The Basics
Written by the doctors and editors at UpToDate � �
What is gout? " � Gout is a form of arthritis. It can cause pain and swelling in the joints. At first, it tends to affect only one joint " � most frequently in the big toe. It happens in people who have too much uric acid in the blood. Uric acid is a chemical that is produced when the body breaks down certain foods. Uric acid can form sharp needle-like crystals that build up in the joints and cause pain. Uric acid crystals can also form inside the tubes that carry urine from the kidneys to the bladder. These crystals can turn into "kidney stones " � that can cause pain and problems with the flow of urine. � �
What are the symptoms of gout? " � People with gout get sudden attacks of severe pain, most often the big toe, ankle, or knee. Often the joint also turns red and swells. Usually, only one joint is affected, but some people have pain in more than one joint. � �
The pain from gout can be extreme. The pain and swelling are worst at the beginning of a gout attack. The symptoms then get better within a few days to weeks. It is not clear how the body "turns off " � a gout attack. � �
Is there a test for gout? " � Yes. To test you for gout, your doctor or nurse can take a sample of fluid from the joint that is in pain. If he or she finds typical gout crystals in the fluid, then you have gout. Even without checking fluid from a joint, the doctor or nurse might still strongly suspect gout if: � �
- You have had pain and swelling in one joint, especially the joint at the base of the big toe
- Your symptoms completely go away between attacks, at least when you first start having them
- Your blood tests show high levels of uric acid
How is gout treated? " � There are a few medicines that can reduce the pain and swelling caused by gout. When you find one that works for you, make sure to keep it on hand all the time. That way you can take it as soon you feel an attack starting. Gout medicines work best if you take them as soon as symptoms start. � �
The medicines used to treat attacks of gout include: � �
- NSAIDs " � This is a large group of medicines that includes ibuprofen (sample brand names: Advil, Motrin) and indomethacin (brand name: Indocin). NSAIDs might not be safe for people with kidney or liver disease, or for people who have bleeding problems.
- Colchicine " � This medicine helps with gout but it can also cause diarrhea, nausea, vomiting, and stomach pain. Doctors and nurses usually give this medicine to people who cannot take NSAIDs.
- Steroids " � Your doctor or nurse might suggest medicines called steroids if you cannot take NSAIDs or colchicine. These steroids are not the kind that athletes take to build up muscle. These steroids reduce swelling and pain. Steroids come in shots or as pills.
Are there medicines to prevent gout attacks? " � Yes, there are medicines that can reduce the chances of having future gout attacks. Most people who have repeated or severe attacks of gout need to take these medicines. In general, they all work by reducing the amount of uric acid in the blood. Examples of these medicines include allopurinol (brand names: Aloprim, Zyloprim), febuxostat (brand name: Uloric), and probenecid. People with severe gout can also get a medicine called pegloticase (brand name: Krystexxa), which is given through a vein. This medicine can cause an allergic reaction in some people. � �
If you take one of the medicines to prevent gout, your doctor or nurse will want to make sure that you use it safely. He or she might also want to check that your uric acid level gets low enough to dissolve the gout crystals. Allopurinol, febuxostat, and probenecid can actually increase gout attacks when you first start taking them. To prevent these attacks, your doctor or nurse might suggest that you take low doses of colchicine when you start the medicines. This will give the gout crystals time to dissolve, and that will put a stop to the attacks. � �
Can I do anything on my own to prevent gout attacks? " � Yes. If you are overweight, losing weight can help relieve gout. Plus, you can make changes to your diet that might help prevent future attacks. � �
You should cut down on: � �
- Red meat and seafood
- Alcohol, such as beer, wine, and hard alcohol
- Foods and drinks that have high-fructose corn syrup (that includes most sodas and store-bought cakes and cookies)
Instead, you should eat lots of: � �
- Low-fat dairy products, such as low-fat milk, cheese, and yogurt
- Whole grains and vegetables
All topics are updated as new evidence becomes available and our peer review process is complete. � �
This topic retrieved from UpToDate on: Nov 04, 2014. � �
Topic 15395 Version 8.0 � �
Release: 22.8 - C22.206 � �
� � 2014 UpToDate, Inc. All rights reserved. � �
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