Gout is a form of acute arthritis that causes severe pain and swelling in the joints. It most commonly affects the big toe, but may also affect the heel, ankle, hand, wrist, or elbow. It affects the spine often enough to be a factor in back pain. Gout usually comes on suddenly, goes away after 5-10 days, and can keep recurring. Gout is different from other forms of arthritis because it occurs when there are high levels of uric acid circulating in the blood, which can cause urate crystals to settle in the tissues of the joints.
Symptoms of gout usually strike unexpectedly. They typically do not last more than 10 days but may recur. Although less common, some patients may have chronic pain due to gout.
Symptoms of a gout attack may include:
Sudden, intense pain in a joint, typically the big toe or ankle, sometimes the knee, hand or wrist
Swelling, inflammation and a feeling that the joint is very hot
Extreme tenderness of the joint to even the lightest touch
Red or purple skin around the joint
In extreme cases alternating chills and fever
With recurring attacks soft fleshy growths may appear, called tophi, which are accumulations of uric acid crystals.
Over time gout attacks may occur more frequently, involve more joints, have more severe symptoms and last longer. Repeat attacks are common if the body's uric acid level is not kept under control.
Gout is caused initially by an excess of uric acid in the blood, or hyperuricemia. Uric acid is produced in the body during the breakdown of purines - chemical compounds that are found in high amounts in certain foods such as meat, poultry, and seafood.
Normally, uric acid is dissolved in the blood and is excreted from the body in urine via the kidneys. If too much uric acid is produced, or not enough is excreted, it can build up and form needle-like crystals that trigger inflammation and pain in the joints and surrounding tissue.
The majority of gout cases are treated with medication. Medication can be used to treat the symptoms of gout attacks, prevent future flares, and reduce the risk of gout complications such as kidney stones and the development of tophi.
Commonly used medications include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids. These reduce inflammation and pain in the areas affected by gout and are usually taken orally.
Medications can also be used to either reduce the production of uric acid (xanthine oxidase inhibitors such as allopurinol) or improve the kidney's ability to remove uric acid from the body (probenecid).
Without treatment, an acute gout attack will be at its worst between 12 and 24 hours after it began. A person can expect to recover within 1 to 2 weeks without treatment.