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Gout is a type of arthritis that results from the deposit and build-up of glass-like crystals of uric acid in your joints. Uric acid is a by-product of the breakdown of waste products in your body called purines. Normally, uric acid is broken down in the blood stream and then eliminated in the urine.
When the body increases its production of uric acid, or the kidneys remove less uric acid than normal, an excess of uric acid results. High levels of uric acid in the blood (hyperuricemia) may lead to gout, although most people with this condition will not develop the symptoms of gout. Conversely, people without hyperuricemia can develop gout.
It is estimated that over 2 million Americans have gout. A severe gout attack is extremely painful and, if left untreated, can cause permanent and severe joint damage. Fortunately, gout can be medically managed or controlled.
What are the risk factors for gout?
[What are the symptoms of gout?
What are the treatments for gout?
Are there screening tests for gout?
[How can I reduce my risk of developing gout?
[What questions should I ask my doctor?
What is it like to live with gout?
A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to develop gout with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing gout. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
Risk factors for gout include:
Age and Gender
Although gout can occur in men and women of any age, it most often occurs in men over age 40. Gout usually does not affect women until after menopause.
Lifestyle Factors
Lifestyle factors that increase the risk of gout include:
- Being overweight
- Eating a diet that includes foods high in purines. For a list of foods, see Reducing your Risk of Gout .
- Fasting or crash dieting
- Drinking alcohol (especially in excess)
Genetic Factors
There appears to be a genetic component to gout. Six percent to eighteen percent of people who have gout have relatives who also have gout. In a small number of people, the risk of gout is increased by an enzyme defect that interferes with the way the body breaks down purines.
Medical Conditions
Serious illness, such as heart attack or stroke , can trigger a gout attack. Other illnesses that may increase the risk for developing gout include:
- High blood pressure
- Vascular disease
- Diabetes mellitus
- Kidney disease
- Kidney Stones
- Thyroid disorders
- Certain types of anemia
- Following surgical procedures
Medical Treatments
Certain medications and vitamins can increase the risk of gout. These include:
- Diuretics
- Salicylates and medicines made from salicylic acid (such as aspirin )
- Caffeine, including medicines containing caffeine
- Levodopa (used in the treatment of Parkinson’s disease )
- Aminophylline
- Withdrawal of corticosteroid medications
- Cyclosporine (used to help control rejection of transplanted organs)
- Niacin (a vitamin)
In addition, surgery, trauma, and cancer treatments such as radiation or chemotherapy may also increase your risk of developing gout.
The symptoms of gout usually come on suddenly and severely. A gout attack usually affects only one joint, most commonly, the joint of the big toe. However, the attack may involve more than one joint. Symptoms frequently develop overnight and worsen over the next 24 to 36 hours. Other affected joints include the knees, ankles, feet, wrists, hands, fingers, and elbows.
Gout of the Big Toe |
Symptoms in the joint affected usually include:
- Severe pain
- Extreme tenderness
- Swelling
- Redness
- Warmth
Other symptoms may include:
- Fever
- Chills
- Overall sick feeling
Symptoms are usually more severe in people who develop gout before age 30. Some people will only suffer one gout attack. Most people with gout, however, will suffer a recurrence within two years of the first attack, and further recurrences after that (if the condition is left untreated).
Possible complications of gout include:
- Build up of uric acid deposits (tophi):
- Hard lumps under the skin near (or around) joints
- Hard lumps at the rim of the ear
- Other parts of the body may be affected such as fingertips, cornea of eye, aorta, spine, or around brain
- Permanent damage to affected joints
- Carpal tunnel syndrome , a painful condition of the wrists
- Kidney stones (if uric acid builds up in the kidneys)
- Kidney damage
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Gout can be difficult to diagnose. The symptoms are often similar to those of other conditions. If gout is suspected, tests may include:
Arthrocentesis (Joint Aspiration)—A needle is inserted into a joint and fluid is withdrawn with a syringe. This is usually performed using local anesthesia. The fluid is then checked under a microscope for uric acid crystals and signs of inflammation. In nearly all cases of gout, uric acid crystals are present.
Blood and Urine Tests—These tests assess kidney function and measure the amount of uric acid in your blood and urine. However, uric acid levels can often be normal during a gout attack. Other blood tests check for white blood cell count and sedimentation rate.
X-rays—X-rays may be performed to check for signs of joint damage, which may be present in recurrent cases of gout.
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
American College of Rheumatology website. Available at: http://www.rheumatology.org/ .
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc; 2000.
There are a number of measures that will help prevent gout from developing or prevent recurrence of gout attacks.
- Avoid foods high in purines.
- Drink plenty of fluids.
- Lose weight (if necessary) and maintain an appropriate weight.
Avoid Food High in Purines
Gout pain is caused by glass-like crystals of uric acid that build-up in your joints. Uric acid is a by-product of the breakdown of waste products called purines. Therefore, one of the main treatments for gout is to avoid foods and beverages that are high in purines. These include:
Organ meats, such as:
- Liver
- Kidney
- Brain
- Sweetbread
- Heart
- Fish roe
- Mussels
- Anchovies
- Herring
- Sardines
Legumes, such as:
- Dried beans
- Peas
- Soybeans
- Meat extracts
- Consommé
- Gravies
- Mushrooms
- Spinach
- Asparagus
- Cauliflower
- Poultry
Alcoholic beverages, especially:
- Beer and wine
- Binge drinking of any type of alcoholic beverage
The severity of gout varies from person to person. Talk with your doctor about how strict your diet should be for your individual situation.
Drink Plenty of Fluids
Fluids help flush uric acid from the body, so drinking lots of fluids can help control and prevent recurrence of gout attacks.
Lose Weight and Maintain an Appropriate Weight
Losing weight can help lower uric acid levels. If you are overweight, losing weight should help reduce your symptoms and prevent future gout attacks. However, do not go on a crash diet because this can make your gout worse. Consult your doctor for help designing a safe and effective weight loss program that includes:
- Setting a proper weight loss goal
- An appropriate diet to both lose weight and maintain a proper weight.
- A regular exercise program.
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
American College of Rheumatology website. Available at: http://www.rheumatology.org/ .
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc; 2000.
Arthritis Foundation
Address:
PO Box 7669
Atlanta, GA 30357-0669
Phone:
1-800-283-7800 (for information and materials)
Internet address:
http://www.arthritis.org
Description of services provided:
This is the main voluntary organization devoted to arthritis. The foundation publishes free pamphlets on many types of arthritis and a monthly magazine that provides up-to-date information on arthritis. In addition, the foundation provides physician and clinic referrals.
National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse (NAMSIC)
Address:
C/O National Institutes of Health
1 AMS Circle
Bethesda, MD 20892–3675
Phone:
1-301-495–4484
Internet address:
http://www.niams.nih.gov
Description of services provided:
This is a public service sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. It provides information about various forms of arthritis and rheumatic diseases. The clearinghouse distributes patient and professional education materials.
American College of Rheumatology
Address:
1800 Century Place, Suite 250
Atlanta, GA 30345
Phone:
1-404-633-3777
Internet address:
http://www.rheumatology.org
Description of services provided:
ACR is a professional organization of rheumatologists and associated health professionals, including physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. The ACR seeks to increase research in the rheumatic diseases, increase federal funding for research in the rheumatic diseases, and advocate for public policy relating to the care of people with arthritis and other rheumatic diseases.
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
Screening Guidelines
Generally, people are not screened for gout. However, according to the American Association for Clinical Chemistry, in some cases when people are undergoing chemotherapy or radiation therapy , blood tests to screen for elevated uric acid levels may be ordered. An increased level of uric acid in the blood increases the risk of developing gout.
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
American College of Rheumatology website. Available at: http://www.rheumatology.org/ .
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc; 2000.
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with gout. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
- Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
- Write out your questions ahead of time, so you don't forget them.
- Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
- Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
Specific Questions to Ask Your Doctor
About Gout
- Why did I develop gout?
- I’ve had one gout attack.
- What are the chances of my having another?
- What can I do to avoid having another?
- Should my children be screened for gout?
About Your Risk of Developing Gout
- If other members of my family have gout, am I likely to develop it?
- Can exercise cause gout?
- What can I do to reduce my risk of gout?
- I’ve had gout attacks. What can I do to reduce to reduce my risk of having another attack?
- I suffer from another form of arthritis. Does this increase my risk of developing gout?
About Treatment Options
- Will I have to take medications to control my gout for the rest of my life?
- What side effects can occur from taking medications for gout?
- Will these medications interfere with any other medications, supplements, or over-the-counter drugs I am already taking?
- Are there any complementary or alternative therapies I should consider?
About Lifestyle Changes
- What lifestyle changes will help control my gout?
- How does my diet affect my gout?
- Do I have to avoid all foods containing purines?
- If my gout is under control, can I drink alcohol at all?
About Your Outlook
- What possible long-term complications may occur from gout?
- If I keep my gout under good control, what are the chances that I can avoid long-term complications from the disorder?
- Am I at increased risk for kidney stones?
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
American College of Rheumatology website. Available at: http://www.rheumatology.org/ .
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc; 2000.
Gout is a type of arthritis that results from the deposit and build-up of glass-like crystals of uric acid in your joints. Uric acid is a by-product of the breakdown of waste products in your body called purines. Normally, uric acid is broken down in the blood stream and then eliminated in the urine.
When the body increases its production of uric acid, or the kidneys remove less uric acid than normal, an excess of uric acid results. High levels of uric acid in the blood (hyperuricemia) may lead to gout, although most people with this condition will not develop the symptoms of gout. Conversely, people without hyperuricemia can develop gout.
It is estimated that over 2 million Americans have gout. A severe gout attack is extremely painful and, if left untreated, can cause permanent and severe joint damage. Fortunately, gout can be medically managed or controlled.
What are the risk factors for gout?
What are the symptoms of gout?
What are the treatments for gout?
Are there screening tests for gout?
How can I reduce my risk of developing gout?
What questions should I ask my doctor?
What is it like to live with gout?
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
American College of Rheumatology website. Available at: http://www.rheumatology.org/ .
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc.; 2000.
A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to develop gout with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing gout. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
Risk factors for gout include:
Age and Gender
Although gout can occur in men and women of any age, it most often occurs in men over age 40. Gout usually does not affect women until after menopause.
Lifestyle Factors
Lifestyle factors that increase the risk of gout include:
- Being overweight
- Eating a diet that includes foods high in purines. For a list of foods, see Reducing your Risk of Gout .
- Fasting or crash dieting
- Drinking alcohol (especially in excess)
Genetic Factors
There appears to be a genetic component to gout. Six percent to eighteen percent of people who have gout have relatives who also have gout. In a small number of people, the risk of gout is increased by an enzyme defect that interferes with the way the body breaks down purines.
Medical Conditions
Serious illness, such as heart attack or stroke , can trigger a gout attack. Other illnesses that may increase the risk for developing gout include:
- High blood pressure
- Vascular disease
- Diabetes mellitus
- Kidney disease
- Kidney Stones
- Thyroid disorders
- Certain types of anemia
- Following surgical procedures
Medical Treatments
Certain medications and vitamins can increase the risk of gout. These include:
- Diuretics
- Salicylates and medicines made from salicylic acid (such as aspirin )
- Caffeine, including medicines containing caffeine
- Levodopa (used in the treatment of Parkinson’s disease )
- Aminophylline
- Withdrawal of corticosteroid medications
- Cyclosporine (used to help control rejection of transplanted organs)
- Niacin (a vitamin)
In addition, surgery, trauma, and cancer treatments such as radiation or chemotherapy may also increase your risk of developing gout.
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
American College of Rheumatology website. Available at: http://www.rheumatology.org/ .
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc; 2000.
The symptoms of gout usually come on suddenly and severely. A gout attack usually affects only one joint, most commonly, the joint of the big toe. However, the attack may involve more than one joint. Symptoms frequently develop overnight and worsen over the next 24 to 36 hours. Other affected joints include the knees, ankles, feet, wrists, hands, fingers, and elbows.
Gout of the Big Toe |
Symptoms in the joint affected usually include:
- Severe pain
- Extreme tenderness
- Swelling
- Redness
- Warmth
Other symptoms may include:
- Fever
- Chills
- Overall sick feeling
Symptoms are usually more severe in people who develop gout before age 30. Some people will only suffer one gout attack. Most people with gout, however, will suffer a recurrence within two years of the first attack, and further recurrences after that (if the condition is left untreated).
Possible complications of gout include:
- Build up of uric acid deposits (tophi):
- Hard lumps under the skin near (or around) joints
- Hard lumps at the rim of the ear
- Other parts of the body may be affected such as fingertips, cornea of eye, aorta, spine, or around brain
- Permanent damage to affected joints
- Carpal tunnel syndrome , a painful condition of the wrists
- Kidney stones (if uric acid builds up in the kidneys)
- Kidney damage
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
American College of Rheumatology website. Available at: http://www.rheumatology.org/ .
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .
The Merck Manual of Medical Information.17th ed. Simon and Schuster, Inc; 2000.
