Penn Rheumatology

Gout Treatment

Gout is a kind of arthritis that occurs when uric acid builds up in the joints. It can be very painful and typically affects one joint at a time, although it can involve many joints.

Gout is caused by too much uric acid in the body. Some patients make too much uric acid and others have a hard time getting rid of uric acid. Not everyone with high uric acid levels in the blood will develop gout. In patients with gout, the uric acid levels build up in the joints, forming crystals in the joint fluid. These crystals cause the joint to swell and become inflamed.

The exact cause of gout is unknown. It can run in families. Gout is more common in males, postmenopausal women, and people who drink alcohol. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have higher levels of uric acid in the blood.

The condition may also develop in people with:

  • Diabetes
  • Kidney disease
  • Obesity
  • Sickle cell anemia and other hemolytic anemias
  • Leukemia and similar types of disorders

The condition may occur after taking medicines that interfere with the removal of uric acid from the body.

Symptoms

If you are experiencing a gouty attack, you may experience the following:

  • Symptoms develop suddenly and usually involve only one or a few joints. The big toe, knee, or ankle joints are most often affected.
  • The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating.
  • The joint appears warm and red. It is usually very tender (it hurts to lay a sheet or blanket over it).
  • There may be a fever.
  • The attack may go away in several days, but may return from time to time. Additional attacks usually last longer

After the first gouty attack, people may have no symptoms. Some people go months or even years between gouty attacks. Other people may develop chronic gouty arthritis. Those with chronic arthritis can develop joint deformities and loss of motion in the joints. They have may joint pain and other symptoms most of the time.

Uric acid deposits may form lumps under the skin called tophi. Tophi develop in cartilage tissue, tendons, and soft tissues and may drain chalky material. Tophi usually develop only after a patient has had gout for many years.

After one gouty attack, more than half of people will have another attack.

Diagnosis

Tests for gout that may be done include:

  • Synovial fluid analysis (shows uric acid crystals)
  • Uric acid - blood
  • Joint X-rays (may be normal)
  • Urine uric acid levels are sometimes performed
  • Synovial biopsy is rarely performed when the diagnosis is unclear
Treatment

For a sudden attack or flare-up of gout, a physician may:

  • Recommend prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or indomethacin as soon as symptoms begin, to be taken for four to 10 days.
  • Prescribe colchicine to help reduce pain, swelling and inflammation
  • Inject corticosteroids into the inflamed joint to relieve the pain.
  • Prescribe oral steroids such as prednisone to relieve a severe flair.
  • Occasionally prescribe strong painkillers such as codeine, hydrocodone or oxycodone.

The pain of acute gout often goes away within 24 hours of starting treatment, and is completely relieved in a few days. Daily use of allopurinol or probenecid decrease uric acid levels in the blood. A physician may prescribe these medicines for patients who have:

  • Several attacks during the same year.
  • Signs of gouty arthritis.
  • Uric acid kidney stones.

Diet and lifestyle changes may also help prevent gouty attacks, including:

  • Avoid alcohol (particularly beer and hard alcohol), red meat, seafood (particularly shellfish), and, organ meat (liver, kidney, and sweetbreads)
  • Eat enough complex carbohydrates such as whole grains, oats, and brown rice.
  • When a flare begins, increase the amount of vitamin C in your diet or try drinking tart cherry juice.