Gout Info - Gout Questions and Answers
This gout website contains general information about gout. It describes what gout is and how it develops. It also explains how gout is diagnosed and treated. If you have further questions after reading this, you may want to discuss them with your doctor.
What Is Gout?
Gout is a painful condition occurring when body a waste product uric acid is deposited as needle-like crystals in the joints or body soft tissues. In the joints, these uric acid crystals cause inflammatory arthritis, which in turn leads to intermittent swelling, redness, heat, pain, and stiffness in the joints.
In many people, gout initially affects the joints of the big toe (a condition called podagra). But many other joints and areas around the joints can be affected in addition to or instead of the big toe. These include the insteps, ankles, heels, knees, wrists, fingers, and elbows. Chalky deposits of uric acid, also known as tophi, can appear as lumps under the skin that surrounds the joints and covers the rim of the ear. Uric acid crystals can also collect in the kidneys and cause kidney stones.
Gout may also develop in people with:
- Kidney disease
- Sickle cell anemia and other hemolytic anemias
- Leukemia and similar types of disorders
Gout can also occur after taking medicines that interfere with the removal of uric acid from the body.
What Is Uric Acid?
Uric acid is a substance coming from a breakdown of purines. A normal part of all human tissue, purines are found in many foods. Normally, uric acid is dissolved in the blood and passed through the kidneys and urine, where it is removed.
If there is an increase in the production of uric acid or if the kidneys do not eliminate enough uric acid from the body, levels of it build up in the blood (a condition called hyperuricemia). Hyperuricemia also may result when a person eats too many high-purine foods, such as liver, dried beans and peas, anchovies, and gravies. Hyperuricemia is not a disease, and by itself it is not dangerous. However, if excess uric acid crystals form as a result of hyperuricemia, gout can develop. The crystals form and accumulate in the joint, causing inflammation.
What Are the Four Stages of Gout?
Gout can progress through four stages:
- Asymptomatic (without symptoms) Gout. In this stage, the gout sufferer has higher levels of uric acid in the blood but no other symptoms. Treatment is usually not required.
- Acute gout, or acute gouty arthritis. In this stage, hyperuricemia has caused the deposit of uric acid crystals in joint spaces. This leads to a sudden onset of intense pain and swelling in the joints, which also may be warm and very tender. An acute attack is often at night and can be triggered by stress, alcohol or drugs, or the another illness. Attacks usually subside within several days, even without treatment and the next gout attack may not happen for months or even years. Over time, however, attacks can last longer and be more frequent.
- Interval Gout. This is the time between acute gout attacks. In this early gout stage, there are no symptoms.
- Chronic Gout. The most chronic and disabling stage of gout is known as chronic gout. This advanced stage of gout tends to develop over a long time period, i.e. 5 to 10 years or more. With chronic-gout, the gout disease may cause permanent damage to the affected joints and sometimes to kidneys. With proper treatment, most people with gout do not progress to the Chronic Gout advanced stage.
When It’s Not Gout, It May Be Pseudo Gout
Gout is sometimes confused with other forms of arthritis because the symptoms are acute and episodic attacks of joint warmth, pain, swelling, and stiffness can be similar. One form of arthritis often confused with gout is called pseudo gout. The pain, swelling, and redness of pseudo gout can also come on suddenly and may be severe, closely resembling the symptoms of gout. However, the crystals that irritate the joint are calcium phosphate crystals, not uric acid. Therefore, pseudogout is treated somewhat differently and is not reviewed in this booklet.
What Causes Gout?
A number of risk factors are associated with hyperuricemia and gout. They include:
- Genetics. Many people with gout have a family history of the disease. Estimates range from 20 to 80%.
- Gender and age. It is more common in men than in women and more common in adults than in children.
- Weight. Being overweight increases the risk of developing hyperuricemia and gout because there is more tissue available for turnover or breakdown, which leads to excess uric acid production.
- Alcohol consumption. Drinking too much alcohol can lead to hyperuricemia, because alcohol interferes with the removal of uric acid from the body.
- Diet. Eating too many foods that are rich in purines can cause or aggravate gout in some people.
- Lead exposure. In some cases, exposure to lead in the environment can cause gout.
- Other health problems. Renal insufficiency, or the inability of the kidneys to eliminate waste products, is a common cause of gout in older people. Other medical problems that contribute to high blood levels of uric acid include:
- high blood pressure
- hypothyroidism (under active thyroid gland)
- conditions that cause an excessively rapid turnover of cells, such as psoriasis, hemolytic anemia, or some cancers
- Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome, two rare conditions in which the enzyme that helps control uric acid levels either is not present or is found in insufficient quantities.
- Medications. A number of medications may put people at risk for developing hyperuricemia and gout. They include:
- Diuretics, which are taken to eliminate excess fluid from the body in conditions like hypertension, edema, and heart disease, and which decrease the amount of uric acid passed in the urine
- Salicylate-containing drugs, such as aspirin
- Niacin, a vitamin also known as nicotinic acid
- Cyclosporine, a medication that suppresses the body’s immune system (the system that protects the body from infection and disease). This medication is used in the treatment of some autoimmune diseases, and to prevent the body’s rejection of transplanted organs.
- Levodopa, a medicine used to support communication along nerve pathways in the treatment of Parkinson’s disease.
Who Is Likely to Develop Gout?
Scientists estimate that 6 million adults age 20 and older report having had gout at some time in their lives. It is rare in children and young adults. Men, particularly those between the ages of 40 and 50, are more likely to develop gout than women, who rarely develop the disorder before menopause. People who have had an organ transplant are more susceptible to gout.
How Is Gout Diagnosed?
Gout may be difficult for doctors to diagnose because the symptoms can be vague, and gout often mimics other conditions. Although most people with gout have hyperuricemia at some time during the course of their disease, it may not be present during an acute attack. In addition, having hyperuricemia alone does not mean that a person will get gout. In fact, most people with hyperuricemia do not develop the disease.
To confirm a diagnosis of gout, a doctor may insert a needle into an inflamed joint and draw a sample of synovial fluid, the substance that lubricates a joint. The joint fluid is placed on a slide and examined under a microscope for uric acid crystals. Their absence, however, does not completely rule out the diagnosis.
The doctor also may find it helpful to look for uric acid crystals around joints to diagnose gout. Gout attacks may mimic joint infections, and a doctor who suspects a joint infection (rather than gout) may also culture the joint fluid to see whether bacteria are present.
Signs and Symptoms of Gout
- presence of uric acid crystals in joint fluid
- more than one attack of acute arthritis
- arthritis that develops in a day, producing a swollen, red, and warm joint
- attack of arthritis in only one joint, often the toe, ankle, or knee.
Gout Key Words
Corticosteroids. Powerful anti-inflammatory hormones made naturally in the body or man-made for use as medicine. Injections of corticosteroid drugs are sometimes used to treat inflammation in the shoulder, knee, and other joints.
Diuretics. A type of medication that promotes the formation and output of urine. Diuretics are prescribed to treat the accumulation of excess fluid in bodily tissues that can result from diseases of the kidneys, liver, lungs, or heart. They may also be used to treat high blood pressure or glaucoma, a condition in which pressure builds up inside the eye.
Hemolytic anemia. A form of anemia (deficiency of red blood cells) caused by the destruction of the cells rather than the body’s inability to produce them in adequate numbers.
Hyperuricemia. The presence of elevated levels of uric acid in the blood.
Hypothyroidism. A condition in which the thyroid gland (the gland that makes and stores hormones that regulate heart rate, blood pressure, body temperature, and the rate at which food is converted to energy) is under active. Without treatment, this condition can result in fatigue, weight gain, other serious medical problems, and even death.
NSAIDs. A class of medications, available over the counter or with a prescription, that ease pain and inflammation.
Podagra. Gout in the big toe.
Pseudo gout. A condition often mistaken for gout that results from the deposit of calcium phosphate crystals (not uric acid crystals as in gout) in the joints and other tissues. This condition is also called chondrocalcinosis.
Psoriasis. An autoimmune disease characterized by a red scaly rash that is often located over the surfaces of the elbows, knees, and scalp, and around or in the ears, navel, genitals, or buttocks. Approximately 10 to 15 percent of people with psoriasis develop an associated arthritis referred to as psoriatic arthritis.
Purines. Found in the DNA and RNA within the nuclei of cells, purines are part of all human tissue and are found in many foods, especially those high in protein.
Synovial fluid. The slippery fluid produced by the synovium (joint lining) to lubricate the joints.
Tophi. Nodular masses of uric acid crystals that sometimes form in the soft tissue of people with chronic gout. Although tophi are most common around the fingers, elbows, and big toe, they can occur in virtually any part of the body. (The singular is tophus.)
Uric acid. A substance that results from the breakdown of purines, which are part of all human tissue and are found in many foods.
Where to Find More Information About Gout?
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health 1 AMS Circle
Bethesda, MD 20892-3675
Toll Free: 877-22-NIAMS (877-226-4267)
American College of Rheumatology (ACR)
The Arthritis Foundation Website is Arthritis.org
More Gout Topics, many of which we are preparing special-reports on (please contact-us to pre-order);
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Do You Have the Gout Gene? The Stabbing Pain in Your Joints could be Genetic – but You Can Knock it Out Once and for All!!
The pain keeps you up at night. Or worse – it wakes you from a restful, sound sleep.
It’s gout. And Johns Hopkins University Scientists have exposed a gene that some people just carry.
Good news is you don’t have to suffer just because you’re genetically “supposed to.”