Gout

Gout is a form of arthritis and is most common in men older than 30. It is less common in women. In women it usually comes after menopause. It is caused by increased blood levels of uric acid, which is made by the breakdown of protein in the body. When blood levels of uric acid rise above a critical level, thousands of hard, tiny uric acid crystals collect in the joints. These crystals act like tiny, hot, jagged shards of glass, resulting in pain and inflammation. Crystals can collect in the tendons and cartilage, in the kidneys (as kidney stones), and in the fatty tissues beneath the skin. {Note: Crystals other than uric acid can cause some acute attacks of gout.}

Gout can strike any joint, but often affects those in the feet, such as the big toe, and those in the legs. A gout attack can last several hours to a few days. Persons who have gout can be symptom-free for years between attacks. Gout can be triggered by:

• Mild trauma or blow to the joint
• Drinking alcohol (beer and wine more than distilled alcohol)
• Taking certain medications (e.g., aspirin, diuretics, and nicotinic acid)

Signs and Symptoms

• Excruciating pain and inflammation in a joint or joints that strike suddenly and peak quickly
• Affected area that is swollen, red or purplish in color, feels warm, and is very tender to the touch
• Feeling of agonizing pain after even the slightest pressure, such as rubbing a sheet against the affected area
• Sometimes a low-grade fever
• Sometimes chills and fever

Treatment and Care


Never assume you have gout without consulting a physician. Many conditions can mimic an acute attack of gout. These include infection, injury, and rheumatoid arthritis. Only a doctor can diagnose the problem.

If you do have gout, treatment will depend on the reasons behind your high levels of uric acid. Your doctor can conduct a simple test to tell if your kidneys arenÕt clearing uric acid from the blood the way they should or to find out if your body simply makes too much uric acid.

The first goal is to relieve the acute gout attack. The second goal is to prevent future attacks.

• For immediate relief, your doctor will prescribe colchicine, a nonsteroidal anti-inflammatory medication and/or other pain reliever (not aspirin) and tell you to rest the affected joint.
• For long-term relief, your doctor will probably recommend that you lose excess weight, limit your intake of alcohol, drink lots of liquids, and take medication, if necessary. One type of medication (allopurinol) decreases uric acid production. Another (probenecid) increases the excretion of uric acid from the kidneys.

(See “Places to Get Information & Help” under “Arthritis” on page 375.)