Info for you:
What is Gout?
Gout is a painful form of arthritis that was described in the days of Hippocrates. Treatments are now available to control most cases of gout, but diagnosing gout can be difficult and treatment plans often have to be individualized to each person’s medical problems and medications.
Cause
Gout is caused by an excess of uric acid in the body. This excess can be caused by an increase in production of uric acid in the body and by the inability of the kidneys to adequately clear uric acid from the body. Certain foods
(shellfish) and an excess of alcoholic beverages may increase uric acid levels and precipitate gout attacks. Medications, including hydrochlorothiazide (a fluid pill) and some transplant medications (cyclosporine and tacrolimus), can also increase uric acid levels. With time, elevated levels of uric acid in the blood may lead to deposits around joints. Eventually, the uric acid may form needle-like crystals in joints, leading to acute gout attacks. Uric acid may also collect under the skin, which is known as tophi, or in the urinary tract as kidney stones.
Health Impact
Gout afflicts an estimated 840 out of 100,000 people. Gout and its complications occur more commonly in men, in women after menopause, and in people with kidney disease. Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes. Some families have a genetic predisposition to gout. African Americans and people with poor kidney function are more likely to have gout attacks.
Diagnosis
Since several other kinds of arthritis can mimic a gout attack, and since treatment is specific to gout, proper diagnosis is essential. The definitive diagnosis of gout is dependent on finding uric acid crystals in the joint fluid during an acute attack. However, uric acid levels in the blood alone are often misleading and may be transiently normal or even low. Additionally, uric acid levels are often elevated in individuals without gout.
Treatment
Since the 1800s, colchicine has been a standard treatment for acute gout. While colchicine is very effective, it can cause nausea, vomiting, diarrhea and other adverse events. Because of the unpleasant side effects of colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) have become the treatment of choice for most acute attacks of gout. The NSAID that is most widely used to treat acute gout is indomethacin. NSAIDs may also have significant toxicity, but if used for the short-term, are generally well tolerated. However, some people are unable to take NSAIDS because of other medical factors such as ulcer disease, poor kidney function, or the use of blood thinners. The elderly often do not tolerate NSAIDs because of multiple side effects. High doses of aspirin and aspirin-containing products should be avoided during acute attacks, but low dose aspirin can be continued. Corticosteorid type medications are also used to treat gout attacks and they can be given in pills or by injection.
Therapy directed at normalizing uric acid levels in the blood should be considered for patients who have had multiple gout attacks or who have developed tophi (uric acid nodules under the skin) or kidney stones. Several drugs that help the kidneys eliminate uric acid are available, such as probenecid, and a drug that blocks production of uric acid by the body, such as allopurinol. Decisions about which treatment is appropriate have to be individualized and depend on kidney function and other medical factors. With correct treatment, gout should be well controlled in almost all cases.
The Rheumatologist’s Role in the Treatment of Gout
The treatment of gout can be complicated in some patients because of their other medical conditions and medications. As experts in the treatment of arthritis, rheumatologists evaluate the patient determine whether gout is the cause of their arthritis, educate patients about the role of medication and diet in the treatment of gout, and are a resource to primary care physicians.
For More Information
For a listing of rheumatologists in your area, check the American College of Rheumatology’s Find a Rheumatologist feature. If you want more information on this or any other form of arthritis, contact the Arthritis Foundation at (800) 283-7800 or visit the Arthritis Foundation Web site at
www.arthritis.org.