Arthritis: Gout

Gout is a form of arthritis (an inflammation of the joints) that causes sudden, severe attacks of pain, tenderness, redness, warmth and swelling (inflammation) in some joints. It usually affects one joint at a time.

The large toe is most often affected, but gout also can affect other joints in the leg (knee, ankle, and foot) and, less often, joints in the arm including the hand, wrist, fingers, and elbow. The spine is almost never affected.

What Are the Symptoms of Gout?

The symptoms of gout include:

• Sudden, intense joint pain, which often can wake a person from sleep.
• Swollen joint that is warm to touch.
• Red or purple skin around the joint.

If someone has gout on and off for years, eventually uric acid crystals may accumulate in the body to form gritty nodules called "tophi." These nodules can appear as lumps under the skin near joints such as the elbows and fingers, at the rim of the ears, or in the kidneys.

Uric acid comes from the natural breakdown of the genetic material in cells, RNA (ribonucleic acid) and DNA (deoxyribonucleic acid). Some foods contain large amounts of purines, especially red meats and organ meats (such as liver and kidneys), as well as some shellfish and anchovies. Purines are broken down to uric acid in the body.

Uric acid in normal amounts remains dissolved in the blood and easily passes through the kidneys, leaving the body as waste. However, uric acid in high amounts makes a person more likely to develop gout.

The amount of uric acid in your blood can change depending on what you eat, your overall health, how much alcohol you drink and what medicines you are taking, as well as in response to a sudden illness.

What Causes Gout?

Gout was once incorrectly thought to be a disease of the rich and famous, caused by consuming too much rich food and fine wine. Although diet and excessive drinking contribute to gout, they are not the main cause of the condition.

Gout results from abnormal deposits of uric acid crystals in the joint cartilage. The crystals are later released into the joint fluid.

Not everyone with high levels of uric acid will develop gout. The kidneys' ability to rid the body of uric acid is partly determined by heredity. Yet, just because someone in the family suffers from gout does not mean everyone in that family will have the disease. This risk varies from person to person.

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.