One of the oldest known diseases, gout was once considered "the disease of kings" because it was associated with those wealthy enough to overindulge in rich food and drink. In fact gout is a complex disorder that can affect anyone and does affect more than 2 million Americans.
Gout causes sudden, severe pain, tenderness and swelling in your joints. It usually affects one joint at a time, often the big toe. At first, bouts of gout may be infrequent and last only about a week or so, but without treatment they may happen more often and last longer.
The photo at the right demonstrates long-standing, severe gouty arthritis. At the finger joints are collections of urate crystals in masses called tophi.
The symptoms of gout are almost always acute and sudden, happening often at night with no warning. Symptoms in the affected joints may include:
- Intense pain
Causes and Risk Factors
Gout is caused by high blood levels of uric acid, a waste formed from the breakdown of purines. These chemical compounds help make up RNA and DNA and are used to form the compounds of uric acids. They are found naturally in our bodies, as well as in all meats, fish and poultry. Anchovies, herring, mackerel and organ meats (such as liver, brains, kidney and sweetbreads) contain high levels of purines.
If the body produces too much or eliminates too little uric acid, it builds up and forms needle-like crystals in a joint or the surrounding tissue, which can cause pain, inflammation and swelling. At the right is a photograph of crystals of monosodiumurate, which cause gout. They are identified by their shape and physical properties when seen under a microscope.
A similar condition, false gout (pseudogout), is caused by crystals made of calcium pyrophosphate dihydrate. These are usually felt in the large joints (knees, wrists and ankles) rather than the big toe.
More men get gout than women, but women become more likely to get it after menopause. People at risk include those who:
- Consume too much alcohol (especially beer). This generally means drinking more than two drinks a day for men and one for women.
- Weigh 30 pounds or more than your ideal weight
- Have untreated high blood pressure, diabetes, high blood fat levels (hyperlipidemia) and narrowing of the arteries (arteriosclerosis)
- Have had surgery, a sudden or severe illness or an injury that requires quiet bed rest can increase uric acid levels
- Use of thiazide diuretics (used to treat high blood pressure by reducing the body's salts and water), low-dose aspirin and cyclosporine (used to prevent organ rejection in transplant patients) and chemotherapy may increase the uric acid in the body.
- Have a family history of gout (25 percent of people with gout have a family history of it)
- Are a man aged 30 to 50 or, to a lesser extent, a woman aged 50 to 70
Gout can be detected using:
- A urine sample to see how much uric acid is being excreted
- A blood test of the level of uric acid in the blood
- A fluid sample from the affected joint to see if there are uric acid crystals in the white blood cells
Gout is treatable, and there are ways to keep it from coming back. Treatment usually consists of:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve symptoms. These include the prescription drug indomethacin (Indocin) or over-the-counter NSAIDs, such as ibuprofen.
- Steroidal anti-inflammatory drugs, such as prednisone
- Colchicine or cortisone injected into the affected joint
While there is no way to guarantee that another attack of gout won't occur, a number of steps can reduce the risk of a future attack. These include:
- Taking drugs, such as allopurinol (Zyloprim, Aloprim) and probenecid (Benemid), to slow the production and speed elimination of uric acid
- Maintaining a healthy weight, which reduces the pressure on weight-bearing joints and may decrease uric acid levels. Weight loss should be done in a slow, steady way because fasting or rapid weight loss can temporarily raise uric acid levels.
- Avoiding too much animal protein. These foods contain purines. Especially to be avoided are organ meats (liver, brains, kidney and sweetbreads), and anchovies, herring and mackerel.
- Limiting or avoiding alcohol
- Drinking plenty of liquids. Fluids help dilute uric acid in the blood and urine.