Gout is a common and complex form of arthritis that can affect anyone. It’s characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe.

Contd. from last edition

Recent surgery or trauma: Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, receiving a vaccination can trigger a gout flare.

Complications

People with gout can develop more-severe conditions, such as:

Recurrent gout: Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.

Advanced gout: Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas, such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.

Kidney stones: Urate crystals may collect in the urinary tracts of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Diagnosis

Doctors usually diagnose gout based on your symptoms and the appearance of the affected joint. Tests to help diagnose gout may include:

Joint fluid test: Your doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope.

Blood test: Your doctor may recommend a blood test to measure the levels of uric acid in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don’t have unusual levels of uric acid in their blood.

X-ray imaging: Joint X-rays can be helpful to rule out other causes of joint inflammation.

Ultrasound: This test uses sound waves to detect urate crystals in joints or in tophi.

Medications to treat gout attacks

Drugs used to treat gout flares and prevent future attacks include:

Nonsteroidal anti-inflammatory drugs (NSAIDs):

NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin, Tivorbex) or celecoxib (Celebrex). NSAIDs carry risks of stomach pain, bleeding and ulcers.

Colchicine:

Your doctor may recommend colchicine (Colcrys, Gloperba, Mitigare), an anti-inflammatory drug that effectively reduces gout pain. The drug’s effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea.

Corticosteroids: Corticosteroid medications, such as prednisone, may control gout inflammation and pain. Corticosteroids may be in pill form, or they can be injected into your joint. Side effects of corticosteroids may include mood changes, increased blood sugar levels and elevated blood pressure.

Medications to prevent gout complications

If you experience several gout attacks each year, or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications. If you already have evidence of damage from gout on joint X-rays, or you have tophi, chronic kidney disease or kidney stones, medications to lower your body’s level of uric acid may be recommended.

Medications that block uric acid production:

Drugs such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) help limit the amount of uric acid your body makes. Side effects of allopurinol include fever, rash, hepatitis and kidney problems. Febuxostat side effects include rash, nausea and reduced liver function. Febuxostat also may increase the risk of heart-related death.

Medications that improve uric acid removal: Drugs such as probenecid (Probalan) help improve your kidneys’ ability to remove uric acid R Dr. Pargat Singh Bhurji MD,FRCP ( C ) Consultant Pediatrician Surrery BC from your body. Side effects include a rash, stomach pain and kidney stones.

Lifestyle and home remedes

Medications are often the most effective way to treat gout attacks and prevent recurrent symptom flares. However, lifestyle choices also are important, and you may want to:

Choose healthier beverages:

Limit alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, drink plenty of nonalcoholic beverages, especially water.

Avoid foods high in purines:

Red meat and organ meats, such as liver, are especially high in purines. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna. Low-fat dairy products may be a better source of protein for people prone to gout.

Exercise regularly and lose weight:

Keeping your body at a healthy weight reduces your risk of gout. Choose low-impact activities such as walking, bicycling and swimming — which are easier on your joints.

Dr. Pargat Singh Bhurji
MD,FRCP ( C ) Consultant Pediatrician Surrery BC