What Is Gout? What Causes Gout?

The word gout comes from Latin gutta and old French gote meaning "a drop". Several hundred years ago gout was thought to be caused by drops of viscous humors that seeped from blood into the joints. In fact, this supposition was not that far from the truth. When a patient experiences the symptoms of a gout attack uric acid has been accumulating in his blood, and uric acid deposits have been forming in the joints. 

Gout is a complex disorder, it is more prevalent among men, and afflicts women more commonly after the menopause. Men have higher uric acid levels in their blood than women.

In 2011, the American College of Rheumatology announced that 8 million Americans have gout - nearly 6% of men and 2% of women.

According to Medilexicon's medical dictionary, Gout is:

"A disorder of purine metabolism, occurring especially in men, characterized by a raised but variable blood uric acid level and severe recurrent acute arthritis of sudden onset resulting from deposition of crystals of sodium urate in connective tissues and articular cartilage; most cases are inherited, resulting from a variety of abnormalities of purine metabolism.

The familial aggregation is for the most part galtonian with a threshold of expression determined by the solubility of uric acid. However, gout is also a feature of the Lesch-Nyhan syndrome, an X-linked disorder [MIM*308000]."

What are the symptoms of gout?

Signs and symptoms of gout are generally acute - they come on suddenly without warning. A significant proportion of patients experience them at night.

• Severe pain in the joints - The patient may experience pain in his ankles, hands, wrists, knees or feet. More commonly the big toe is affected (podagra). Many patients describe the affected areas as warm/hot. The fluid sacs that cushion tissue (bursae) may become inflamed (bursitis) - when this happens in the elbow it is called olcranon bursitis, while in the knee prepatellar bursitis.


• Gradually goes away - A bout can last for over a week if left untreated - and then gradually goes away during the following week or two.


• Itchy and peeling skin later - As the gout subsides the skin around the affected area may be itchy and peel. By the end of it the patient feels fine.


• Redness and inflammation - The sufferer will most likely have tender, red and swollen joint(s) in the areas that experienced the most pain.


• Red/purplish skin - The affected area may become red or purplish, making the patient think he has an infection.


• Fever - Some patients have an elevated temperature.


• Less flexibility - The affected joint may be harder to use, the patient has limited movement.


• No symptoms - Some patients experience no symptoms. In these cases it may develop into chronic gout.


• Nodules - The gout may first appear as tophi (nodules) in the elbows, hands, or ears.

Gout presenting in the metatarsal-phalangeal joint of the big toe

What causes gout?

The levels of uric acid in your blood rise until the level becomes excessive (hyperuricemia), causing urate crystals to build up around the joints. This causes inflammation and severe pain when a gout attack happens. 

When the human body breaks down chemicals called purines it produces uric acid. Purines can be found naturally in your body, as well as in food, such as organ meats, anchovies, asparagus, mushrooms and herring. 

Most of the time uric acid dissolves and goes into the urine via the kidneys. However, if the body is producing too much uric acid, or if the kidneys are not excreting enough uric acid, it builds up. The accumulation results in sharp urate crystals which look like needles. They accumulate in the joints or surrounding tissue and cause pain, inflammation and swelling. 

Surprisingly, hyperuricemia is commonly found in many people who never develop gout. Scientists are not completely sure what causes hyperuricemia. There is definitely a genetic factor because a person who has close relatives with hyperuricemia is more likely to develop it himself. 

The following have been known to bring about a gout attack and may be contributory causes of gout:

• obesity
• heavy alcohol consumption, especially beer
• a diet high in purine foods, such as seafood and meat, and meat organs
• extremely low calorie diets
• regular aspirin use
• regular niacin use
• drinks high in fructose linked to gout risk - females who regularly consume beverages with a high fructose content are 74% more likely to develop gout, compared to women who consume such drinks no more than once a month, researchers from Boston University School of Medicine reported in JAMA (November 2010 issue).
• regular use of diuretic medicines
• medicines taken by transplant patients, such as cyclosporine
• fast weight loss
• chronic kidney disease
• hypertension (high blood pressure)
• psoriasis
• tumors
• myeloma
• hemolytic anemia
• lead poisoning
• hypothyroidism
• surgery
• Kelley-Seegmiller syndrome
• Lesch-Nyhan syndrome

When should you see a doctor?

If you have a sudden and intense pain in a joint get in touch with your doctor. If you do not treat it, the gout can gradually get worse over time. If you also have a temperature, and the joint is hot and/or inflamed, get medical attention as soon as possible - it could mean you have an infection.

How to test for gout?

After examining you, your doctor may carry our either or both these tests:

• Blood test - to measure your levels of uric acid. This test is not definitive as some people with high uric acid levels never have gout symptoms; while others who have gout symptoms do not have high levels of uric acid in their blood.
• Joint fluid test - a needle is used to collect fluid from the affected joint. The liquid is then examined under a microscope to see whether urate crystals are present.

What are the complications of gout?

Gout does not commonly cause any further problems. However, some are possible:

• Recurrent gout - while some people just get one attack, and never experience another one again, others may have recurrent attacks. There are drugs which help reduce the number of recurrent attacks, or even eliminate them.
• Advanced gout - If the gout is not treated urate crystals may form under the skin in nodules, they are known as tophi. They may become swollen and tender whenever the patient has a gout attack, but are not painful otherwise.
• Kidney stones - Urate crystals can accumulate in the urinary tract of a patient who suffers from gout. This causes kidneys stones. There are drugs which can lower the chances of developing kidney stones.
• Damage to joints - if the tophi (nodules) become inflamed the joints could become damaged.
• Gout might spread - The gout could spread to other joints.

Treatments for Gout

1) Medication

Gout is usually treated with medications, these include:

• NSAIDs (nonsteroidal anti-inflammatory drugs) - these help combat inflammation and pain. Ibuprofen and naproxen are NSAIDs. There is an increased risk of stomach pain, ulcers and bleeding for some patients who take this drug - the higher the dosage, the higher the risk.
• Colchicine - an effective drug for gout. However, a number of patients might experience diarrhea, vomiting and/or nausea. Colchicine is often given to patients who are unable to take NSAIDs.
• Steroids - these may help combat inflammation and relieve pain. The patient may receive the medication orally or it could be injected right into the joint. Some patients who take steroids may experience a thinning of bones, poor wound healing, while others find that their immune systems become weaker and it is harder to fight off infections. Steroids are usually given to patients who are unable to take either colchicines or NSAIDs.
• Uloric (febuxostat), a drug that lowers levels of uric acid in the blood, was approved by the US FDA in February 2009, for the treatment of hyperuricemia and chronic gout.

2) Self Help

These measures may help ease the pain and swelling:

• Raise and rest your limb.
• Some people use a splint to immobilize the joint.
• Do not do vigorous exercise.
• Keep the joint cool, apply an ice pack or bag of frozen vegetables wrapped in a towel. Do not apply directly to your skin without a towel as this could damage your skin. Allow the temperature of the affected area to return to normal before repeating this.
• Do not cover the joint.

How to prevent gout

1) Medications

There are some medicines which can reduce your risk of future gout attacks. These are usually taken after an attack is over:

• Reducing the production of uric acid - Allupurinol reduces the amount of uric acid your body produces, which in turn lowers your chances of having an attack recurrence. Some patients who take this medication may have a rash, and/or a low blood count.
• Removing uric acid more effectively - Probenecid helps your kidneys eliminate uric acid more effectively, thus lowering your blood uric acid levels, which in turn reduces your chances of recurrence of an attack. Some patients may develop a rash when taking this medication, while others may have stomach pains, and a very small number may develop kidney stones.

2) Nutrition

Although diets have not been proven to reduce a person's risk of gout, this is due to a lack of studies rather than the existence of studies that prove diet is ineffective. It would make sense not to consume too many foods that are high in purines, such as red meat, meat organs, and seafood. Reducing your consumption of alcoholic drinks may also be beneficial. Some people suggest you should consume more low-fat dairy products, while others mention a good intake of whole-grain breads is beneficial. If you drink plenty of water you might dilute the amount of uric acid in your blood, some say. 

A study published in September 2012, in the journal Arthritis & Rheumatism, suggested that eating cherries could reduce the risk of gout attacks by 35%.