Gout – type of arthritis caused by uric acid build-up
By: Kenneth Ripp, M.D.
Historically known as “the disease of kings” or “rich man’s disease, gout was first documented in Egypt around 2,600 BC in a description of arthritis of the big toe.
Gout is a type of arthritis that often affects the big toe (and is called podagra when it does); but it can affect other joints as well. Gout is characterized by a sudden attack of burning pain to the involved area. Pain may be accompanied by stiffness and swelling to the joint.
Gout is caused by having too much uric acid in the blood – a condition known as hyperuricemia. Hyperuricemia often exists without any symptoms and many people with high levels of uric acid do not develop gout. Gout occurs when the uric acid in the blood forms crystals that build up in the joints. These crystals cause the pain and flare-ups associated with gout.
Certain factors put you at higher risk for developing gout. Some of these include:
• Being male
• Family history of gout
• A diet rich in meat and seafood
• A diet very low in calories
• Moderate to heavy alcohol use
• Chronic kidney disease
• High blood pressure
• Regular use of aspirin (more than 1 or 2 per day)
• Medications used as diuretics
• Acute illness or infection
• Lead exposure
• Injury to a joint
Uric acid crystals may build up for years before the symptoms of gout appear. They include warmth, pain swelling and tenderness to the affected joint, however symptoms vary from person to person. An attack often starts during the night and may be so severe that even light pressure from bed covers is painful. The discomfort may increase for a few hours and then decrease gradually over then next few days to a week. Attacks can vary in severity. Mild attacks may stop after a day; severe attacks can last two or three weeks. As the attack subsides, the skin around the joint may peel and feel itchy.
Most people have an interval that is symptom-free between attacks or flare-ups of gout. If untreated, the frequency of attacks usually increases over time.
Even though pain from gout may subside after an attack, it’s still important to see your doctor about the disease. The uric acid that led to the attack continues to build in your system, causing crystals for form in your joints leading to the likelihood of future attacks. Your doctor can help create a treatment plan to prevent future flare-ups and to deal with the pain of an attack when it occurs.
Your doctor also may be able to help decrease the severity of an attack by using an injection of corticosteroids or a prescription of oral medications. Relief often begins with 24 hours if you begin treatment early in the attack.
In addition, your doctor may prescribe home treatment that included nonsteroidal anti-inflammatory drugs (NSAIDS). Some of these, such as naproxen sodium (Aleve) and ibuprofen (Advil and Motril) can be purchased over-the-counter. Although aspirin is an NSAID, do not take aspirin for a gout attack. Aspirin can alter the uric acid level in the blood, and actually make gout worse.
Other home treatment includes resting the affected area, elevating it and using ice to reduce swelling.
In order to prevent or lessen future attacks, your doctor may prescribe medication to reduce uric acid build-up in your blood. It is important to take this medication exactly as prescribed.
Other lifestyle habits and choices can help you manage gout. You may need to decrease consumption of meat, seafood and alcohol while increasing consumption of water and other healthy liquids.
In the past, gout was thought to be brought on by drinking too much alcohol and eating too many rich foods. This may be why the disease was seen as being one that affected kings. While these factors do precipitate a rise in the uric acid levels in the blood, we now know that there are numerous factors that cause high uric acid levels that can result in crystals forming in the joints, which leads to gout. Certain healthy lifestyle choices can help to prevent the likelihood of gout. If you do develop the disease or have an attack to a joint that you suspect may be gout, make and appointment to see your primary care physician. Treatment is available to decrease the frequency of attacks and their severity.
Dr. Ripp is a board certified family practice physician at Raiter Clinic.