Dr. M.J. Bazos, MD
Patient Handout
GOUT
About Your
Diagnosis
Gout is an abrupt and very painful form of
arthritis. It usually affects only one joint at a time, typically the great toe,
foot, ankle, knee, wrist, or elbows. Gout usually affects men older than 40
years. It is unusual in women until they have passed through menopause (the
change of life). Gout “attacks” are caused by the release of
“crystals” into a joint, resulting in inflammation, pain and
swelling. These crystals are made of a substance in the blood called uric acid.
In individuals with gout, either too much uric acid is made or not enough is
eliminated by the kidney. Alcohol, aspirin, certain medicines, and rarely
certain foods (liver and other organ meats, sardines, anchovies) may cause
levels of uric acid to rise in individuals, making them more prone to developing
gout. The only way to diagnose gout with certainty is to place a needle into the
affected joint, remove the joint fluid and look for the gout crystals under a
microscope.
Living With Your
Diagnosis
Individuals who have an
attack of gout notice rapidly developing pain, swelling, warmth, and redness in
the affected joint. The pain can be so intense that even lightly touching the
joint will cause severe pain. The pain is usually continuous and more painful if
the joint is moved. Everyday activities such as walking, dressing, and lifting
may be difficult. Attacks may occur at any time; however, certain events can
trigger attacks such as injuries, surgery, an acute illness, or ingestion of
alcoholic beverages. Once the attacks are treated, the symptoms usually resolve
within hours to a few days. If attacks are not treated, they may last several
days. In between attacks the symptoms resolve completely. Individuals with
higher uric acid levels in their blood are more prone to recurring attacks.
Persistently elevated uric acid levels for many years can cause deposits of uric
acid in nodules under the skin. These are called “tophi.” Some
individuals with gout are also prone to developing kidney
stones.
Treatment
There
are two ways to approach the therapy for gout: treatment of attacks and
prevention of attacks. Preventive treatment is necessary in individuals with
tophi, kidney stones, and frequent attacks. Attacks of gout are usually treated
with nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin.
Potential side effects of NSAIDs include stomach upset, ulcers, constipation,
diarrhea, headaches, dizziness, difficulty hearing, and skin rash. Colchicine is
another type of anti-inflammatory drug that is particularly effective early in
the attack. Potential side effects of colchicine include stomach cramps, nausea,
vomiting, and diarrhea. Occasionally, a more potent anti-inflammatory medicine
such as prednisone, a cortisone-like medicine, is necessary. Potential side
effects of cortisone like medicines are increased appetite, weight gain,
difficulty sleeping, easy bruising, and stomach upset. Removal of the joint
fluid from the affected joint, followed by a cortisone injection is another
common treatment for gout. Cortisone injections usually provide the most rapid
and complete relief of pain and swelling. Aside from the discomfort of the
injection, there are very few side effects from cortisone injections. Prevention
of gouty attacks is accomplished by lowering uric acid levels. Two common
medicines that lower uric acid levels are allopurinol and probenecid. The
specific medicine your doctor chooses will depend upon other medicines you are
taking and other medical conditions you have. The most common side effects of
allopurinol and probenecid are skin rash and upset
stomach.
The
DOs
• Rest the affected joint
until the symptoms begin to
improve.
• Take your medicines as
prescribed.
• Ask your doctor which
over-the-counter medications you may take with your prescription
medications.
• Follow your
doctor’s advice by limiting your use of alcoholic beverages and avoiding
certain foods or medications.
The
DON’Ts
• Don't wait to see
if side effects from the medications will go
away.
When to Call Your
Doctor
• You experience any
medication side effects.
• The
treatment is not decreasing your symptoms in a reasonable amount of
time.
• You begin to lose more
movement in the affected joint.
• You
experience worsening warmth, redness, or pain after a cortisone
injection.