Alternative Names acute gout, gouty arthritis, acute gouty arthritis
Definition Gout is a disease caused by increased uric acid in the bloodstream. Uric acid is a chemical produced by the normal breakdown of cells. Uric acid crystals are deposited in the joints, creating arthritis.
What is going on in the body? Gout results from a defect in metabolism that causes overproduction of uric acid. Metabolism is the chemical processes involved in normal body functions. Gout can also result from the kidneys' reduced ability to remove uric acid from the bloodstream. The exact cause of the metabolic defect is not known. Gout usually affects individual joints.
Usually the pain starts at night. It occurs in joints such as the main joint in the great toe. Pain can also occur in fingers. It usually affects only one or two joints at a time. The pain may last for two or three days and then stop. It can then recur occasionally. The affected joint will be red and tender and may look infected. The pain is described as excruciating, throbbing, and crushing.
What are the signs and symptoms of the disease? The signs and symptoms are:
joint stiffness
joint pain
joint swelling
redness
fever
a lump over the joint, a chalky material may drain out
The pain begins suddenly and it may occur in one or more joints. Hand, foot or toe joints, and ankles are the most commonly affected. Other joints affected are:
knees
hips
shoulders
elbows
wrists
What are the causes and risks of the disease? Certain diseases increase the risk of developing gout. They include diabetes mellitus, which is abnormally high blood sugar, obesity, kidney disease, and sickle cell anaemia. Sickle cell anaemia is an inherited form of abnormal blood haemoglobin. Haemoglobin is the molecule that carries oxygen. Gout may occur after drug therapy. Alcohol consumption, trauma, and a diet high in purines can increase the risk of gout. Purines are chemical compounds that are converted to uric acid by the body. Gout occurs in close to one in 5,000 people. It is more common in men, although women are at increased risk after menopause, the end of normal menstruation or "change of life" in women.
What can be done to prevent the disease? It may help to avoid factors that contribute to the condition, such as excessive alcohol intake or dietary purines. Foods that contain high levels of purines are:
organ meats (e.g. liver, pancreas)
beer
wine
certain types of fish
There is also medication that can help reduce and prevent the attacks.
How is the disease diagnosed? The diagnosis of gout can usually be made by examination. However, this is not always enough. It may also be necessary to remove some of the joint fluid with a needle and look at it under a microscope to study the crystals that form when an individual develops gout. There are also blood tests that look for uric acid. X-rays may be performed to rule out any other abnormalities. Usually, if gout is in the acute stage, the short time period surrounding an attack, the X-rays will be normal.
What are the long-term effects of the disease? People with gout can live normal lives. But when the disease is active, it can have a significant effect on quality of life. Gout can progress to a chronic state, and can lead to kidney stones and chronic changes in the affected joints. The chronic state is more likely to occur when the disease starts before the age of 30.
What are the risks to others? Gout is not contagious. It is thought to run in families.
What are the treatments for the disease? There are treatments for both the acute phase of gout and for preventing the condition. For acute attacks, the drug colchicine is used to reduce the pain.Indomethacin and other non-steroidal anti-inflammatory drugs, like ibuprofen, are also useful. Very occasionally, other analgesics or drugs that reduce pain, including narcotics, may be prescribed. Once the acute attack has resolved, allopurinol, taken daily, can help prevent future attacks. Colchicine and non-steroidal anti-inflammatory (NSAIDs) drugs are given only during the acute attack. Fluid intake should be increased because it helps dilute the urine and reduces the formation of kidney stones. Eating a diet low in purines is also important.
What are the side effects of the treatments? Colchicine, non-steroidal anti-inflammatory drugs, and allopurinol can all have side effects that affect the stomach and intestines. There are several other side effects. They should be discussed with the doctor.
What happens after treatment for the disease? People with gout can have recurrent episodes throughout their lives. These are not always associated with rises in the uric acid level in the blood. It is important to start the treatment of acute gouty attacks early in the episode. This helps improve the quality of life and reduces the chances of any chronic changes in the joint.
How is the disease monitored? The doctor will describe how to monitor the disease. Most will want to know about the number of attacks, the length of each attack, and which joint is involved. The doctor will also monitor uric acid levels and any side effects of the medications.
Author: James Broomfield, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
