What is Gout?

Gout is a hereditary, metabolic disorder characterized by inflammation and pain in affected joints. Gout occurs more frequently in men than in women. It is caused by an excess of uric acid in the blood and tissues. Crystals of the acid form under the skin and in the joints, causing local pain. In normal circumstances, uric acid above a certain low concentration is excreted in the urine. Gout occurs either when too little uric acid is excreted or when there is too much of the acid for the kidneys to excrete. Alcohol may increase the incidence of attacks of gout.

Q: What are the symptoms of gout?

A: An attack begins suddenly with severe pain and swelling in a joint. The overlying skin becomes red and shiny. A severe attack may cause fever and nausea. Untreated, an attack of gout lasts between three and seven days. Even when the symptoms disappear, further attacks are likely. An infection in a joint can appear very similar. A physician should be consulted.

Q: What brings on an attack of gout?

A: In general, the causes are not known, but minor injuries and some drugs, for example, diuretics, can bring on an attack. Alcohol also can precipitate an attack.

Q: How is gout diagnosed?

A: A physician has to make sure that the inflamed joint is not the result of infection, osteoarthritis, or acute rheumatoid arthritis. A diagnosis of gout is made after the fluid from an inflamed joint is examined for crystals. A blood test to check the uric acid level is often performed.

Q: How is gout treated?

A: During an acute attack, the joint is rested until the pain subsides. The drug colchicine can bring relief within a few hours, but possible side effects make it unsuitable for the elderly and for patients with heart, liver, or kidney disorders. Other drugs prescribed for an acute attack include sulindac, ibuprofen, naproxen, and indomethacin.

After an attack, treatment is aimed at reducing the blood level of uric acid by means of drugs and an increased intake of fluids. Colchicine can be taken regularly, as can probenecid, sulfinpyrazone, or allopurinol. Aspirin negates the effect of the drugs and should be avoided; acetaminophen is an acceptable substitute. Alcohol should be avoided.

Q: Does gout have any complications?

A: Yes. If gout is not treated in its early stages, the condition may become chronic. Chronic gout results in deposits of uric acid (tophi) in the joints. These deposits may cause permanent arthritis. The most serious danger from the metabolic disorder that causes gout is that uric acid crystals may be deposited in the kidneys.