Gout (Gounty Arthritis, Crystal Arthritis)
Gout is a type of arthritis that can cause an attack of sudden burning pain, stiffness and swelling in a joint (usually a big toe). These attacks can occur over and over unless it is treated. They can harm your joints, tendons, and other tissues over time. This condition is most common in men.
What causes gout?
Gout occurs when there is too much uric acid in the blood. Having too much uric acid isn’t harmful most of the time. Many people with high levels of uric acid in their blood never get gout. However, when uric acid levels in your blood are too high, uric acid may form hard crystals in your joints.
If you are overweight, drink too much alcohol or eat too much meat and fish that are high in chemicals called purines, your risk of getting gout is higher. Some medicines such as water pills (diuretics) may also bring on gout.
What are risk factors for gout?
Gout is more common after:
Certain medications such as diuretics (water pills) can raise the level of uric acid in the bloodstream. Some medications that lower the level of uric acid in the bloodstream such as allopurinol (Zyloprim, Aloprim) may initially cause a flare of gout. The reason is that raises or lowers the uric acid level can cause a gout flare by causing uric acid crystals to deposit in a joint.
SYMPTOMS OF GOUT (GOUNTY ARTHRITIS, CRYSTAL ARTHRITIS)
- Podagra: Warmth, pain, swelling, and extreme tenderness in a joint (usually a big toe joint). This symptom is called. It may worsen quickly and last for hours. It could be so intense that even light pressure from a sheet is intolerable
- Very red or purplish skin: Around the affected joint and may appear to be infected
- Limited movement: In the affected joint
- Peeling and itching: The skin around the affected joint as the gout gets better
TREATMENT OPTIONS AVAILABLE FOR GOUT (GOUNTY ARTHRITIS, CRYSTAL ARTHRITIS)
Treatment usually involves medications. The type of medication prescribed will be based on your current health and your own preferences.
Acute attacks and prevention of future attacks as well as reducing your risk of complications from gout can be treated with medications such as the development of tophi from urate crystal deposits.
Medications to treat gout
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others) as well as more-powerful prescription such as indomethacin (Indocin) or celecoxib (Celebrex) may be prescribed. A higher dose may be needed to stop an acute attack followed by a lower daily dose to prevent future attacks. Side effects may include stomach pain, bleeding and ulcers.
- Colchicine: Colchicine (Colcrys, Mitigare), a type of pain reliever that effectively reduces gout pain may be recommended. The effectiveness is offset in most cases. However, with intolerable side effects such as nausea, vomiting and diarrhea. Your doctor may prescribe a low daily dose of colchicine to prevent future attacks after an acute gout attack resolves.
- Corticosteroids: Corticosteroid (prednisone) may control gout inflammation and pain. They may be administered in pill form or injected into your joint. They are generally reserved for people who can’t tolerate NSAIDs or colchicine. Side effects may include mood changes, increased blood sugar levels and elevated blood pressure.
Medications to prevent gout complications
Your doctor may recommend medication to reduce your risk of gout-related complications if you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful. The options include:
- Medications that block uric acid production: Xanthine oxidase inhibitors including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) work to limit the amount of uric acid your body makes. This may lower your blood’s uric acid level and reduce your risk. Allopurinol side effects include a rash and low blood counts. Febuxostat side effects include rash, nausea and reduce d liver function.
- Medication that improves uric acid removal: Probenecid (Probalan) improves your kidneys’ ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.
If symptoms have occurred off and on with no treatment for more than 10 years, uric acid crystals may have built up in the joints to form gritty, chalky nodules called tophi.
Your doctor may be able to treat them with medicine if tophi are causing infection, pain, pressure, and deformed joints. If it doesn’t work, your doctor may recommend surgery to remove them.
- Joint fluid test: A needle to draw fluid from your affected joint. Your joint fluid may reveal urate crystals when examined under the microscope.
- Blood test: A blood test may be recommended to measure the levels of uric acid and creatinine in your blood. However, results can be misleading. Some people with high uric acid levels never experience gout. While, some people have signs and symptoms of gout but don’t have unusual levels of uric acid.
- X-ray imaging: Can be helpful to rule out other causes of joint inflammation.
- Musculoskeletal Ultrasound: Detect urate crystals in a joint or in a tophus.
- Dual Energy CT scan: Detect the presence of urate crystals in a joint even when it is not acutely inflamed. This technique is not used routinely in clinical practice due to the expense and is not widely available.