What is Gout?

Gout is a metabolic disease and a form of inflammatory arthritis that is caused by excessive buildup of uric acid crystals in the joint. It usually affects one joint at a time often the big toe. Uric acid is a product of purine breakdown from many foods we eat and alcohol. Underexcretion of uric acid results in deposition of needle-like crystals of uric acid in a joint and can cause attacks of painful arthritis, uric acid kidney stones, and deposition in kidney interstitium with uric acid crystals, leading to kidney failure. Not everyone with hyperuricemia develops gout and up to two-thirds of people with hyperuricemia never have any symptoms.

What is the epidemiology of Gout?

Gout usually affects middle-aged to elderly men and postmenopausal women. It is rare in children commonly develops earlier in adult men than in women. It is estimated that gout affects nearly 4 percent of adults in the United States which range from three million to eight million Americans. 

What are the risk factors for Gout?

Risk factors that increase a person’s risk of developing gout include:

  • Obesity
  • High blood pressure
  • Abnormal kidney function
  • Overeating or prolonged fasting
  • Heavy alcohol intake
  • Consumption of large amounts of meat or seafood
  • Consuming beverages containing high fructose corn syrup (such as non-diet sodas)
  • Certain medications that affect blood levels of urate (diuretics, ACEI, ARB, Aspirin, Ethambutol, Pyrazinamide)

What are the symptoms of Gout?

  • Intense joint pain most often in the big toe but it can occur in any joint
  • nodules under the skin called tophi,
  • Limited range of motion
  • Joint inflammation, warmth, and redness

How to diagnose Gout?

Careful medical history and physical examination based on patients’ symptoms is crucial in establishing gout diagnosis. Imaging such as X-ray and lab test to detect hyperuricemia may be part of the work-up for gout but the most reliable test for gout is a joint aspiration to detect uric acid crystals in the joint fluid. This procedure is performed using a sterile technique with topical local anesthesia. The fluid is aspirated from the inflamed joint with a syringe and needle for analysis.

What are the differential diagnoses of Gout?

  • Septic arthritis
  • Reactive arthritis
  • Calcium pyrophosphate dihydrate (CPPD) deposition disease
  • Rheumatoid arthritis

How is Gout treated?

Treatment is focused on presentation; it can be acute or chronic

  • Acute Gouty Arthritis
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to relieve pain and reduce swelling in a joint
    • Corticosteroids – These drugs can be taken by mouth or injected into an inflamed joint to quickly relieve the pain and swelling of an acute attack. 
    • Colchicine – This anti-inflammatory medicine and most effective when started within 24 hours of the first symptoms of a gout flare
  • Chronic Gout Arthritis: uric acid–lowering agents are used to prevent or reduce the reoccurrence of gout. Examples of medications used are:
    • Allopurinol: It works by reducing how much uric acid the body produces.
    • Febuxostat: It works by reducing how much uric acid the body produces
    • Probenecid: It acts on the kidneys to eliminate excess uric acid.
    • Pegloticase is used when all medication fails. It reduces uric acid quickly and to lower levels than other medications. 

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