Gouty Arthritis

By Dr. Nowarat Songsiridej

GoutHistorically gout was thought to be a rich man’s disease.  We now know gout is largely caused by genetics and also appears in people who have kidney problems.  Gout can be controlled easily; not so much with diet, but with alcohol consumption and compliance with medications.

About Gout
Gout is an acute inflammatory arthritis.  This medical condition is characterized by a red, hot, tender and swollen joint.  About 50 percent of cases appear in the joint of the big toe.  It occurs due to an elevated level of uric acid in the blood, which can result from genetics, insulin resistance, hypertension, kidney problems, obesity, diet and alcohol consumption.

Most new gout attacks will go away by themselves within seven to 14 days.  However, because it is quite painful, many patients seek relief immediately.  Because pain medication itself usually has a difficult time controlling the pain, medical providers often prescribe or recommend taking NSAID (ibuprofen, Aleve, Indomethacin).

Crystal Formation
To discover whether arthritis is gout or not, aspiration of the swollen joint is needed to look for crystals.  Tophi is an accumulation of crystals.  Most often the early tophi is on the first toe, the back of the elbow and the ear.  It is important to draw the fluid the first day or two after the joint swells up, before the body begins to break down the crystals.

Alcohol and Gout
Alcohol consumption is a major cause of gout flare ups.  When you drink alcohol, uric acid does not properly excrete out through the kidneys, which causes the uric acid level to elevate.  If you drink every day it can cause an accumulation of the crystals in the joints and tissue but might not cause flare ups; when you do start flaring up you might already have knobs all over.
                       
By the time you see a doctor the kidneys may have already recovered and excreted the uric acid, but the damage is done.  The crystal is already in the joints, so that is why medical professionals cannot always use the level of uric acid to diagnose gouty arthritis.

Preventing Flare Ups
To prevent flare ups, medications called xantine oxidase inhibitors are used.  There are two kinds of these medications.  Your doctor will determined which one is suitable for you.

The target level of uric acid is less than six.  If it is still higher than six, you might be put on another medication (called Colchicine) or NSAID to prevent the flares of your gouty arthritis until the level is lower than six.

If you have any questions or think you might suffer from gouty arthritis, talk to your doctor and seek medical help in the event of a flare up.

(Dr. Nowarat Songsiridej (Song) is a board certified rheumatologist.  Her interests are in the treatment of rheumatoid arthritis and osteoporosis.  She has served on the teaching faculty at the University of Iowa and University of North Dakota.  Dr. Song sees patients at The Clinics of St. Alexius.)