From the Guidelines
Gout is a form of inflammatory arthritis caused by the buildup of uric acid crystals in joints, most commonly affecting the big toe, and is characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints. Gout typically develops when there's too much uric acid in the blood, which can form sharp, needle-like crystals in joints and surrounding tissues 1. The condition is caused by the accumulation of excess urate crystals (monosodium urate) in joint fluid, cartilage, bones, tendons, bursas, and other sites 1.
Key Characteristics of Gout
- Sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints
- Buildup of uric acid crystals in joints, most commonly affecting the big toe
- Can be caused by the body producing too much uric acid or the kidneys not efficiently excreting it
- Risk factors include overweight or obesity, hypertension, alcohol intake, diuretic use, and a diet rich in meat, seafood, and high-fructose food or drinks 1
Management of Gout
To manage gout, the following steps can be taken:
- Take prescribed medications:
- Lifestyle changes:
- Maintain a healthy weight
- Limit alcohol intake, especially beer and spirits
- Reduce consumption of purine-rich foods (e.g., red meat, organ meats, certain seafoods)
- Stay hydrated
- During an attack:
- Rest the affected joint
- Apply ice to reduce inflammation
- Elevate the affected limb
It is essential to note that gout management should prioritize reducing uric acid levels and preventing future attacks, rather than just treating individual attacks. By reducing purine intake and improving uric acid elimination, you can help prevent gout attacks and manage the condition long-term 1.
From the FDA Drug Label
Gout is a metabolic disorder which is characterized by hyperuricemia and resultant deposition of monosodium urate in the tissues, particularly the joints and kidneys. The etiology of this hyperuricemia is the overproduction of uric acid in relation to the patient's ability to excrete it
Gout is a metabolic disorder characterized by hyperuricemia and deposition of monosodium urate in tissues, particularly the joints and kidneys. It is caused by the overproduction of uric acid in relation to the patient's ability to excrete it 2.
From the Research
Definition and Characteristics of Gout
- Gout is a metabolic disease characterized by hyperuricemia and the deposition of monosodium urate (MSU) crystals in the joints and soft tissues 3.
- It is an inflammatory arthritis caused by MSU crystal deposition in articular and non-articular structures 4.
- Gout consists of a self-limited acute phase characterized by recurrent attacks of synovitis and a chronic phase in which inflammatory and structural changes of the joints and periarticular tissues may lead to persistent symptoms 3.
Symptoms and Signs of Gout
- Acute gout is characterized by a sudden monoarthritis of rapid onset, with intense pain, mostly affecting the big toe (50% of initial attacks), the foot, ankle, midtarsal, knee, wrist, finger, and elbow 3.
- The joint affected is usually hot, red, swollen, and very painful, often associated with skin erythema 5.
- Gout has a predilection for lower extremity joints, and it often starts at the first metatarsophalangeal joint, a condition termed podagra 5.
Risk Factors and Triggers
- The prevalence of gout increases with age, and risk factors include increasing serum uric acid levels, alcohol consumption, purine-rich foods, and the use of loop and thiazide diuretics 5.
- Obesity, high alcohol and purine-rich food consumption, and the use of diuretics can exacerbate gout flares 4.
- Dehydration, increasing creatinine levels, and surgery are also known to precipitate flares 5.
Diagnosis and Management
- Diagnosis requires synovial fluid analysis with direct visualization of MSU crystals 3, 4.
- Acute flares are managed with steroids, non-steroidal anti-inflammatory drugs, or colchicine 5, 6, 4.
- Long-term management includes lifestyle modifications, such as weight loss, avoidance of alcohol, purine-rich foods, and diuretics, and urate-lowering therapy (ULT) in patients with 2 or more gout flares/year, tophi, or radiographic evidence of gouty arthropathy 7, 6, 4.