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Gout Pain

Senior man making an ugly and funny grimace

What the heck is gout, anyway?  It’s one of the most frequently recorded medical illnesses throughout history, but all many people know about gout is that it hurts.

Metabolic arthritis, Gout

Gout

Actually, gout is an especially painful form of arthritis caused by deposits of uric acid crystals, a breakdown product of some foods.  This acid is usually flushed out by the kidneys. However, if not dissolved in the blood and processed by the kidneys, the uric acid crystals build up. The tiny crystals are sharp-edged and so this build-up can cause acute tenderness and inflammation.

Also called metabolic arthritis or gouty arthritis, gout is most often associated with toes, but although the joint at the base of the big toe is the most common site for an attack, deposits can collect at other joints as well.  For example, uric acid can also accumulate in the ankles, knees, wrists, fingers and elbows.

The deposits can potentially harm joints, tendons and other tissues–symptoms may never go away.  In untreated gout, gritty nodules of uric acid may form under the skin, and can progressively cause destruction of cartilage and bone.  In extreme cases kidney stones may develop and the kidneys can be damaged.

Who’s at risk for a gout attack?

Because of the role alcohol and obesity can play, gout was once considered a “rich man’s disease.”  Although that is no longer the conventional wisdom, some people are more likely to develop the condition than others. It is more prevalent in men than women and more prevalent in African-American men than white men.  Chances of a gout attack also increase with age.  Risk factors also include:

  • obesity
  • moderate to heavy alcohol intake
  • hypertension
  • hypothyroidism
  • abnormal kidney function

What happens during an attack?

Usually over a number of years uric acid crystals build up in the joints and surrounding tissues.  That can eventually cause an attack that starting with moderate pain that grows worse.  Pain, selling, redness, and warmth are often seen in the single joint.  Only gradually do the symptoms subside.  The area may be so tender that the weight of a sheet is excruciating.

Most attacks stop after about a week.  Mild attacks may last only a day or two; severe attacks can last several weeks.  Many people have another attack within 6 months to a year, or there may be years between flare-ups.  Untreated, the frequency of attacks usually increases.

When should a doctor be called?

  • Severe pain in a single joint that comes on quickly
  • Swollen, tender joins with warm red skin over them

How is gout treated?

  • Rest
  • Ice
  • NSAIDS but not aspirin
  • Prescription drugs such as corticosteroids

What will help prevent recurrence?

  • Talk to your doctor about your medications
    • Some medications can actually raise uric acid levels
    • Anti-inflammatories and corticosteroids may help prevent gouty arthritis and kidney stones
  • Manage your weight
  • Limit alcohol (especially beer)
  • Make dietary changes (meat and shellfish are purine-rich)
  • Fluid intake is important

With medical guidance and careful self-discipline, gout can be managed, or even avoided.  It is crucial, though, to be well-informed and talk to your doctor.  Some gout details are surprising.  For example, weight management is important, but fasting or crash diets may actually temporarily raise uric acid levels and make the problem worse.  Likewise, though NSAIDs are a basic part of gout treatment, aspirin must be avoided because it can also raise uric acid levels.  Read more about the subject here.  As with any health concern, treatment must start with talking to your doctor.

Adriann Griffith
Adriann Griffith
Adriann has been blogging for Home Instead since the Baton Rouge blog's inception. She is an award-winning writer and a published poet. Adriann's particular passion is writing about Alzheimer's disease, embracing Proverbs 31:8, "Speak up for the people who have no voice."

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