Gout is a type of inflammatory arthritis caused by high uric acid levels in the blood (hyperuricemia). When uric acid crystals deposit in joints, they trigger sudden, painful attacks of swelling and redness. Gout commonly affects the big toe but can involve other joints such as the ankle, knee, and fingers. Proper treatment can control attacks and prevent long-term joint damage.
Causes and Risk Factors
- High uric acid production
- Reduced uric acid excretion by kidneys
- High-purine diet (red meat, seafood, organ meats)
- Alcohol consumption
- Obesity
- Kidney disease
- Genetic predisposition
- Medications such as diuretics and low-dose aspirin
Symptoms of Gout
- Sudden, severe joint pain (usually at night)
- Redness and swelling around the joint
- Warmth and tenderness
- Limited joint movement
Chronic Gout Symptoms
- Frequent gout attacks
- Tophi (uric acid crystal deposits under the skin)
- Joint deformity
Diagnosis
- Serum uric acid levels – elevated in most cases
- Joint fluid analysis – confirms presence of urate crystals
- X-rays – may show joint damage in chronic gout
- Ultrasound – detects crystal deposits
Treatment of an Acute Gout Attack
The goal is to reduce pain and inflammation quickly.
1. NSAIDs
- Indomethacin
- Ibuprofen
- Naproxen
2. Colchicine
- Effective if given early during an attack
- Lower doses reduce side effects
3. Corticosteroids
- Prednisolone (oral)
- Intra-articular steroid injections for severe pain
Long-Term Management (Lowering Uric Acid)
These medicines are used after the acute attack is controlled.
1. Xanthine Oxidase Inhibitors
- Allopurinol – commonly used
- Febuxostat – alternative for patients intolerant to allopurinol
2. Uricosuric Agents
- Probenecid – increases uric acid excretion
3. Pegloticase
- Used in severe, refractory gout
Note: Long-term medicines should NOT be started during an acute attack.
Diet and Lifestyle Management
- Avoid high-purine foods (red meat, shellfish, organ meats)
- Reduce alcohol, especially beer
- Stay hydrated
- Lose weight gradually
- Limit sugary soft drinks
Complications of Gout
- Tophi formation
- Chronic joint damage
- Kidney stones
- Reduced kidney function
Patient Counseling
- Use NSAIDs or colchicine at the first sign of an attack
- Do not start allopurinol during an acute attack
- Avoid alcohol and high-purine foods
- Drink plenty of water
- Regularly monitor uric acid levels
- Take long-term uric acid–lowering drugs daily as prescribed
Detailed Notes:
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