Gout

Gout is a common and complex form of arthritis that can affect anyone. It’s characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

Gout symptoms may come and go, but there are ways to manage symptoms and prevent flares.

Symptoms

The signs and symptoms of gout almost always occur suddenly, and often at night. They include:

Intense joint pain.Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
Lingering discomfort.After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
Inflammation and redness.The affected joint or joints become swollen, tender, warm and red.
Limited range of motion.As gout progresses, you may not be able to move your joints normally.

Causes

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.

Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Risk factors

You’re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

Eating a diet rich in meat and seafood and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
If you’re overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.
Medical conditions.Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
Certain medications.The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
Family history of gout.If other members of your family have had gout, you’re more likely to develop the disease.
Age and sex.Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
Recent surgery or trauma.Experiencing recent surgery or trauma has been associated with an increased risk of developing a gout attack.

Medications to treat gout attacks

Drugs used to treat acute attacks and prevent future attacks include:

Nonsteroidal anti-inflammatory drugs (NSAIDs).NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin) or celecoxib (Celebrex).

Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks.

NSAIDs carry risks of stomach pain, bleeding and ulcers.

Your doctor may recommend colchicine (Colcrys, Mitigare), a type of pain reliever that effectively reduces gout pain. The drug’s effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea, especially if taken in large doses.

After an acute gout attack resolves, your doctor may prescribe a low daily dose of colchicine to prevent future attacks.

Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be in pill form, or they can be injected into your joint.

Corticosteroids are generally used only in people with gout who can’t take either NSAIDs or colchicine. Side effects of corticosteroids may include mood changes, increased blood sugar levels and elevated blood pressure.

At Alimran Medical Center, we may recommend any of the following treatments

Pulsed radiofrequency

Botox® injections

Acupuncture

Regenerative medicine treatment (Prolotherapy)

Steroid injection

Chiropractic