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Understanding Gout

By Jodi Rigotti
Reviewed by QualityHealth's Medical Advisory Board

For the 2.1 million Americans who experience gout attacks each year, the symptoms are all too familiar: a sudden occurrence of hot, swollen, and tender joints (often in the big toe or ankle) accompanied by excruciating pain. Without treatment, symptoms often subside in about a week, but over time, attacks can become more frequent and severe, potentially causing permanent joint damage.

Gout Symptoms and Risk Factors

Affecting mostly in men between the ages of 40 and 50, gout occurs when excess uric acid accumulates in the body and crystals deposit in the joints. Kidneys produce uric acid as a waste product, and it may accumulate if the kidneys are unable to remove uric acid from the body adequately or if uric acid production increases. Over time, increased uric acid levels in the blood may lead to deposits of monosodium urate crystals in and around the joints, resulting in painful gout attacks.

According to the National Institutes of Health (NIH), approximately 18 percent of people who develop gout have a family history of the condition. Diseases such as diabetes, obesity, kidney disease, and sickle cell anemia also play a part, and certain lifestyle factors may put you at risk, including:

  • Regular consumption of certain medications such as moderate dose-aspirins and diuretics;
  • Excessive intake of foods high in purines, which produce a great deal of uric acid when broken down by the body; and
  • Excessive consumption of alcohol.

Gout Diagnosis and Treatment

Gout can be difficult to diagnose because the symptoms often mimic those of other arthritic conditions. To confirm a diagnosis of gout, a doctor may insert a needle into an inflamed joint and draw a sample of synovial fluid, the substance that lubricates the joint. The fluid will then be examined under a microscope for the presence of uric acid crystals and for bacteria to rule out a joint infection. The doctor also may find it helpful to examine chalky, sodium urate deposits around the joints.

Once you've been diagnosed, your doctor may prescribe medication to decrease the amount of uric acid in the joints, which helps to reduce symptoms and prevent further attacks, according to the NIH. Gout attacks are often treated with nonsteroidal anti-inflammatories (NSAIDs) or corticosteroids, but due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used under the care of a physician. If gout attacks occur frequently, long-term, daily medication that helps the kidney eliminate uric acid or block the production of it may be prescribed.

According the American Academy of Family Physicians, gout sufferers may also find it helpful to put a heating pad or ice pack on the affected joints to ease pain during flare-ups. In addition, diet plays an important role in keeping your condition under control. The NIH suggests limiting or eliminating the following foods, which are high in purines:

  • Anchovies;
  • Asparagus;
  • Brains;
  • Dried beans and peas;
  • Game meats;
  • Gravy;
  • Mushrooms;
  • Offal (internal animal organs)
  • Seafood such as herring, mackerel, sardines, scallops; and
  • Sweetbreads.

Retired Director, Surgical Services, GI Lab, Pain Management