joints.
• Kidney stones.
• Inflammation of bones, ligaments and tendons.

PROBABLE OUTCOME--The first attack may last a few days, but recurrent attacks are common without treatment to reduce the uric-acid level in the blood. Symptoms can be eliminated with treatment.

How To Treat

GENERAL MEASURES--

• Use warm or cold compresses on painful joints.
• Keep the weight of bedclothes off any painful joint by making a frame that raises sheets off the feet.

MEDICATION--Your doctor may prescribe:

• Nonsteroidal anti-inflammatory drugs to control inflammation in the painful joints.
• Prescription medications such as colchicine, indomethacin or prednisolone to control the pain of the acute attack.
• For some patients, lifelong medication, such as allopurinol to decrease uric-acid production or probenecid to increase the kidneys' excretion of uric acid. These medications have significant side effects and adverse reactions. Obtain as much information as possible regarding their use.

ACTIVITY--Acute attacks will end sooner with complete rest.

DIET--

• Don't eat liver, sweetbreads, kidney or sardines.
• Drink 8 to 10 glasses of water daily.
• Don't drink alcoholic beverages, especially beer or red wine (they can worsen or trigger an attack).
• If you are overweight, begin a medically approved weight loss diet. Do not go on a crash diet, as quick weight loss may bring on gout

Call Your Doctor If

• You have symptoms of gout.
• The following occurs during treatment: Fever of 101F (38.3C) or higher. Skin rash, sore throat, red tongue or bleeding gums. Marked swelling of feet or abrupt weight increase. Diarrhea or vomiting.
• Symptoms are not relieved in 3 days despite treatment.
• New, unexplained symptoms develop.