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General Concepts > Gout What is Arthritis? The term "arthritis" is actually used to describe a group of distinct diseases, primarily affecting joints of the body, all having related symptoms. These may include pain, swelling, and stiffness of the joints and surrounding areas. The word "arthritis" means, literally, “swelling of the joint.” Arthritis can attack one or many joints, suddenly or more gradually over time, depending on the particular type one may have. Symptoms may be constant or may come and go, but generally the effects of arthritis are chronic, meaning that they will last for a long time, perhaps for the rest of your life. A diagnosis of arthritis does not mean that you are confined to a life of pain and immobility, however. There are many different treatments that can lessen pain, increase your range of motion and even slow the progress of your disease. You should talk to your doctor about these options. It is important to keep a positive outlook throughout your treatment, as this will assist in the healing process. What is Gout? Gout is an arthritic condition involving needle-like crystals which deposit in the joints, causing swelling and extreme pain. The crystals are uric acid, which is a normal waste product of the body. Uric acid is normally filtered out of the body by the kidneys, and is eliminated as urine. In patients with gout, the level of uric acid rises above normal, and crystals deposit in the ligaments and cartilage. The joint most affected in gout is the big toe, though other joints may also be affected, such as the knee, ankle, foot, hand, wrist and elbow. Gout affects more men than women. Causes of Gout? Most people who have gout are men who are middle-aged or older, with the peak age at 75. A very small percentage of cases -- around 5% -- involve women, usually those who have completed menopause. It is estimated that in the United States alone one million people suffer from attacks of gout. Sometimes called "the scourge of the ages," Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history. It is often related to an inherited abnormality affecting the body's ability to process uric acid. Uric acid is a byproduct of the breakdown of purines, a component of many foods we eat. An abnormality in the production or elimination of uric acid can cause attacks of gouty arthritis, kidney stones, and even, in extreme cases, the blockage of the kidney tubules with uric acid crystals, leading to kidney failure. Many people, on the other hand, develop elevated uric acid levels -- known as hyperuricemia -- without experiencing arthritis or kidney problems. The relationship between hyperuricemia and gout is unclear. Many people with hyperuricemia do not develop gout, while some of those with repeated gout attacks have normal or low uric acid levels in their blood. Among the male population in the United States, approximately ten percent have hyperuricemia. However, only a small portion of those with hyperuricemia actually develop gout. Contributing factors and causes of gout include:
While there is no cure for gout, attacks can generally be controlled with medication and diet. Symptoms of Gout? For some reason, the joint most typically affected by gout is the big toe. The painful inflammation of the first toe joint is called podagra. The pain may be so severe that a gentle breeze or a bed sheet brushing up against it may produce exquisite pain. Subsequent attacks often affect other joints of the foot and leg (such as the knee and ankle joints) and, less frequently, the joints of the hand, wrist, and elbow. In addition to arthritis, gout causes the formation of tophi. Tophi are lumpy deposits of uric acid crystals just under the skin. Common places for tophi to develop are in the outer edge of the ear, on or near the elbow, over the fingers and toes, and around the Achilles tendon. Sometimes gout results in kidney stones made of uric acid. Your doctor will suspect that you have gout if:
Medications can also affect the level of uric acid in the blood. It is important to inform your health care provider about all the medications you are using, both prescription and nonprescription. The tophi that result from gout do not cause any symptoms unless they open and drain. Very often they are not painful, but, depending on their location, they may limit the movement of joints. The symptoms of uric acid stones are similar to those of other kidney stones. They are likely to cause abdominal pain and other occasional symptoms such as nausea, vomiting, fever, or blood in the urine. Treatment of Gout? The first step in the treatment of gout is clearly identifying the disease by means of blood tests. These usually reveal an abnormally high level of uric acid. Your doctor will also inquire about other aspects of your health, including your diet, consumption of alcohol, and use of medications. A physician may arange for your joint to be aspirated (drained) to test the fluid for uric acid crystals. If you do have symptoms of gout, it is important to treat the arthritis or kidney stones. The next treatment objective is to then try to prevent the recurrence of these problems by controlling uric acid levels. The standard treatment for gout is a drug called colchicine. Although very effective, colchicine may cause nausea, vomiting, and/or diarrhea. For this reason, many people prefer to use a nonsteroidal anti-inflammatory drug (NSAID) such as indomethacin for pain relief during an attack. These medications are sometimes used on a daily basis to prevent recurrent attacks of gouty arthritis. Steroids such as prednisone are sometimes used for the most severe attacks. Because of their side effects, however, steroids are not considered a good long term treatment strategy. If attacks of gout occur frequently, becoming chronic, one of two additional drugs, allopurinol and probenecid, may be used. Each of these helps to prevent damaging crystal deposits in the joints by controlling the production and elimination of uric acid. These medications are powerful and have side effects that need to be discussed with your doctor. Rest, relaxation, proper diet and exercise, and weight management can all be of benefit in reducing the effects of gouty arthritis. Exercise is always important in maintaining or achieving health and wellness. Your doctor will recommend exercises that do not aggravate your gout, such as walking or swimming. Exercise helps you to maintain a normal range of motion, keeps joint cartilage well-lubricated, and strengthens the muscles around your joints. Protection of the joints with braces or splints, and the use of canes, crutches, or a walker can assist you during the painful episodes while still allowing you to remain relatively active. Applying hot or cold packs, using a whirlpool, heated pool, or even taking warm baths may also be helpful as the acute episode is receding. Living With Gout? Because only some individuals with high uric acid levels develop problems, it is usually not necessary to treat everyone with medication before the symptoms of gout develop. In special circumstances (for example, if you have a strong family history of gouty arthritis or kidney stones) you may be treated for gout even if you do not have any symptoms other than hyperuricemia. Gout is one of a number of distinct arthritic diseases, each of which primarily affects joints of the body. All of these conditions have related symptoms, most typically pain, swelling, and stiffness of the joints and surrounding parts of the body. The word arthritis means, literally, "swelling of the joint." Arthritis may attack one or many joints, suddenly or more gradually over time, depending on the particular condition you have. Symptoms may be constant or they may wax and wane. Generally the effects of arthritis are chronic, meaning that they can be expected to last for a long time, perhaps for the rest of your life. It is important to keep in mind that a diagnosis of arthritis does not mean you are confined to a life of pain and immobility. There are many different treatments that can lessen the pain of gout, increase your range of motion, and even slow the progress of your disease. You should talk to your doctor about these options. Developing a positive outlook assists in the healing process, and often makes a major difference throughout treatment. It is important to understand your abilities and limitations as a result of gout, and to remain optimistic about your management program. Above all, try to be patient and committed to the changes in diet or lifestyle your doctor may recommend. The more active a role you play in the management of your condition, the better control you will have over gout and other aspects of your health. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. © 2000 DynoMed.com, LLC, Indianapolis, IN |