Gout is an autoimmune disorder that causes intense pain and tenderness in the joints. Attacks are usually sudden and severe – characterized by painful joint swelling. Most gout attacks occur in the joint at the base of the big toe. However, attacks can occur in other small joints, such as those in the fingers, and large joints (knees and hips). Gout may damage the kidneys, tendon sheaths, and bursae, fluid-filled sacs that serve as cushions between bones and soft tissues. Elbow and kneecap bursae are the most commonly affected.
Gout is frequently stigmatized as being caused by overindulgence in rich foods. While diet can contribute to gout, anyone can develop this autoimmune disorder. (See Risk Factors below.)
Symptoms of Gout
Gout symptoms tend to be acute – meaning they develop suddenly and without warning. Most of the time, these symptoms come on at night:
- Intense acute joint pain that lasts for 12-24 hours before subsiding.
- Lingering joint pain or discomfort that lasts for days or weeks after the episode.
- Inflammation, redness, or tenderness in the affected joint.
Causes of Gout
Gout occurs when the body produces too much uric acid and/or is unable to eliminate enough uric acid. Your physician may use the term hyperuricemia, which refers to high levels of uric acid in the blood stream. In a healthy person, uric acid dissolves in the bloodstream, is processed by the kidneys, and excreted from the body in the form of urine. In individuals with gout, uric acid is released into the joints in the form of sharp, needle-like urate crystals, which cause the painful symptoms of gout.
Note: Hyperuricemia does not always cause gout. In fact, approximately two-thirds of all people with elevated levels of uric acid in the bloodstream never have gout attacks.
Gout Risk Factors
Gout is the most common form of inflammatory arthritis in men over the age of 40. Men are seven to nine times more likely to develop this disease than women. The following dietary and medication habits can also contribute to an individual’s risk for having gout.
- Eating certain foods, such as shellfish and red meat
- Consuming food and drinks high in sugar and high fructose
- Drinking alcohol in excess
- Using certain medications, such as aspirin, some diuretics, and immunosuppressants
Having a family history of the disease, high blood pressure, diabetes, kidney disease, or some types of anemia can also increase risk for gout.
Testing For & Diagnosing Gout
Some instances of gout may be difficult to distinguish from other types of arthritis. A rheumatologist at Hedley Orthopaedic Institute may be able to tell the difference between gout and other types of arthritis by using a joint fluid test, blood test, or other diagnostic tests.
- Joint Fluid Analysis: In this test, a physician will use a needle to draw fluid out of the painful joint. When examined under a microscope, the fluid may reveal tiny urate crystals, which could indicate the presence of gout. Some patients with advanced symptoms may have tophi, bulbous deposits of urate crystals beneath the skin. Tophi can be tested using this same method.
- Uric Acid Blood Test: A uric acid blood test could reveal abnormally high levels of urate acid in the blood. However, this test alone does not necessarily indicate the presence of gout, as many people have high levels of uric acid in the blood without any other symptoms of gout.
- Diagnostic imaging tests (e.g. x-rays, ultrasounds, and dual energy CT scans) may also be used to view damage to the joints.
Treatment of gout consists of (1) relieving pain during acute attacks, (2) preventing future gout attacks, (3) and reducing the risk of joint damage and tophi.
- Inflammation and pain caused by gout may be managed at home through the use of R.I.C.E.: rest, ice, compression, and elevation. Non-steroidal anti-inflammatory drugs (NSAIDs) can also be used for managing symptoms, such as pain, inflammation, and fever.
- Your rheumatologist may write you a prescription for higher-grade pain medicines or colchicine, an anti-inflammatory for gout.
Prevention & Joint Protection
Patients prone to gout attacks may be given medication to control uric acid levels in the bloodstream. Patients who receive these medications generally have more than three gout attacks a year, gout attacks that are severe and disabling, tophi, or kidney stones / kidney damage. Preventative drugs include colchicine, probenecid acid, allopurinol, and febuxostat.
Patients who have developed degenerative arthritis due to chronic gout may require surgical treatment. Surgery can be performed to remove tophi, fuse degenerated joints, and replace painful joints – including hip and knee.
Schedule Your Appointment With a Rheumatologist
If you’re suffering from intense acute joint pain – especially in the base of the big toe – you may wish to schedule an appointment with a rheumatologist in Mesa. At Hedley Orthopaedic Institute, your rheumatologist can provide state-of-the-art treatment and therapy for gout, all under the same roof as some of Arizona’s best-known orthopaedic surgeons and sports med physicians. Contact us to schedule your appointment.