What is gout?
Gout is a form of arthritis characterized by severe joint inflammation (swelling, warmth, redness and tenderness) of one or more joints which results from the deposition of uric acid crystals in the affected joints.
Who is affected by gout?
Gout can occur at any age, but it is more common in individuals over the age of 40. It also affects men earlier in life than women, but the incidence of gout in women rises after menopause to equal that of men. The estimated prevalence of gout in the U.S. ranges from 3-8 million people.
What are risk factors for developing gout?
Patients with specific medical conditions such as kidney disease, obesity, hypertension, and diabetes, or those with a family history of gout are at increased risk.
External risk factors that can increase the risk for gout include:
- Medications that alter uric acid levels (diuretics, chemotherapy, cyclosporine, low dose aspirin)
- Trauma
- Surgery
- Dehydration
Consumption of food or drink with high purine content can increase the risk for gout attacks, since purines get converted by the body to uric acid.
What are the signs and symptoms of gout?
Patients with acute gout typically experience an abrupt onset of severe joint pain, swelling, warmth and redness that peak in intensity within 24 hours. These attacks frequently occur at night or early morning. Most often, patients reveal inflammation of a single joint, classically the big toe (“podagra”), but any joint can be affected. In some patients, several joints are affected simultaneously. Patients with long-standing or poorly controlled gout may accumulate uric acid crystals deposits, known as tophi, under the skin. Tophi are most frequently found on the elbows and tips of the ears, but can also be present in other places, such as fingers or toes. Some patients with gout will also develop kidney stones composed of uric acid.
How is gout diagnosed?
The diagnosis of gout is based on clinical history, physical findings of joint inflammation (warmth, swelling, redness and tenderness), and most importantly, the identification of uric acid crystals in joint fluid obtained from the affected joint. X-rays of affected joints may show joint damage. Laboratory abnormalities may include elevated inflammatory markers, such as ESR and CRP, as well an elevated uric acid level. However, uric acid level can be normal or low during an acute attack, so a normal uric acid level does NOT exclude the possibility of acute gout. Likewise, the presence of an elevated uric acid alone, in the absence of suggestive clinical symptoms, is not diagnostic of gout.
How is gout treated?
It is important to begin therapy quickly as the joint pain is often debilitating. Mild to moderate gout attacks can be managed with non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen. Colchicine (Colcrys) can be used for acute gout, either alone or in conjunction with NSAIDs, but can also be continued long-term for prevention of future gout. Oral or intravenous steroids, as well as local steroid injections into affected joints, can quickly resolve joint inflammation and should be considered in patients who are unable to tolerate NSAIDs.
Patients who suffer from frequent and severe gout attacks, who have a history of uric acid stones or tophi, or who have joint damage on X-ray attributable to gout are candidates for long-term therapy with allopurinol or Uloric. These medications lower the level of uric acid in the bloodstream, thereby decreasing the risk of recurrent gout. Patients who fail to respond to all conventional therapies may be eligible to receive Krystexxa, an intravenous infusion given twice a month.
Are there any useful lifestyle modifications that I can make?
Several lifestyle modifications have been shown to be beneficial in gout:
- Dietary modifications, include restriction of purine-rich foods (i.e. red meat and shellfish), alcohol (especially beer) and fructose sweetened beverages can decrease the incidence of recurrent gout
- Weight reduction in overweight patients has been shown to reduce both the development of gout and its recurrence in patients with established disease
- There is suggestive evidence that increasing consumption of cherries can reduce the risk of recurrent gout, and that vitamin C intake can lower uric acid levels in the blood, but additional studies are needed to verify their role in the management of gout
Learn more about gout by checking out this infographic, presented by the Rheumatology Division at Hospital for Special Surgery
Dr. Dee Dee Wu is a rheumatologist who specializes in the treatment of rheumatoid arthritis, psoriatic arthritis, osteoarthritis and osteoporosis. She practices at both the HSS Outpatient Center in Paramus and the hospital’s main campus in New York.
