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Gout

Gout is an example of an inflammatory arthritis caused by microscopic crystals made of uric acid. Uric acid is normally made when our bodies use food proteins for energy. Sometimes if the uric acid level is too high, uric acid crystals may form in joints and cause a gout attack. Gout may happen in any joint, but is most known for causing severe pain with redness and swelling in the big toe joint. In severe cases of gouty arthritis, the uric acid levels are so high it forms whitish lumps in the skin filled with chalky material made of pure uric acid called tophi. (The word tophus is a Latin term that refers to a porous type of volcanic rock). Gout also can cause an ongoing (chronic) arthritis, which is not as intensely painful as a gout attack but may cause severe joint damage.

The reason some people have high uric acid levels is not known, but heredity seems to play a role. Other conditions may cause an increase in uric acid. Foods high in a certain class of protein called purines can increase uric acid in some people (such as foods containing organ meats – such as sausage made using animal liver, hearts or kidneys). Fatty fish (anchovies, tuna) and shellfish (shrimp, lobster), dark beers and heavy red wines also contain high purines levels. The uric acid level goes up with dehydration and obesity. Medications used to treat high blood pressure called diuretics (“water pills”) may increase uric acid. It now is known that sugary drinks containing high fructose corn syrup can also increase uric acid levels.

The diagnosis of gout is certain when uric acid crystals are seen in fluid removed from the joint or from a tophus. Sometimes it is not possible to see the crystals, and gout may be presumed to be present if other typical gout signs and symptoms are present. These include a typically red painful and swollen big toe joint, attacks painful arthritis starting abruptly in other joints, along with high uric acid levels.

A high uric acid level without gouty arthritis does not require treatment. In fact, most people with high uric acid levels do not get gout. If attacks are frequent, unusually severe, or if joint damage is seen on x-rays then medications often are used to lower the uric acid level, and prevent gout attacks. The two most commonly used medicines are allopurinol and the newer medicine Uloric. These should not be started to treat a gout attack. If these two medications are not helpful, a newer medication called Krystexxa may be tried. This is given in the vein usually at an infusion center.

During an attack of gout, cold packs are helpful and medications called non-steroidal anti-inflammatory medications (NSAIDs for short) are used to stop the pain and inflammation. Some of the more commonly prescribed of these include medications such as Ibuprofen, Naprosyn, Indocin and Celebrex. If NSAIDs should not be used due to stomach ulcers, kidney disease, high blood pressure or blood thinners, other types of medicines are used. These include colchicine (Colcrys), and sometime a cortisone-like medicine called prednisone. Occasionally a cortisone injection into the painful joint is used to control gout symptoms.

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