Gouty arthritis, commonly called gout, is a type of arthritis caused by the build- up of uric acid in the blood. Uric acid is a chemical which is produced when your body breaks down purines.
Purines are substances found in foods, such as anchovies and mackerel, and beverages, like wine and beer. Most uric acid dissolves in the blood, travels to the kidneys and is eliminated in urine. The normal uric acid value ranges between 3.5 and 7.2 mg/dL. Normal value ranges may vary slightly among different laboratories. (1)
Sometimes, your body produces too much uric acid or it may have difficulty eliminated uric acid. This leads to elevated blood levels of uric acid. The condition is called hyperuricemia.
If excessive uric acid accumulates in the synovial fluid, which is the fluid around your joints, uric crystals form. The uric crystals cause inflammation of the joints. This is gouty arthritis. (2)
The exact cause of gout is unknown. However, it tends to run in families and occurs with higher frequency in men, post-menopausal women and individuals who consume excessive amounts alcohol. Thiazide diuretics or water pills, such as hydrochlorothiazide, can interfere with the removal of uric acid from the body and increase the risk of developing gout.
Individuals with diabetes, kidney disease, sickle cell anemia, leukemia and other types of blood cancers have an increased for developing gout. Untreated hypertension, hyperlipidemia, arteriosclerosis and obesity are known risk factors for gout. (2, 3)
Gout is a complex form of arthritis which can be acute or chronic. Acute gout is a painful condition that typically affects one joint, usually, the big toe, knee or ankle joint. The pain is most severe within the first 12 to 24 hours following onset. It is often described as throbbing, crushing or excruciating.
The affected joint is swollen, tender and red. After the severe pain subsides, some degree of joint discomfort can last a few days or a few weeks. It is possible to experience intermittent attacks, which can last longer than the initial attack. About half of all individuals experience subsequent attacks while others will have no symptoms following the first attack. (1)
Chronic gout is repeated episodes of pain and inflammation in more than one joint. With chronic gout, there is joint damage, chronic joint pain and loss of motion in the joints. (1)
Diagnosis is confirmed by the results of specific diagnostic testing. These tests include synovial fluid analysis and a blood test to measure uric acid levels. Not everyone with high uric acid blood levels gets gout and not everyone with gout has high uric acid blood levels.
Gout attacks can be prevented by increasing your daily fluid intake to 8 to 16 cups (about 2 to 4 liters) of fluid each day, including at least half water. Limiting or avoiding alcohol, eating a healthy, low-fat diet and maintaining a healthy weight can reduce your risk of gouty arthritis.
Your physician may prescribe medication to help you manage the pain and reduce the risk for a repeat attack. Drugs of choice include nonsteroidal anti-inflammatory drugs, colchicine and corticosteroids. Medications which block the uric acid production and medications which improve uric acid removal are prescribed to prevent complications associated with frequent gout attacks. (4)
(1) Medline Plus: Uric Acid- Blood, Dec.5, 2011
(2) University of Maryland Medical Center: Gout- Overview, Dec. 5, 2011
(3) Mayo Clinic: Gout- Risk Factors, Dec. 5, 2011
(4) Mayo Clinic: Gout-Treatment and Drugs, Dec. 5, 2011
Reviewed December 5, 2011
by Michele Blacksberg RN
Edited by Jody Smith