Gout is a disease in which uric acid builds up in the joints, causing painful swelling. Gout can be acute--happening only once--or chronic, with attacks happening months or even years apart. Some people who experience one episode of gout never have the problem again. Although the symptoms of gout can be treated, there is no cure for the disease.
How Does a Patient Get Gout?
According to Dr. Eggbeen of the University of Pittsburgh, gout can be caused by higher than normal levels of uric acid in the blood, which is called hyperuricemia. Hyperuricemia can be a short-lived) or a chronic condition. Hyperuricemia can cause gout when levels of uric acid get to be so high that crystals form in the fluid around the joints. Patients can have hyperuricemia and never develop symptoms of gout, and patients with normal uric acid levels can also develop gout.
Acute and Chronic Gout
Gout occurs as either an acute or a chronic disease. Acute gouty arthritis involves severe pain, redness, swelling and disability. It usually involves a single joint in the leg or the toe, most of the time the knee or big toe. About 75% of patients experience their first episode of gout in the big toe, which is a condition called podagra.
Chronic gout involves numerous episodes of gout with pain and inflammation. It can involve more than one joint, which is called polyarticular gout. Chronic gout can lead to damage to the joints (arthritis) and white, chalky deposits of uric acid crystals under the skin, which are known as tophi.
Symptoms and Physical Examination
The most common symptom of gout is a red, swollen joint that may feel hot to the touch and is typically painful with any type of movement. Physical examination may reveal tophi which are white and chalky deposits under the skin that may occur in patients with long-standing disease. Gout patients who develop kidney stones may have flank pain, a fever and blood in the urine. A physician tap the back over the kidneys to check for tenderness.
Lab Tests
Gout is usually diagnosed through a physical exam, but lab tests can help with long-term management. For example, a serum uric acid test can be performed to help determine if an individual has hyperuricemia (elevated uric acid levels). Another test involves taking a sample of joint fluid (synovial fluid) to check for crystals. A simple x-ray of the joint may also be helpful to check for other disorders that cause pain and swelling.
Treatment
The best long-term treatment for gout is making lifestyle changes to prevent future attacks. Decreasing excessive alcohol use and limiting the intake of meat and fatty foods are important steps. Weight loss can also help, but people who decide to lose weight should do so slowly as quick weight loss has been associated with uric acid kidney stones.
Treatment of an acute gout attack involves decreasing the inflammation that is the primary cause of the symptoms. Medications for acute gout include colchicine, non-steroidal anti-inflammatories, and glucocorticoids (steroids). According to Dr. Laubscher of the University of Saskatchewan, if a single-joint is involved, a steroid injection may be helpful. Allopurinol and Probenecid--oral medications used to lower uric acid levels--can help with long-term management of hyperuricemia.
