Some years ago my grandmother called me complaining of a swollen toe so painful that it woke her up and hurt for the sheets to touch it. Because she was in chemotherapy and had other health issues, I knew it was probably gout. She called her physician, started medication and had relief within a day.
Gout was once known as the “disease of kings” because episodes of gout can be triggered by eating a lot of meats and rich food. But in the United States it is commonly seen in association with diabetes, kidney disease, obesity, sickle cell and other anemias, leukemia and chemotherapy.
When your body makes too much uric acid or is not getting rid of it (through urination) as it should, high levels of uric acid (hyperuricemia) develop in the blood. Gout happens when excess uric acid in the blood forms monosodium urate crystals, which look like microscopic needles, and they deposit into a joint. Doctors do not yet know why only some people who have hyperuricemia develop gout and require treatment.
Men have gout more than women, although after menopause the incidence of gout in women increases. Lead exposure and taking niacin, diuretics, higher doses of aspirin, cyclosporine or levodopa regularly may increase your risk of developing gout. Some families have a genetic abnormality that causes elevated uric acid levels.
Symptoms of gout often come on suddenly at night and include intense joint pain (frequently in the big toe), redness, swelling, warmth and stiffness in the joint(s), tenderness and fever. After the initial severe joint pain eases, discomfort may linger for several weeks. It can be 6 to 12 months before another attack, but future episodes may last longer and affect more joints. Chronic gout, also called gouty arthritis, causes joint pain and other symptoms most of the time and can damage joints.
If you have a joint pain you think may be from gout, please see your health care provider, who may check the uric acid levels in your blood and/or urine. Joint x-rays may be recommended, as well as synovial fluid analysis or synovial biopsy.
Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen and naproxen) can control inflammation and pain from gout. If over-the-counter NSAIDs stop helping, your health care provider may suggest a prescription NSAID.
Colchicine is also prescribed to effectively relieve gout pain; however, many people have intolerable side effects (nausea, vomiting, diarrhea) from it.
Corticosteroids, such as prednisone, in pills or injections, can help control inflammation and pain. Because there are many side effects (thinning bones, poor wound healing, difficulty fighting infection) associated with corticosteroids, they are usually only recommended if you cannot take NSAIDs or colchicine and are prescribed for the shortest amount of time possible.
Depending on how often you have symptoms and how severe they are, your doctor may recommend medication to prevent or reduce the severity of future gout attacks. In addition to preventing pain, the other goals of treatment are to prevent the formation of large urate crystals (called tophi) under the skin and kidney stones. There are medications that block the production of uric acid and a medication that helps your body rid itself of uric acid.
If you have had gout, it helps to follow the dietary recommendations found here: www.mayo clinic.com/health/ gout-diet/MY01137. If you have diabetes, controlling your blood sugar may help reduce your problems with gout. I also recommend keeping your fluid intake high, limiting or avoiding alcohol and sugary drinks and maintaining a healthy body weight to help prevent future gout attacks and slow or prevent damage to your joints over time.
Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.