Diseases & Conditions

Acute Gout - Gout


Overview, Causes, & Risk Factors

Gout is a form of arthritis, or joint inflammation, that is caused by increased uric acid in the bloodstream. Uric acid is a chemical produced by the normal breakdown of cells.

What is going on in the body?

Gout results from an excess of uric acid in the body. The excess uric acid is deposited in 1 or more joints, causing arthritis.

What are the causes and risks of the disease?

Gout is caused by an excess of uric acid in the bloodstream. Uric acid accumulates in the body and may form crystals in the joints under the following conditions:

  • if the person has a defect in metabolism that causes overproduction of uric acid. Metabolism refers to the chemical processes involved in normal body functions.
  • if the kidneys have a reduced ability to remove uric acid from the bloodstream
  • if the person's diet is high in purines, which are broken down into uric acid in the body. Foods high in purines include organ meats, seafood, and dried beans.
  • Certain risk factors increase a person's chance of developing gout or having a flare-up of symptoms once he or she has the disease. These factors include the following:

  • a diet high in purines
  • alcohol consumption
  • obesity
  • high blood pressure
  • high levels of cholesterol, triglycerides, and other lipids in the blood
  • diabetes
  • kidney disease
  • sickle cell anemia, a blood disorder that causes abnormal red blood cells
  • Gout occurs in approximately 1 in 5,000 people. It is more common in men, although women are at increased risk after menopause, the end of normal menstruation.


    Symptoms & Signs

    What are the signs and symptoms of the disease?

    Gout can cause a sudden onset of severe joint pain such as the following:

  • The pain is usually described as excruciating, throbbing, or crushing.
  • The pain usually starts during the night.
  • Generally, only the main joint of 1 or both of the big toes is involved.
  • Usually, only 1 or 2 joints are affected at a time.
  • It typically lasts for 2 or 3 days and then stops.
  • It recurs occasionally.
  • Although gout is most commonly seen in the great toes, it may also affect the joints of the fingers, hands, feet, or toes. Less commonly, the hips, shoulders, elbows, and wrists can be involved.

    Following are other symptoms of gout:

  • joint swelling
  • redness over and around the joint
  • fever
  • a lump over the joint that has a chalky material draining from it
  • joint stiffness

  • Diagnosis & Tests

    How is the disease diagnosed?

    The diagnosis of gout starts with a medical history and physical examination. Then the healthcare provider may do a joint aspiration, inserting a needle into the joint space to remove some of the joint fluid. The fluid is examined in the laboratory for the presence of uric acid crystals.

    There also are blood tests that can be used to check for uric acid, but the results may be normal or even low in people with gout. Joint X-rays may be used to rule out any other abnormalities. Usually, if gout is in the acute stage, the joint X-rays will be normal.


    Prevention & Expectations

    What can be done to prevent the disease?

    Some cases of gout can be prevented by controlling conditions that are strongly associated with gout, such as high blood pressure or high cholesterol.

    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 it can lead to kidney stones and chronic changes in the affected joints. The chronic stage is more likely to occur when the disease starts before the age of 30. Untreated gout can lead to permanent disability.

    What are the risks to others?

    Gout is not contagious and poses no risk to others.


    Treatment & Monitoring

    What are the treatments for the disease?

    There are treatments for both the acute phase of gout and for preventing flare-ups of symptoms. For acute attacks, the anti-inflammatory medication colchicine is used to reduce the pain. Indomethacin and other nonsteroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen, are also useful. Occasionally, pain medications may be prescribed.

    After the acute attack has resolved, other medications can be used to minimize acute attacks of gout. Allopurinol blocks the body's production of uric acid and probenicid helps the kidneys eliminate excess uric acid.

    A person with gout will also be advised to make the following lifestyle changes:

  • Drink plenty of liquids.
  • Eat a diet low in purines.
  • Limit alcohol intake.
  • Maintain a healthy body weight.
  • Follow effective treatment for conditions such as diabetes, high blood pressure, high cholesterol, kidney disease, and sickle cell anemia.
  • What are the side effects of the treatments?

    Colchicine, nonsteroidal anti-inflammatory drugs, also called NSAIDs, and allopurinol may cause nausea, vomiting, diarrhea, abdominal distress, and allergic reactions.

    What happens after treatment for the disease?

    People who have gout can have recurrent episodes throughout their lives. These episodes are not always associated with increases in the uric acid level in the blood. Early treatment of acute gout attacks is important. This helps improve the quality of life and reduces the chances of any chronic changes in the joint.

    How is the disease monitored?

    The healthcare provider 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 provider will also monitor uric acid levels and any side effects of the medications. Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:James Broomfield, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:02/28/01
    Reviewer:Barbara Mallari, RN, BSN, PHN
    Date Reviewed:07/13/01