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Gout – A Painful Form of Arthritis

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Jeffrey R. Carlson, MD
Gout is a common form of arthritis that typically affects the big toe joint; however the ankles, knees, elbows, wrists and fingers can also be affected. The problem occurs when too much uric acid remains in the blood after being processed by the kidneys.  The uric acid forms into thin, spike-like crystals, which can settle in joints, causing intense pain and other troubling symptoms.
What causes gout and what are the risk factors?
Uric acid is formed naturally when the body breaks down purines, a substance also normally found in the body, but which is also found in steak, seafood and organ meats.  Alcohol (especially beer) and fruit sugars also can cause high levels of uric acid in the blood. Typically, uric acid dissolves in the blood and is excreted through the kidneys in urine.  When this process doesn’t work correctly, an overload of uric acid in the bloodstream can result, which in turn causes urate crystals to form in the joint.
Obesity is a known risk factor for gout, and those who eat a rich diet, high in uric acid, are at risk.  Men typically get gout more often than women because they produce more uric acid. After menopause, the production of uric acid in women increases.  Having a family member with gout puts a person more at risk.  Having certain chronic illnesses, like diabetes or hypertension, can up your chances for gout.  Taking diuretics and low-dose aspirin can also increase uric acid levels.
How is gout different from other forms of arthritis?
Gouty arthritis is one of two forms of disease that causes crystals to form in the joints.  Crystalline Deposition Disease (pseudo-gout) is the other condition; but the crystals are formed from a type of calcium, similar to an abrasive commonly found in toothpaste.  Osteoarthritis (OA), rheumatoid (RA) and psoriatic arthritis (PA) do not cause crystals to form in the joint.
OA, RA and PA can all cause, pain, swelling and stiffness in the joints, but Gout pain tends to be excruciating, and the joint becomes red, inflamed and difficult to move.   Gout tends to appear suddenly and other forms of arthritis typically appear more gradually.   Sufferers report that they cannot bear to have clothing over the joint, a bedsheet touching it or wear shoes that compress the gouty joint.  That type of acute, severe pain is not typical of most arthritis.
If gout is untreated, it can develop into tophi, which are nodule deposits of uric acid under the skin, along the fingers, back of the shins, feet and hands.  These unsightly lumps can become tender and swollen during gout flares.
Untreated gout is often a precursor for the development of kidney stones. 
How is Gout diagnosed?
There are several ways to diagnose Gout:

  1. A blood test for uric acid and creatinine – a negative test can be misleading, so this test is often done in conjunction with other tests
  2. Joint fluid test – fluid is withdrawn from the painful joint and viewed under a microscope to look for crystals
  3. X-rays of the joint – helps to rule in or out other forms of arthritis
  4. Patient description of condition onset, pain, other symptoms, what at home remedies help or do not help

How is Gout Treated?
Gout is treated with medication(s), typically to treat the inflammation of the joint, to relieve pain and to address the overproduction of uric acid.  Anti-inflammatory medication, both over the counter and prescription can be used.  Corticosteroid injections can also be helpful. A specific type of pain reliever called Colchicine is effective in treating gout pain; however, the side effects of nausea, vomiting and diarrhea can be difficult to stomach (pun intended).  Medications may also be prescribed that block uric acid production and that assist in its removal from the bloodstream and body.
Patients with Gout are advised to follow a strict diet which restricts consumption of seafood, red meat, organ meat, beans, alcohol and high-fructose foods, all known to increase uric acid production.  They are advised to drink plenty of water, get much of their protein from low-fat dairy and eat plenty of vegetables.
Gout sufferers are also advised to lose weight, if needed, and to exercise regularly to help keep affected joints mobile.
If you have other medical conditions, such as hypertension, diabetes, heart or kidney disease, your gout can be worse.  It is important that you treat those conditions concurrently for maximum gout relief.

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