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Gout Treatment at Penn Medicine
Gout is a kind of arthritis that occurs when uric acid builds up in the joints. It can be very painful and typically affects just one joint.
Gout is caused by too much uric acid in the body. The bodies of some patients make too much uric acid. While others have a hard time getting rid of uric acid, not everyone with high uric acid levels in the blood has gout. In patients with gout, the uric acid levels build up in the joints, forming crystals in the synovial fluid. These crystals cause the joint to swell up and become inflamed.
The exact cause of gout is unknown. It may 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
Symptoms of acute gouty attacks include:
- 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 have no symptoms. Some people go months or even years between gouty attacks. Other people may develop chronic gouty arthritis. Those with chronic arthritis develop joint deformities and loss of motion in the joints. They have 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)
- Synovial biopsy
- Uric acid - urine
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.
- Occasionally prescribe strong painkillers such as codeine, hydrocodone or oxycodone.
- Prescribe colchicine to help reduce pain, swelling and inflammation.
- Inject corticosteroids into the inflamed joint to relieve the pain.
The pain of acute gout often goes away within 12 hours of starting treatment, and is completely relieved in 48 hours. 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:
- Avoiding alcohol, anchovies, sardines, oils, herring, organ meat (liver, kidney, and sweetbreads), legumes (dried beans and peas), gravies, mushrooms, spinach, asparagus, cauliflower, consommé, and baking or brewer's yeast.
- Limiting the amount of meat eaten at each meal.
- Avoiding fatty foods such as salad dressings, ice cream, and fried foods.
- Eating enough carbohydrates.
Patients with gout who are trying to lose weight should lose it slowly. Quick weight loss may cause the formation of uric acid kidney stones.
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