Diseases and Surgical Procedures

Gout

What is gout?

Gout refers to joint pain and inflammation associated with the accumulation of crystalline uric acid in the body

With proper treatment, gout is manageable

Left untreated, gout can cause permanent damage to the joints as well as the kidneys

What causes gout?

Gout can occur when uric acid levels in the body are too high (hyperuricemia)

Normally, uric acid is formed as a byproduct of certain metabolic processes. Uric acid produced by the body dissolves in the bloodstream

Kidneys filter the blood, removing metabolic wastes (including uric acid) along with excess fluids and salts, to form urine. Urine is eliminated, excreting uric acid from the body. Thus, uric acid does not accumulate in the blood

In certain circumstances, however, uric acid levels in the body can increase, resulting in hyperuricemia

Although most people with hyperuricemia do not develop gout, gout can occur when hyperuricemia leads to crystallization of uric acid in the bloodstream. Once formed, needle-like crystals of uric acid can accumulate in joint spaces, causing pain and inflammation

What are the risk factors associated with hyperuricemia and gout?

  • Family history of gout
  • Overweight/obesity
  • Alcohol abuse

Diet high in purine-rich foods:
  • Dried beans and peas
  • Anchovies
  • Sardines
  • Brains
  • Liver
  • Kidneys
  • Gravies
  • Environmental or occupational exposure to lead

Use of certain medications:
  • Diuretics
  • Salicylates (such as aspirin)
  • Nicotinic acid
  • Cyclosporine (used to prevent organ transplant rejection)
  • Levodopa (used in the treatment of Parkinson's disease)

What are the symptoms of gout?

Gout occurs in four stages, each with characteristic symptoms:
  • Asymptomatic hyperuricemia
  • Acute gout/acute gouty arthritis
  • Interval/intercritical gout
  • Chronic tophaceous gout

What is asymptomatic hyperuricemia?

With asymptomatic hyperuricemia, high blood levels of uric acid (hyperuricemia) are present.

No other symptoms occur, and treatment usually is not necessary.

What are the symptoms of acute gout?

Gout reaches the acute stage after uric acid has crystallized and accumulated in the joints.

Accumulation of uric acid crystals leads to the occurrence of acute gouty attacks.

Acute attacks:
  • Are characterized by sudden intense joint pain and inflammation (swelling, warmth, tenderness)
  • Often occur at night
  • Often affect joints of the big toe first, but also may affect the instep, ankles, heels, knees, wrists, fingers, or elbows

Symptoms of the first attack may improve without treatment, over the course of 3 to 10 days. Months or years may pass before a second attack occurs.

In many cases, second and future attacks grow:
  • More frequent
  • More severe/prolonged
  • More destructive to the joints

What is the intercritical stage?

During the intercritical stage (between attacks):
  • No symptoms are present
  • Joint function is normal

What are the symptoms of chronic tophaceous gout?

If left untreated for a long period of time (10 or more years), gout can advance to a chronic, disabling stage.
Symptoms of chronic gout include:
  • Tophi (singular, tophus): hard or gritty deposits of uric acid under the skin. Tophi occur most often around the joints and at the rim of the ear
  • Kidney stones
  • Permanent joint damage
  • Permanent kidney damage

With proper treatment, gout rarely progresses to the chronic stage.

How is gout diagnosed?

Sudden symptoms of joint inflammation can suggest gout.

Diagnosis is confirmed by examining fluid taken from the affected joint (synovial fluid), to check for the presence of uric acid crystals.

How is gout treated?

Treatment of gout can include both:
  • Behavior modifications
  • Medications