Gout: Symptoms, Diagnosis & Treament

What Causes Gout?

Risk factors for over-production of uric acid and gout include:

• Genetics – An estimated 20 to 80 percent of people with gout have a family history of the disease.
• Gender and age – It is more common in men than in women and children.
• Weight – Being overweight increases risk.
• Alcohol consumption – Drinking too much alcohol keeps the body from removing uric acid.
• Diet – Eating high-purine foods can lead to gout flares or make them worse. These foods include anchovies, asparagus, beef kidneys, brains, dried beans and peas, game meats, gravy, herring, liver, mackerel, mushrooms, sardines, scallops, and sweetbreads (animal glands).
• Lead exposure
• Other health problems – A common cause of gout in older people is the kidneys being unable to eliminate waste products from the body. Other problems that may contribute to gout include: high blood pressure, hypothyroidism (underactive thyroid gland), psoriasis, hemolytic anemia, or some cancers, and some inherited disorders in which the enzyme helping control uric acid is not present or doesn’t work properly.
• Medications – A variety of medicines may increase your risk for gout. They include:
  • Diuretics (water pills): These are taken to ease high blood pressure, edema, and heart disease. They also decrease the amount of uric acid passed in the urine.
  • Salicylate-containing drugs, such as aspirin
  • Niacin, a vitamin also known as nicotinic acid or vitamin B3
  • Cyclosporine, a drug used to suppress the immune system in the treatment of some autoimmune diseases and to prevent rejection of transplanted organs
  • Levodopa, used to treat Parkinson’s disease

Who is likely to develop gout?

Some six million Americans aged 20 and older report having gout at some time in their lives. It is rare in children and young adults. Men between the ages of 40 and 50 are more likely to develop gout. Women rarely develop it before menopause. People who have had an organ transplant also are more susceptible to gout.

How Is Gout Diagnosed?

Gout may be difficult to diagnose because the symptoms can be vague and could be from other conditions. To be sure that what you have is gout, your doctor draws a sample of synovial fluid from your joint. The fluid is examined under a microscope for uric acid crystals. However, not finding the crystals doesn’t always mean that you don’t have gout. The crystals may also be around the joints, so your doctor may search for them there as well. Also, gout attacks may look like joint infections. So the joint fluid may also be cultured to see if bacteria grow from it.

Treatment

Gout is treated with one or more therapies to ease the pain of acute attacks, prevent future episodes, and avoid formation of uric acid crystals and kidney stones. Treatment also can help prevent long-term damage to joints and disability. Treatment of acute attacks includes:

• Non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen) taken by mouth. NSAIDs reduce
  inflammation but have no effect on the amount of uric acid in the body.
• Corticosteroids, such as prednisone, taken either orally or injected into the affected joint. With corticosteroids, patients often begin to improve within a few hours and attacks usually end within a week.
• Colchicine, another drug, is used when NSAIDs or corticosteroids do not work. But it must be taken within the first 12 hours of an acute attack.

Your doctor may prescribe small daily doses of either NSAIDs or oral colchicine to prevent future attacks. Other medicines may be considered to treat hyperuricemia, reduce the frequency of acute bouts and development of uric acid crystals. Losartan, a blood pressure medication, and fenofibrate, used to lower fats in the blood, can also be useful for gout. Your doctor may also advise you to lose weight, limit alcohol consumption, and limit or avoid high-purine foods that raise uric acid levels.

Tips for Staying Healthy with Gout

Fortunately, gout can be controlled. Taking medications as prescribed can reduce the severity and frequency of attacks. Acute gout is best controlled if medications are taken at the first sign of pain or inflammation. Other tips to help control gout:

• List all the medicines and supplements you take. Your healthcare professional can tell you which, if any, can increase your risk of elevated uric acid.
• Schedule follow-up visits with your health professional to evaluate your progress.
• Drink plenty of nonalcoholic fluids, especially water, to help eliminate uric acid. Alcohol can raise the levels of uric acid in your blood.
• Maintain a healthy weight and exercise regularly. If you are overweight, avoid low-carbohydrate diets designed for quick loss. When you don’t eat enough carbohydrates, your body can’t completely burn its own fat. The resulting abnormality in your metabolism can increase the level of uric acid in your blood.
• Avoid foods high in purines.