Gout is an extreme and complicated type of inflammatory arthritis. Although it often occurs in only a single joint at a time, it is exceedingly painful and may flare up in multiple spots at once. The extremities contain the most commonly affected joints, including the toes, ankles, knees, elbows, wrists, and fingers.
Although gout can’t necessarily be “cured,” there are several options for treatment and prevention of future incidences. Here is a look at the causes, symptoms, diagnosis, and treatment of gout.
The overriding cause of gout arthritis is an excess of uric acid in the blood. Normally, the body is able to break down uric acid so that it disintegrates and disappears through the kidneys in urine. However, if too much uric acid is made by the body or the kidneys can’t get rid of enough of it, it begins to develop in unhealthy quantities.
The excess uric acid results in sharp urate crystals that form in the joints or tissues nearby. This causes the inflammation and pain that accompanies episodes of gout. According to the Arthritis Foundation, injuries to joints, some medications or treatments, infections, surgeries, or illnesses may be contributing triggers of gout. Additionally, lifestyle choices such as excessive consumption of alcohol, poor diet, and dehydration may also cause an increase of uric acid that lead to this type of arthritis.
A sharp pain in the big toe during sleep is often the first sign of gout. The first 12 hours are often the most painful, but gout is also characterized by less severe but continuous discomfort. The joints may be swollen, red, and hot or tender to touch. These episodes of pain may only go on for days, or the may continue for weeks. The longer gout is present, the more extensive these episodes are likely to be.
It can become more difficult to use the affected joints as gout progresses, potentially limiting mobility and joint usage. Eventually “tophi,” or collections of urate crystals, may also cause visible lumps under the skin. Additionally, kidney stones may form from the excessive uric acid if the condition is left untreated.
There are several different types of testing that can be used to determine if gout is present. While blood tests can show high levels of uric acid, normal levels do not always mean that gout isn't present—even normal levels can be problematic if the kidneys can’t properly filter the uric acid. Conversely, others may have high levels of uric acid and no gout.
A joint fluid test takes a sample of fluid from a joint experiencing pain. This fluid is then examined for urate crystals. Imaging tests, such as radiographs, ultrasounds, or dual energy computerized tomography scanning may allow medical professionals to rule out other causes or to see urate crystals or inflammation in the joints.
There are several options for treating gout arthritis. This includes treating joint pain with nonsteroidal anti-inflammatories (NSAIDs), or it might involve treating excess uric acid at the source.
Colchicine has been the most effective method of relief for pain caused specifically by gout, but it also comes with a host of extreme side effects. Oral medication or injections of corticosteroids may also be effective for managing gout arthritis pain. It is important to discuss the best option for you with your doctor, as each of these medications comes with potential consequences.
For those who experience gout more commonly or more severely, other treatments may be more appropriate. Xanthine oxidase inhibitors work by controlling the amount of uric acid produced by the body. Drugs like Probenecid, on the other hand, help the kidneys get rid of greater amounts of uric acid. If you think you’ve been experiencing episodes of gout, talk to your doctor to help prevent further pain or complications.