The Disease of Kings and Anybody Else

The ins and outs of gout

December 9, 2011 / Author:  / Reviewed by: Joseph V. Madia, MD

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Gout is a form of arthritis that has been known for thousands of years. At times, it has been called "the disease of kings," as it has been falsely linked to the excess eating and drinking that only the rich could afford.

The truth is that gout can affect anyone, causing sudden and severe attacks of painful swelling in single joints. Gout frequently affects joints in the feet, especially the big toe.

There are many factors that can put you at risk of developing gout, including obesity and diabetes. Luckily, there are ways to treat the disease and reduce the number of debilitating attacks. From exercise to avoiding certain foods to using medications, you have plenty of options to manage your pain.

What is gout?

Like many forms of arthritis, gout causes sharp pain and inflammation of the joints. It generally affects only one or a few joints, mainly the big toe, knee, or ankle.

Gout comes in sudden attacks, which often occur at night. These attacks can be severely painful. An affected joint can become swollen, red, and so tender that it is excruciating to even lay a paper on it.

Along with the pain and inflammation, gout can be accompanied by a fever.

After your first episode of gout, or "gouty attack," the symptoms may disappear. However, about half of gout patients have another attack. This is known as chronic gout.

In cases of chronic gout, patients experience repeated episodes of pain and inflammation. Chronic gout - which often occurs in the joint of the first attack but can spread to affect other joints - can cause joint damage and loss of motion in your joints.

As many as 6.1 million Americans have had at least one gout attack. The disease affects men more often the women, yet the risk to women is only slightly smaller that that of men. Some research has shown that black men are nearly twice as likely as white men to develop gout.

Over the past few decades, gout has become more and more common in the United States. These rising rates of gout could be due to the growing obesity and diabetes epidemics.

What causes gout?

Gout happens when uric acid builds up in your body and forms sharp crystals around your joints. These crystals are what make your joints swell up and become inflamed.

Uric acid is a normal waste product that is produced when the body breaks down substances called purines. People develop gout when too much uric acid accumulates in the blood stream. Uric acid build-up can occur if the body makes too much uric acid or if the kidneys cannot filter it fast enough.

For ages, people thought that gout was caused by overindulgence in food and drink. For this reason, gout was known as "the disease of kings" or "the rich man's disease." Now we know that this assumption is incorrect, at least partially.

While diet and alcohol can play a role in the development of gout, it is the build-up of uric acid that is at the root of the disease. So, what factors increase levels of uric acid in your body?

Lifestyle Choices

Your lifestyle choices can put you at a greater risk for gout. Certainly, the type and amount of food and alcohol you consume are part of those lifestyle choices. Foods that are high in purines - like seafood and organ meats - can increase uric acid levels in your body and trigger a gout attack. Drinking too much alcohol, especially beer, can increase your risk of gout. Excessive drinking is generally defined as more than two drinks a day for men and more than one for women.

Other Diseases and Conditions

People who already have certain diseases and health problems have an increased risk of gout. These conditions include high blood pressure, high cholesterol, narrowed arteries, obesity, diabetes, and kidney disease. Leukemia and other blood cancers may also increase the risk of developing gout.

Medications

Some medications are known to increase uric acid levels. These include thiazide diuretics (used for treating high blood pressure), low-dose aspirin, and anti-rejection drugs for organ transplant patients.

Age and Gender

Men are more likely than women to develop gout. However, after women go through menopause, their uric acid levels become more like those of men. While women are more likely to develop gout in old age, men are more likely to be diagnosed with gout between 40 and 50 years of age.

Genetics

People with a family history of gout have a higher risk of developing the disease.

How is gout diagnosed?

Because gout can resemble several other forms of arthritis, it is important to get an accurate diagnosis. If your doctor suspects you have gout, he or she will initially look for joint pain and swelling in one or two joints followed by periods without pain.

A proper diagnosis, however, is made by finding those urate crystals (the crystals that form from uric acid build-up). There are two main tests that doctors use to help diagnose gout. The first is a joint fluid test, in which your doctor uses a needle to draw fluid from your affect joint. Your doctor then looks at that fluid under a microscope. It is a good indicator that you may have gout if the microscope reveals urate crystals in your joint fluid.

Your doctor may also use a blood test to measure levels of uric acid in your body. However, it is important to note that uric acid levels are not always an accurate sign of gout. It is possible for someone to have high levels of uric acid but never develop gout. Similarly, someone can have all the signs and symptoms of gout while having relatively normal levels of uric acid in their blood.

X-rays of and urine tests may also be used in the diagnosis of gout. Recent research has suggested that CT scans may help confirm gout in patients who are suspected of having gout even though traditional tests showed negative results.

What are the treatment options for gout patients?

When it comes to treating gout, the main goal is to relieve pain. In most cases, treatment involves medications prescribed by your doctor. But you can also take steps on your own to manage your disease.

Medications

Your doctor may prescribe medications in order to treat attacks of gout and to prevent future attacks. Medications can also reduce the risk of gout complications.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to control swelling and pain. High doses of NSAIDs are used to stop an acute attack of gout. After an acute attack is stopped, a low daily dose of NSAIDs can prevent future attacks. NSAIDs come in both over-the-counter forms and stronger prescription forms. Over-the-counter forms include Advil (ibuprofen), Motrin (ibuprofen), and Aleve (naproxen). Prescription options include drugs like Indocin (indomethacin).

If you cannot take an NSAID, your doctor may prescribe colchicine. Colchicine is an effective treatment for gout pain. However, it may not be a desirable treatment option as it causes many side effects, including nausea, vomiting, and diarrhea.

Corticosteroids are also used to control the swelling and pain of gout. Corticosteroids are usually prescribed only if a patient cannot take either NSAIDs or colchicine. One corticosteroid used to treat gout is prednisone, which is sold under the brand names Deltasone, Liquid Pred, and Meticorten among others.

Your doctor may also prescribe drugs that control the amount of uric acid in your body. Some of these drugs limit the amount of uric acid your body makes, while others help your kidneys remove uric acid from your body. Drugs like Zyloprim (allopurinol), Aloprim (allopurinol), and Uloric (febuxostat) block uric acid production. Probalan (probenecid) is used to improve the kidneys' ability to filter uric acid out of the body.

Diet

Medications are the most effective treatment for your gout symptoms. However, their are also cheap and easy ways to give yourself some relief.

Making changes to your diet can help prevent gouty attacks. You should avoid alcohol and eat less foods high in purine. Purine-rich foods include anchovies, sardines, herring, organ meat, beans, peas, mushrooms, spinach, asparagus, and cauliflower among others. Find out the purine content of your food if you fear having a gouty attack. It is also a good idea to limit your meat intake at each meal and to avoid fatty foods.

While your doctor can prescribe medications, and even though you can play a part in the management of your disease, treating your gout involves a partnership between you and your doctor. By communicating regularly and openly with your doctor, he or she can make the most informed decisions about your treatment plan.

Even though gout is a chronic disease, you do not have to stop living your life if you are diagnosed with the disease. If you suspect you have gout, or any other form of arthritis, find a doctor who can help and give you a proper diagnosis. Then work with your doctor to find which treatments work best for you. In the end, however, you have to take the steps to make your life better. Learn as much as you can about your condition so that you know all of the options available to you.