Arthritis Services Arthritis Services

Gouty Arthritis

Gout is a type of arthritis that is caused by the formation of microscopic crystals in the joints and surrounding tissues.  It is a common cause of arthritis that may result in periodic attacks of joint pain and may cause a more chronic, deforming type of arthritis.  This article will discuss the causes of gout and the approach to treatment.

What causes gout?
Our bodies produce a chemical called uric acid as a byproduct of the normal breakdown of our own cells and of foods rich in components called purines.  If the uric acid becomes elevated above normal this chemical may form into crystals that can then be deposited in and around the joints.  When these crystals are detected by our immune system, a series of responses occur that result in inflammation.  This inflammation is characterized by redness, swelling, warmth, and pain.  Once this episode of inflammation subsides, the joint may return to normal.

What causes the uric acid to become elevated?
Uric acid levels become elevated due to the over production of uric acid or due to a decrease in excretion of uric acid in the urine.  Diets high in purine rich foods such as meat, seafood, and alcohol (especially beer ) may contribute to higher levels of uric acid. 
Diseases which result in an increase in the production and death of our cells, including psoriasis and some cancers, may also cause an increase in uric acid levels.  A decrease in kidney function related to aging or diseases affecting the kidney may also cause the uric acid levels to rise.  Finally, some medications such as diuretics (used to treat high blood pressure and fluid retention) may contribute to elevated uric acid levels.

How do I know if my arthritis is due to gout?
Gout typically first appears in men between the ages of 30-45 years and in women between the ages of 55-70 years.  Gouty arthritis typically starts out as episodic “attacks” of joint pain, swelling, and warmth.  The most commonly affected area is the big toe, but gout attacks may also occur in the ankles, knees, or joints in the upper body.  A typical gout attack will resolve over several days but attacks may occur repeatedly and become more frequent over time.  Your physician may suspect gout if your arthritis has these typical characteristics.  Joint fluid can occasionally be removed from a swollen joint and gout crystals may be seen under the microscope.  A blood test can also let your physician know if your uric acid levels are elevated and x-rays may show joint damage if you have had repeated attacks of gout or deposits of uric acid (called tophi) in and around the joints.

How is gout treated?
The approach to treating gout depends on whether the attacks occur infrequently (typically less than 3 attacks per year), frequently (more than 3 attacks per year), and based on other medical problems a patient may have.  Infrequent attacks are typically treated with NSAIDS (medications such as ibuprofen, naproxen, and indomethacin) or with steroid medication such as prednisone.  When attacks become more frequent your physician may discuss starting on daily prescription medication to lower the uric acid in order to prevent or decrease the frequency of attacks.  Currently available medications for lowering the uric acid include probenecid, allopurinol, and febuxostat.

Summary
In summary, gout is a type of arthritis caused by the formation of uric acid crystals in a joint.  The crystals cause the body’s immune systems to respond with an “attack” of inflammation characterized by pain, swelling, warmth, and redness.  Gout attacks are treated with medications to control inflammation.  Daily medication may be needed for individuals who experience frequent attacks of gout.