GOUT

 Basic information

description

Gout is a disorder that affects the body's joints, especially the base of the big toe. Gout may also involve the foot, ankle, knee, elbow, hand, arm, or shoulder. It affects adults of both sexes but is more common in men than women, until after menopause.

FREQUENT SIGNS & SYMPTOMS

• Sudden onset of severe pain (usually at night) in the inflamed joint. This is often at the base of the big toe.
• Involved joints may be hot, swollen, and very tender. Skin over the joint is red and shiny.
• Fever, chills, or fatigue (sometimes).

causes

A high level of uric acid in the blood. This may be due to increased production of uric acid or decreased elimination of uric acid by the kidneys.

risk increases with

• Family history of gout.
• Obesity.
• Excess alcohol use.
• Kidney disease, thyroid disorders, high blood pressure, leukemia, or lymphoma.
• Use of certain drugs, such as diuretic drugs (water pills), high blood pressure drugs, aspirin, drugs that treat gout, and others.
• Starvation or dehydration.
• Eating large amounts of foods that contain purines. These include anchovies, sardines, sweetbreads, kidney, liver, tongue, and large amounts of red meat, shellfish, peas, lentils, and beans.
• Trauma.

PREVENTIVE MEASURES

Avoid risk factors, where possible.

expected outcomes

The first attack may last a few days up to a week. Recurrent attacks are common unless the uric acid level in the blood is reduced. Treatment relieves symptoms and helps prevent any long-term health problems.

possible complications

• Crippled, deformed joints.
• Kidney stones or kidney disease.
• Continued gout attacks (if untreated).
• Uric acid deposits called tophi develop in soft tissue, cartilage tissue, and tendons.

 diagnosis & treatment

general measures

• Your health care provider will do an exam of the joints. Medical tests may include blood and urine levels of uric acid and studies of fluid removed from the joint. An x-ray may be done.
• Goals of treatment are to control the symptoms, prevent a recurrence, and to lower uric acid levels. Treatment usually involves drug therapy, lifestyle changes, and rarely, surgery.
• Lifestyle changes may include diet changes and weight loss (if overweight).
• Surgery is rare, but may be recommended if the disorder was untreated or treated late.
• For home care—use warm or cold compresses on painful joints. Keep the weight of bedclothes off any painful joint. Make a frame to raise sheet off the feet.

medications

• Nonsteroidal anti-inflammatory drugs or colchicine to control inflammation and pain are usually prescribed.
• Steroids (e.g., prednisone) may be prescribed.
• Lifelong treatment with drugs to decrease uric acid production or to increase the kidneys' excretion of uric acid may be needed. Your health care provider will explain the risks and benefits.

activity

• During an attack, rest and elevate the foot. Take care to avoid joint injury. Wear shoes that fit properly.
• When able, exercise daily.

diet

• Drink plenty of water and other liquids daily. Fluids keeps the urine diluted (helps prevent kidney stones).
• Don't drink alcoholic beverages, especially beer or liquor. They can worsen or trigger an attack.
• If you are overweight, begin a medically approved weight-loss diet. Do not go on a crash diet, as rapid weight loss may bring on a gout attack.
• A low-purine diet may be recommended. A dietitian can help with meal planning.
• Increase low-fat dairy products. They reduce the risk of gout symptoms.

 notify our office if

• You or a family member has symptoms of gout.
• Pain gets worse, or fever and chills occur.
• New, unexplained symptoms develop.

Special Notes: