Chronic Gouty Arthritis
Chronic Gouty Arthritis
What is gout? — Gout is a form of arthritis. It can cause pain and swelling in the joints. At first, it tends to affect only 1 joint – most frequently the big toe. It happens in people who have too much uric acid in the blood. Uric acid is a chemical that is produced when the body breaks down certain foods. Uric acid can form sharp needle-like crystals that build up in the joints and cause pain. Uric acid crystals can also form inside the tubes that carry urine from the kidneys to the bladder. These crystals can turn into "kidney stones" that can cause pain and problems with the flow of urine.
What are the symptoms of gout? — People with gout get sudden "flares" or attacks of severe pain, most often the big toe, ankle, or knee. Often the joint also turns red and swells. Usually, only 1 joint is affected, but some people have pain in more than 1 joint. Gout flares tend to happen more often during the night.
The pain from gout can be extreme. The pain and swelling are worst at the beginning of a gout flare. The symptoms then get better within a few days to weeks. It is not clear how the body "turns off" a gout flare.
Is there a test for gout? — Yes. To test you for gout, your doctor or nurse can take a sample of fluid from the joint that is in pain. If he or she finds typical gout crystals in the fluid, then you have gout. Even without checking fluid from a joint, the doctor or nurse might still strongly suspect gout if:
You have had pain and swelling in 1 joint, especially the joint at the base of the big toe
Your symptoms completely go away between flares, at least when you first start having them
Your blood tests show high levels of uric acid
How is gout treated? — There are a few medicines that can reduce the pain and swelling caused by gout. When you find one that works for you, make sure to keep it on hand all the time. That way you can take it as soon you feel a flare starting. Gout medicines work best if you take them as soon as symptoms start.
The medicines used to treat gout flares include:
NSAIDs – This is a large group of medicines that includes ibuprofen (sample brand names: Advil, Motrin) and indomethacin (brand name: Indocin). NSAIDs might not be safe for people with kidney or liver disease, or for people who have bleeding problems.
Colchicine – This medicine helps with gout but it can also cause diarrhea, nausea, vomiting, and stomach pain.
Steroids – Steroids can reduce swelling and pain. These steroids are not the kind that athletes take to build up muscle. Steroids can be taken as pills or as shots.
Are there medicines to prevent gout flares? — Yes, there are medicines that can reduce the chances of having future gout flares. Most people who have repeated or severe flares of gout need to take these medicines. In general, they all work by reducing the amount of uric acid in the blood. Examples of these medicines include allopurinol (brand names: Aloprim, Zyloprim), febuxostat (brand name: Uloric), and probenecid. People with severe gout can also get a medicine called pegloticase (brand name: Krystexxa), which is given through a vein. This medicine can cause an allergic reaction in some people.
If you take one of the medicines to prevent gout, your doctor or nurse will want to make sure you use it safely. He or she might also want to check that your uric acid level gets low enough to dissolve the gout crystals. Allopurinol, febuxostat, and probenecid can actually increase gout flares when you first start taking them. To prevent these flares, your doctor or nurse might suggest that you take low doses of colchicine when you start the medicines. This will give the gout crystals time to dissolve, and that will put a stop to the flares over time. If you do have a gout flare, it's important to keep taking your daily medicines normally.
Your doctor will check your uric acid levels regularly. This is to make sure the medicines are working and you are taking the right dose.
Can I do anything on my own to prevent gout flares? — Yes. If you are overweight, losing weight can help relieve gout.
It's not clear that following a specific diet plan will help with gout symptoms. But eating a balanced diet can help improve your overall health. It can also help you lose weight, if you are overweight.
In general, a healthy diet includes plenty of fruits, vegetables, whole grains, and low-fat dairy products. It's also important to drink plenty of water, and try not to get dehydrated. You should limit sugary drinks and alcohol, which can make gout flares worse.
Some people with gout also have other health problems, such as heart disease, high blood pressure, kidney disease, or obesity. If you have any of these issues, it's important to work with your doctor to manage them. This can help improve your overall health and might also help with your gout.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15395 Version 15.0
Release: 28.2.2 - C28.105
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