Gout

Gout is the most common inflammatory arthritis, affecting over 9 million Americans. It is caused by an inflammatory response to monosodium urate (MSU) crystals that precipitate from high uric acid levels in the blood, also known as hyperuricemia. 

When uric acid builds up, it can form needle-like crystals that can lodge in joints.  This can trigger episodic, sudden, and intense joint pain.  The big toe is most commonly involved, which is called podagra, but it can affect every other joint in the body, including the other toes, ankles, knees, elbows, wrists, and fingers.  

Attacks typically occur at night, and patients experience swelling, warmth, redness, and exquisite sensitivity to light touch. Patients often say they can’t bear having clothes or bedsheets touch their affected joints during a flare. Attacks may last 1-2 weeks, but treatments can stop a flare within days. Subsequent gout flares may not occur for months or even years thereafter. Gout is more common in men than women, although after menopause (once women lose the protective effects of estrogen), it affects both equally.

Many factors can lead to gout, including genetics, declining kidney function, advancing age, other health conditions (like psoriasis, cancer, obesity, and high blood pressure), and diet. Foods high in purines can trigger gout, like alcohol, red meat, organ meats, and shellfish, since purines get broken down to uric acid.  

Certain medications like diuretics (water pills) can also lead to gout. Infections, severe illness, recent surgery, and trauma to a specific joint can also trigger gout.  

Gout can be diagnosed by a thorough history and physical examination performed by your rheumatologist. A serum uric acid (sUA) level blood test can detect hyperuricemia.  Imaging studies like x-rays, musculoskeletal ultrasound, and dual-energy CT (DECT) scans help to detect gout deposits (known as tophi) throughout the body and the damage caused by them–specifically erosions of the joints where the crystals are lodged. The crystals themselves can often be seen under a microscope if your provider obtains a sample of joint fluid via a needle inserted into the affected joint.

Gout can be treated effectively.  

Talk with your provider about the best treatment plan for you based on the frequency and severity of your symptoms and your personal preferences. 

Options include:

• Lifestyle modifications: Adopting a low-purine diet, regular exercise, and weight loss may help to lower uric acid levels naturally.
• Anti-inflammatory medications: These include non-steroidal anti-inflammatory drugs (NSAIDS, like ibuprofen or naproxen), colchicine, or corticosteroids (like prednisone).
• Urate-lowering therapies: These medications lower uric acid levels in the blood.  Examples are allopurinol, febuxostat, probenecid, and pegloticase.

In most cases, a treat-to-target approach is used. The goal is to lower a patient’s serum uric acid level to less than 6 mg/dL, although it often needs to be lowered to 2-3 mg/dL if significant tophi are present.  If treated appropriately, patients may never have another gout attack again, and tophi may completely resolve.

If you think you may be suffering from gout, feel free to talk with the providers at AOCC about your symptoms. With the proper care, you don’t have to suffer from gout!