What is Gout?

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Gout is caused by uric acid crystals deposition in the joints leading to episodic flares of severe disabling joint pain along with marked swelling, redness and warmth. A typical gout flare or attack in big toe is called 'Podagra'. Uric acid crystals are formed in the joint due to super saturation of blood with uric acid that occurs due to variety of other reasons such as kidney problems, certain medications as well as certain genetic factors. It occurs more commonly in male and multiple family members can have gout in one family. 

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What are the symptoms?

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A typical gout flare is sudden onset, rapidly progressive, intense pain in one or more joints along with significant swelling, warmth and sometimes redness.  Commonly, it occurs in toe joints (specifically big toes), ankles, finger joints, wrists, knees and elbows. 

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If someone has untreated gout for some time, he or she can have gout tophi formation which are uric acid deposits under the skin (chalky white material). Tophi are commonly seen at fingers, toes, elbows, knees and Achilles tendons.

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Untreated long-term gout can lead to joint erosions, damage and destruction of the joint as well near by bones. 

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How is it diagnosed?

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Typically, gout is diagnosed when joint fluid is aspirated from the joint and the fluid shows uric acid crystals (needle shaped yellow or blue colored) under the microscope (a special kind of microscope called polarized microscope). Sometimes, typical symptoms are enough to make a diagnosis in an appropriate situation. Blood uric acid levels can also help make the diagnosis.

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How is it treated?

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Gout treatment involves treatment of ongoing gout attack (or flare) as well as prevention of future gout flares and progression of joint damage.

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Staying hydrated and maintaining healthy lifestyle (such as weight loss) play a big role in overall gout control. Some evidence suggests limiting certain trigger foods (such as red meat, shellfish, fructose rich products like sodas) as well as alcohol products such as beer can reduce risk of flares. 

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Medications such as allopurinol and febuxostat are needed for long term control of gout. Colchicine, non-steroidal anti-inflammatory medications and steroids can be used to treat ongoing acute gout flare. 

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Many gout patients are untreated or under treated for a long time which can be a reason for recurrent and unexpected disabling flares as well as progressive joint damage. Timely and effective treatment by a specialist can stop any such complications. 

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