X-ray of foot with gout
April 30, 2018 | by Jane Park MD

Gout is often referred to as 'the disease of kings.’ Alexander the Great, Charlemagne, and King Henry VIII all suffered from gout. As rulers of their day, they enjoyed plenty of rich food and drink, which can play a role in the development of gout. Today, gout is the most common form of inflammatory arthritis, affecting more than 8.3 million adults in the U.S. Unfortunately only 10 percent of people with gout seek needed treatment.

Gout is characterized by high levels of uric acid in the blood, increasing the risk of uric acid crystal formation. Uric acid crystals trigger inflammation leading to a gout attack. Gout is often associated with high blood pressure, obesity, diabetes, and chronic kidney disease.

There are three stages of the disease:

  • An acute gout attack frequently occurs in a single joint in the legs, often at the base of the big toe, but can be any joint, bursa, tendon or in the spine. It causes severe pain, redness, swelling, and warmth and typically peaks in 12 to 24 hours. Inflammation can extend beyond the joint, and can be associated with fever. Onset of the attack often occurs at night when levels of uric acid in the body are higher. Pain often resolves in a few days or week without treatment. However, when left untreated, multiple sites can be affected simultaneously.
  • Intercritical gout refers to the time between gout attacks. During this period, gout is asymptomatic, and you may go months or years before another acute attack. This time period tends to shorten without treatment.
  • Tophaceous gout occurs when a large collection of urate crystals, fibrous tissue, and inflammatory cells form on the ears, joints, tendons, or bursa. They are generally not painful or tender, but lead to destructive changes in the surrounding tissue and joints. These growths rarely develop before a first acute attack.

Risk factors for gout include:

  • Male
  • Age 45+
  • Asian or Pacific Islander heritage
  • Genetic disposition for high uric acid
  • Consumption of:
    • Beer, hard liquor
    • Meat and seafood
    • High fructose
    • Diuretics
  • High blood pressure
  • Obesity
  • Chronic kidney disease
  • Organ transplant

Diagnosing gout is done with a detailed clinical history and descriptions of symptoms, joint fluid analysis to look for uric acid crystals, and a blood test to measure the uric acid level. Treatment for acute gout attacks include:

  • Steroid injections
  • Anti-inflammatories (indomethacin, ibuprofen, etc)
  • Steroid pills (prednisone, Medrol)
  • Colchicine

Long-term preventive medication for gout is recommended for people with frequent or disabling gout attacks, joint damage, tophi, kidney disease, or uric acid kidney stones.

Prevention of gout includes:

  • A diet high in low-fat dairy
  • a diet low in meat, seafood, sugary beverages and beer and spirits
  • maintaining a healthy weight

If you suspect you’ve had an acute gout attack or may have gout, talk with your doctor about a referral to a rheumatologist. Gout is treatable and can be managed before permanent joint damage or deformities occur.

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Written By: Jane Park MD