Gout

Signs and Symptoms

The hallmark symptom of gout is a sudden, severe attack of pain, redness, swelling and tenderness in a joint, often the first toe. Inflammation also can occur in the knee, ankle, foot, hand, wrist and elbow. Gout typically occurs quickly in only one joint at a time, but symptoms may occur in two or three joints simultaneously.

Deposits of uric acid, called tophi, can appear as lumps under the skin around the joints and at the rim of the ear. Occasionally, uric acid collects in the kidneys and forms stones.

Diagnosis

Your doctor will begin by recording your complete medical history and asking you to describe your symptoms. Then you will undergo a physical examination during which your doctor will check for physical signs of the condition.

The best way to diagnose gout is to remove fluid from an affected joint and examine it under a microscope for uric acid crystals. However, this may not always be necessary.

Treatment

Most people with gout are able to control their symptoms and enjoy active lives with the use of proper medication. Treatment aims to reduce pain, prevent future attacks and avoid the development of tophi and kidney stones.

Drug Therapy

Nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids, which are either taken orally or injected into the affected joint, are two of the most common treatments for acute attacks of gout. NSAIDs and corticosteroids reduce the inflammation caused by deposits of uric acid crystals, although they have no effect on the amount of uric acid in the body. Patients often begin to improve within a few hours of treatment, and the attack usually goes away completely within a week or so.

Patients who have multiple gout attacks or who develop tophi or kidney stones are candidates for therapy that aims to normalize uric acid levels in the blood. Such drugs include those that help the kidneys eliminate uric acid, such as probenecid, and drugs that block production of uric acid by the body, such as allopurinol.

During the initial phases of such treatment, low dose of the anti-inflammatory drug colchicine might be used to prevent a gout attack.