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Gout

What Is Gout?

Gout is one of the most painful forms of arthritis. It occurs when too much uric acid builds up in the body. The buildup of uric acid can lead to:

  • Sharp uric acid crystal deposits in joints, often in the big toe

  • Deposits of uric acid (called tophi) that look like lumps under the skin

  • Kidney stones from uric acid crystals in the kidneys.

    For many people, the first attack of gout occurs in the big toe. Often, the attack wakes a person from sleep. The toe is very sore, red, warm, and swollen.

    Gout can cause:

  • Pain

  • Swelling

  • Redness

  • Heat

  • Stiffness in joints.

    In addition to the big toe, gout can affect the:

  • Instep

  • Ankles

  • Heels

  • Knees

  • Wrists

  • Fingers

  • Elbows.

    A gout attack can be brought on by stressful events, alcohol or drugs, or another illness. Early attacks usually get better within 3 to 10 days, even without treatment. The next attack may not occur for months or even years.

    What Causes Gout?

    Gout is caused by the buildup of too much uric acid in the body. Uric acid comes from the breakdown of substances called purines. Purines are found in all of your body's tissues. They are also in many foods, such as liver, dried beans and peas, and anchovies.

    Normally, uric acid dissolves in the blood. It passes through the kidneys and out of the body in urine. But uric acid can build up in the blood when:

  • The body increases the amount of uric acid it makes.

  • The kidneys do not get rid of enough uric acid.

  • A person eats too many foods high in purines.

    When uric acid levels in the blood are high, it is called hyperuricemia. Most people with hyperuricemia do not develop gout. But if excess uric acid crystals form in the body, gout can develop.

    You are more likely to have gout if you:

  • Have family members with the disease

  • Are a man

  • Are overweight

  • Drink too much alcohol

  • Eat too many foods rich in purines

  • Have an enzyme defect that makes it hard for the body to break down purines

  • Are exposed to lead in the environment

  • Have had an organ transplant

  • Use some medicines such as diuretics, aspirin, cyclosporine, or levodopa

  • Take the vitamin niacin.

    How Is Gout Diagnosed?

    Your doctor will ask about your symptoms, medical history, and family history of gout. Signs and symptoms of gout include:

  • Hyperuricemia (high level of uric acid in the blood)

  • Uric acid crystals in joint fluid

  • More than one attack of acute arthritis

  • Arthritis that develops in 1 day, producing a swollen, red, and warm joint

  • Attack of arthritis in only one joint, usually the toe, ankle, or knee.

    To confirm a diagnosis of gout, your doctor may draw a sample of fluid from an inflamed joint to look for crystals associated with gout.

    How Is Gout Treated?

    Doctors use medicines to treat an acute attack of gout, including:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin*

  • Corticosteroids, such as prednisone

  • Colchicine, which works best when taken within the first 12 hours of an acute attack.

    Sometimes doctors prescribe NSAIDs or colchicine in small daily doses to prevent future attacks. There are also medicines that lower the level of uric acid in the blood.

    * Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

    What Can People With Gout Do to Stay Healthy?

    Some things that you can do to stay healthy are:

  • Take the medicines your doctor prescribes as directed.

  • Tell your doctor about all the medicines and vitamins you take.

  • Plan followup visits with your doctor.

  • Maintain a healthy, balanced diet. Avoid foods that are high in purines, and drink plenty of water.

  • Exercise regularly and maintain a healthy body weight. Ask your doctor about how to lose weight safely. Fast or extreme weight loss can increase uric acid levels in the blood.

  • Nutritional and Herbal Therapy for Gout
    • Consume plenty of water. Dehydration may make gout worse.
    • Limit purines in your diet. Purines will increase lactate production in your body. Lactate competes with uric acid for excretion. Foods that are high in purine content include beef, organ meats, sweetbreads, mussels, anchovies, herring, mackerel, and yeast. Foods with a moderate level of purines include meats, poultry, fish and shellfish not listed above. Other foods with a moderate level of purines include spinach, asparagus, beans, lentils, mushrooms, and dried peas.
    • Do not drink alcohol beverages, especially beer.
    • Eat a half a pound of cherries a day (fresh or frozen) for two weeks in order to lower uric acid and prevent further attacks. Cherries and other dark berries, such as hawthorn berries and blueberries, contain anthocyanadins that increase collagen and decrease inflammation. Cherry juice (8 to 16 ounces of a day) can  also be helpful.
    • Folic acid (10 to 75 mg a day) inhibits xanthine oxidase, an enzyme that is required for uric acid production.
    • Do not take Niacin in doses greater than 50 mg a day. Nicotinic acid can cause a gout attack.
    • Bromelain (125 to 250 mg three times a day) is an anti-inflammatory that can be helpful during an attack.
    • The Chinese herbal formula, Si Miao Wan can help relieve symptoms of gout.

     


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