You wake up in the middle of the night, and your big toe feels as if it’s on fire. It’s hot, swollen and so tender that the weight of the blanket on it is nearly intolerable.
If so, you might be experiencing an acute attack of gout — or gouty arthritis — a form of arthritis that’s characterized by sudden, severe attacks of pain, redness and tenderness in joints.
Gout has been recognized for more than 2,000 years, making it one of humankind’s oldest known diseases. In the past, gout was often known as “the disease of kings” because it was associated with wealthy men who overindulged in rich food and drink. Today, it’s known that gout is a complex disorder that can affect anyone. In fact, it’s a painful problem for more than 2 million Americans.
It’s true that men are more likely to get gout than women are, but women become increasingly susceptible to it after menopause. Fortunately, gout is treatable, and there are ways to keep it from recurring.
The symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:
The cause of gout is an excessive blood level of uric acid, a waste product formed from the breakdown of purines. These are substances found naturally in your body as well as in certain foods, especially organ meats — such as liver, brains, kidney and sweetbreads — and anchovies, herring and mackerel. Smaller amounts of purines are found in all meats, fish and poultry.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much or excretes too little of this acid. In that case, uric acid can build up, forming sharp, needle-like crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
Crystal deposits also cause another condition, known as false gout (pseudogout). But rather than being composed of uric acid, pseudogout crystals are made of calcium pyrophosphate dihydrate. And while pseudogout can affect the big toe, it’s more likely to attack large joints such as your knees, wrists and ankles.
The following conditions or circumstances can increase the chances you’ll develop high levels of uric acid that may lead to gout:
To help diagnose gout, your doctor may withdraw fluid from the affected joint to check for crystals of uric acid in your white blood cells. Other tests may include:
For gout attacks, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) may provide relief. Keep in mind that these medications can cause side effects, including stomach pain, bleeding and ulcers. What’s more, NSAIDs have a ceiling effect — a limit as to how much pain they can control. This means that beyond a certain dosage, they don’t provide additional benefits.
For severe cases, your doctor may prescribe a corticosteroid drug such as prednisone. Although steroids can provide dramatic relief, they can also cause serious side effects, including thinning bones, poor wound healing and decreased ability to fight infection. Sometimes doctors inject cortisone into the affected joint, but this approach can still cause side effects, and shots are generally limited to no more than three a year.
Once the acute attack is under control, your doctor may recommend preventive treatment to slow the rate at which your body produces uric acid or to increase the rate at which it’s excreted.
There’s no sure way to prevent initial or subsequent attacks of gout, but if you already have gout, your doctor may prescribe certain drugs to reduce the risk or lessen the severity of future episodes. These drugs include allopurinol (Zyloprim, Aloprim) and probenecid (Benemid). Taken daily, they slow the rate at which uric acid is produced and speed its elimination from your body. In general, keeping uric acid levels within a normal range is the long-term key to preventing gout.
Lifestyle changes can’t cure gout, but the following measures may help relieve symptoms:
Doctorsolve Healthcare Solution site strives to provide you with timely, accurate information, which is not intended for diagnosis or treatment.