You wake up in the middle of the night, and your big toe feels as if it's on fire. It's hot, swollen and so tender that the weight of the blanket on it is nearly intolerable.
If so, you might be experiencing an acute attack of gout (or gouty arthritis) — a form of arthritis that's characterized by sudden, severe attacks of pain, redness and tenderness in joints.
Gout has been recognized for more than 2,000 years, making it one of humankind's oldest known diseases. In the past, gout was often known as "the disease of kings" because it was associated with wealthy men who overindulged in rich food and drink. Today, it's known that gout is a complex disorder that can affect anyone. In fact, it's a painful problem for more than 2 million Americans.
It's true that men are more likely to get gout, but women become increasingly susceptible to it after menopause. Fortunately, gout is treatable, and there are ways to keep it from recurring.
The symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:
- Intense joint pain. Gout usually affects the large joint of your big toe but can occur in
your feet, ankles, knees, hands and wrists. The pain typically lasts 5 to 10 days and then stops. The
discomfort subsides gradually over 1 to 2 weeks, leaving the joint apparently normal and pain-free.
- Inflammation and redness. The affected joint or joints will become swollen, tender and red.
Gout is caused by excessive blood levels of uric acid, a waste product formed from the breakdown of purines. These are substances found naturally in your body as well as in certain foods, including organ meats — such as liver, brains, kidney and sweetbreads — and anchovies, herring, and mackerel. Smaller amounts of purines are found in all meats, fish and poultry.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body produces too much or excretes too little of this acid. In that case, uric acid can build up, forming sharp, needlelike crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
Another condition, known as false gout (pseudogout), is also caused by crystal deposits. But rather than being composed of uric acid, pseudogout crystals are made of calcium pyrophosphate dihydrate. And while pseudogout can affect the big toe, it's more likely to attack large joints such as your knees, wrists and ankles.
The following conditions or circumstances can increase the chances you'll develop high levels of uric acid or gout:
- Lifestyle factors. The most common include excess consumption of alcohol, especially beer.
Excess alcohol generally means more than two drinks a day for men and one for women. Weighing 30 pounds
or more than your ideal weight also increases your risk.
- Medical conditions and medications. Certain diseases and medications also make it more
likely you'll develop gout. They include untreated high blood pressure (hypertension) and chronic
conditions such as diabetes, high levels of fat in the blood (hyperlipidemia) and narrowing of the
arteries (arteriosclerosis). Surgery, sudden or severe illness or injury, and immobility due to bed
rest can also increase uric acid levels. So can the use of thiazide diuretics (medicines used to treat
hypertension by lowering the amount of salts and water in the body), low-dose aspirin and cyclosporine
(used in transplant patients to prevent rejection of an organ). Chemotherapy treatments for cancer may
increase the breakdown of abnormal cells, releasing large amounts of purines into your blood.
- Genetics. One out of four people with gout have a family history of the ailment.
- Age and sex. Gout occurs more often in men. Women tend to have lower uric acid levels than
men do until after menopause when their uric acid level approaches that of men. Men are likely to
develop gout between the ages of 30 and 50, while women experience gout later — usually between
the ages of 50 and 70.
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When to Seek Medical Advice
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If you experience sudden, intense pain in a joint, call your doctor — even if the pain goes away in 1 or 2 days. Gout that remains untreated can lead to worsening pain and joint damage.
Seek medical care immediately if you have a fever and a joint is hot and inflamed. This could be a sign of infection.
If you have previously been diagnosed with gout and have another attack, consult with your physician, who may prescribe a medication to try and prevent or lessen the severity of future episodes of the condition.
Your doctor may withdraw fluid from the affected joint to detect crystals of uric acid within your white blood cells. He or she may also ask for a urine sample and a blood test. A urine sample can provide information on how much uric acid you’re excreting. A blood test can indicate levels of uric acid in your blood.
Some people with gout develop a chronic form of arthritis, often with discolored deposits under the skin called tophi. A small number of people with gout develop kidney stones.
For gout attacks, nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve symptoms. These include the prescription drug indomethacin (Indocin) or over-the-counter NSAIDs such as ibuprofen (Advil, Motrin, others). Your doctor also may prescribe a steroidal anti-inflammatory drug such as prednisone.
Be sure to ask your doctor how long you should take steroids or NSAIDs — some should be used for only 3 to 7 days. Long-term use of these medications can have serious side effects, including ulcers and intestinal bleeding.
For acute attacks of gout, your doctor may prescribe colchicine or inject cortisone into the affected joint. And once your gout attack is under control, your doctor may advise preventive treatment to slow the rate at which your body produces uric acid.
There's no sure way to prevent initial or subsequent attacks of gout. However, if you have gout, your doctor may prescribe certain drugs to prevent or lessen the severity of future episodes. These drugs may include allopurinol (Zyloprim, Aloprim) and probenecid (Benemid), which are taken daily to slow the production and speed elimination of uric acid. Keeping uric acid down in the normal range is the long-term key to preventing gout.
Lifestyle changes can't cure gout, but they can help treat it. The following measures may help relieve or prevent symptoms:
- Maintain a healthy weight. Gradual weight loss will lessen the load on affected
weight-bearing joints. Losing weight may also decrease uric acid levels. Avoid fasting or rapid weight
loss because doing so may temporarily raise uric acid levels.
- Avoid excessive amounts of animal protein. These foods contain purines. Rich sources include
organ meats (liver, brains, kidney and sweetbreads), and anchovies, herring, and mackerel. Smaller
amounts occur in all meats, fish and poultry.
- Limit or avoid alcohol. Consuming too much alcohol can inhibit excretion of uric acid, lead
to its buildup and cause an attack of gout. Limit alcohol to no more than two drinks a day if you're a
man. Limit alcohol to one drink a day if you're a woman. If you have gout, it’s best to avoid alcohol
completely.
- Drink plenty of liquids. Fluids help dilute uric acid in your blood and urine.
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February 28, 2002 —
