Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis

Gout is an abrupt and very painful form of arthritis. It usually affects only one joint at a time, typically the great toe, foot, ankle, knee, wrist, or elbows. Gout usually affects men older than 40 years. It is unusual in women until they have passed through menopause (the change of life). Gout “attacks” are caused by the release of “crystals” into a joint, resulting in inflammation, pain and swelling. These crystals are made of a substance in the blood called uric acid. In individuals with gout, either too much uric acid is made or not enough is eliminated by the kidney. Alcohol, aspirin, certain medicines, and rarely certain foods (liver and other organ meats, sardines, anchovies) may cause levels of uric acid to rise in individuals, making them more prone to developing gout. The only way to diagnose gout with certainty is to place a needle into the affected joint, remove the joint fluid and look for the gout crystals under a microscope.

Living With Your Diagnosis
Individuals who have an attack of gout notice rapidly developing pain, swelling, warmth, and redness in the affected joint. The pain can be so intense that even lightly touching the joint will cause severe pain. The pain is usually continuous and more painful if the joint is moved. Everyday activities such as walking, dressing, and lifting may be difficult. Attacks may occur at any time; however, certain events can trigger attacks such as injuries, surgery, an acute illness, or ingestion of alcoholic beverages. Once the attacks are treated, the symptoms usually resolve within hours to a few days. If attacks are not treated, they may last several days. In between attacks the symptoms resolve completely. Individuals with higher uric acid levels in their blood are more prone to recurring attacks. Persistently elevated uric acid levels for many years can cause deposits of uric acid in nodules under the skin. These are called “tophi.” Some individuals with gout are also prone to developing kidney stones.

There are two ways to approach the therapy for gout: treatment of attacks and prevention of attacks. Preventive treatment is necessary in individuals with tophi, kidney stones, and frequent attacks. Attacks of gout are usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin. Potential side effects of NSAIDs include stomach upset, ulcers, constipation, diarrhea, headaches, dizziness, difficulty hearing, and skin rash. Colchicine is another type of anti-inflammatory drug that is particularly effective early in the attack. Potential side effects of colchicine include stomach cramps, nausea, vomiting, and diarrhea. Occasionally, a more potent anti-inflammatory medicine such as prednisone, a cortisone-like medicine, is necessary. Potential side effects of cortisone like medicines are increased appetite, weight gain, difficulty sleeping, easy bruising, and stomach upset. Removal of the joint fluid from the affected joint, followed by a cortisone injection is another common treatment for gout. Cortisone injections usually provide the most rapid and complete relief of pain and swelling. Aside from the discomfort of the injection, there are very few side effects from cortisone injections. Prevention of gouty attacks is accomplished by lowering uric acid levels. Two common medicines that lower uric acid levels are allopurinol and probenecid. The specific medicine your doctor chooses will depend upon other medicines you are taking and other medical conditions you have. The most common side effects of allopurinol and probenecid are skin rash and upset stomach.

The DOs
• Rest the affected joint until the symptoms begin to improve.
• Take your medicines as prescribed.
• Ask your doctor which over-the-counter medications you may take with your prescription medications.
• Follow your doctor’s advice by limiting your use of alcoholic beverages and avoiding certain foods or medications.

The DON’Ts
• Don't wait to see if side effects from the medications will go away.

When to Call Your Doctor
• You experience any medication side effects.
• The treatment is not decreasing your symptoms in a reasonable amount of time.
• You begin to lose more movement in the affected joint.
• You experience worsening warmth, redness, or pain after a cortisone injection.