WHAT IS IT?
Gout is one of the most painful rheumatic diseases. It results from deposits of needle-like crystals of uric acid in the connective tissue, joint spaces, or both.
For many people, gout initially affects the joints in the big toe, a condition called podagra. Sometime during the course of the disease, gout will affect the big toe in about 75 percent of patients. Gout can also affect the instep, ankles, heels, knees, wrists, fingers, and elbows.
WHY DOES IT HAPPEN?
Needle-like uric acid crystal deposits lead to inflammatory arthritis, which causes swelling, redness, heat, pain, and stiffness in the joints. Uric acid is a substance that results from the breakdown of purines or waste products in the body. Normally, uric acid is dissolved in the blood and passes through the kidneys into the urine, where it is eliminated. If the body increases its production of uric acid or if the kidneys do not eliminate enough uric acid from the body, levels build up (a condition called hyperuricemia). Hyperuricemia may also result when a person eats too many high-purine foods, such as liver, dried beans and peas, anchovies, and gravies. Hyperuricemia is not a disease and by itself is not dangerous.
CAN I STOP IT?
To help prevent future attacks, take the medicines your doctor prescribes. Carefully follow instructions about how much medicine to take and when to take it. Acute gout is best treated when symptoms first occur.
- Tell your doctor about all the medicines and vitamins you take. He or she can tell you if any of them increase your risk of hyperuricemia.
- Plan follow-up visits with your doctor to evaluate your progress.
- Maintain a healthy, balanced diet; avoid foods that are high in purines; and drink plenty of fluids, especially water. Fluids help remove uric acid from the body.
- Exercise regularly and maintain a healthy body weight. Lose weight if you are overweight.
The most common treatments for an acute attack of gout are high doses of nonsteroidal anti-inflammatory drugs (NSAID’s) and injections of corticosteroid drugs into the affected joint. NSAID’s reduce the inflammation caused by deposits of uric acid crystals. The NSAID’s most commonly prescribed for gout are indomethacin (Indocin¹) and naproxen (Anaprox, Naprosyn), which are taken by mouth (orally) every day. Patients usually begin to improve within a few hours of treatment, and the attack goes away completely within a few days.