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Gout Prevention and Treatment


Anyone who has ever had gout in their toe would likely agree with Hippocrates’ moniker for the inflammatory arthritis as “the unwalkable disease.” Of course, while gout often attacks the big toe, it can also attack the ankles, heels, knees, wrists, fingers, and elbow.


Causes

Gout occurs when uric acid, a byproduct of metabolism, builds up and urate crystals deposit in the joints. The urate crystal deposits in the joints are responsible for the inflammation and intense pain during a gout attack.


Symptoms

A gout attack feels like an assault on the affected joint. It occurs suddenly and can last days or weeks. Symptoms at the affected joint may include:

  • Intense pain

  • Swelling

  • Redness

  • Tenderness

  • Warmth

  • Limited range of motion


Risk factors

Gout is associated with the following risk factors:

  • Diet rich in meat, organ meats, seafood, alcohol, sugary drinks

  • Being male

  • Post-menopausal women

  • Obesity

  • Certain medications such as diuretics

  • Kidney disease

  • Family history of gout


Diagnosis

In addition to symptoms assessment and examination of the affected joint(s), the diagnosis of gout may include:

  • Use of a needle to draw joint fluid to look for urate crystals

  • Blood test for uric acid levels. Keep in mind that blood uric acid levels can be misleading. Some people with high uric acid levels do not experience gout and levels may be normal or low during an acute attack.

  • X Ray to assess for joint damage in long-standing gout

  • Ultrasound or CT scan can show early features of gouty joint involvement


Treatment

The management strategy for gout can be grouped into medications that are helpful during acute attacks and medications that are used to reduce the risk of recurrence of gout flares.


Treatment of acute attack

Drugs that are used to treat acute gout attacks include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, can decrease inflammation and pain in the joints and other tissues. They provide the fastest relief of symptoms but may cause stomach upset, ulcer, or diarrhea.

  • Corticosteroids, such as prednisone, can also decrease inflammation and are a useful option for those who can not take NSAIDs. They can be in a pill form or delivered by injection. Corticosteroids can increase blood sugars, blood pressure, and alter moods.

  • Colchicine can be effective for pain if given early. Low daily doses of colchicine can also prevent gout flares. Side effects such as nausea, vomiting, and diarrhea may occur, especially with high doses.


Medications to prevent gout and its complications

People who have recurrent gout flares, abnormally high levels of blood uric acid, evidence of damage from gout on imaging studies, or kidney stones may consider medications to lower their blood uric acid level. These medications work by either blocking uric acid production (such as allopurinol) or increasing uric acid removal (such as probenecid). The physician will need to tailor the preventative strategy since treatment choices depend on the medication side effects profile, the patient’s kidney function along with other health problems.




References

https://medlineplus.gov/gout.html

https://www.cdc.gov/arthritis/basics/gout.html

https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout

https://www.niams.nih.gov/health-topics/gout