Arthritis and Gout
How Frequent Are Gout Attacks?
Gout attacks can recur from time to time in the same joint. The initial attack may last several days to two weeks unless treated.
Over time, gout attacks may occur more often, involve more joints, have more severe symptoms and last longer. Repeated attacks can damage the joint.
Some people will have only a single attack. However, most people who have one gout attack will have at least a second attack, although it may not occur for several years after the initial onset. Others may have attacks every few weeks.
Who Is Affected By Gout?
Gout affects more than two million Americans -- most commonly men between the ages of 40 and 50, people who are overweight, people who frequently drink alcohol and people who use diuretics ("water pills") to lower blood pressure or treat heart failure.
When gout affects women, it usually is after menopause, especially in women who are taking certain medications. Less often, younger people may be affected by gout if they have been taking certain medications for long periods of time, frequently drink alcoholic beverages or have certain genetic disorders.
In addition to diuretics, there are some medications that reduce the body's ability to flush out uric acid, thus increasing the risk for developing gout. These medicines include:
- Anti-inflammatory drugs made from salicylic acid, such as aspirin.
- Cyclosporine, a medicine used to suppress the body's immune system (Cyclosporine is often used to prevent the rejection of transplanted organs.).
- Levodopa, a medicine used to treat Parkinson's disease.
- Niacin, a vitamin that is part of the vitamin B complex and sometimes used to treat high cholesterol.
How Is Gout Diagnosed?
Gout cannot be diagnosed simply from a blood test, because many people have elevated blood uric acid levels but do not have gout. Rather, gout is diagnosed from the fluid of an inflamed joint. The fluid is observed under a microscope for uric acid crystals.
Fluid is removed through a needle during a procedure called arthrocentesis. Extracting the fluid not only aids in diagnosing the condition, but it may also reduce pressure within the joint, thereby reducing pain.
If crystals are not found in the fluid, the diagnosis of gout cannot be made with certainty. Occasionally, crystals may not be seen the first time, but may be seen if additional fluid is removed during a subsequent attack.
Since gout can cause chronic joint pain and involve other joints, it is extremely important that an accurate diagnosis be made so your doctor can prescribe the appropriate treatment.
How Is Gout Treated?
There is no cure for gout, but it can be treated and controlled. Symptoms often are relieved within 24 hours after treatment has begun.
The type of treatment prescribed will depend on several factors, including the person's age, type of medications he or she is taking, overall health, medical history, and severity of gout attacks. Gout is mainly treated with anti-inflammatory drugs. These include:
- NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen or naproxen, are generally prescribed to treat sudden and severe gout attacks. They usually reduce inflammation and pain within hours.
- Corticosteroids (also called steroids), may be prescribed for people who cannot take NSAIDs. Steroids also work by decreasing inflammation. Steroids can be injected into the affected joint or given as pills.
- Colchicine is often used to treat gout and usually begins working within a few hours of taking it. This drug is used less often due to concerns about its side effects.
- Krystexxa (pegloticase) has been approved for adults with long-standing chronic gout who do not improve with or cannot tolerate other treatments. Krystexxa does have some side effects. A quarter of the patients who participated in the clinical trials experienced a severe allergic reaction to the new drug. The FDA recommends that health care providers provide patients a corticosteroid and an antihistamine to reduce the risk of an allergic reaction.