What is Gout?

Gout has been described as the most painful type of inflammatory arthritis.  It is characterized by sudden, severe attacks of intense pain, swelling, and tenderness in one joint.  This type of arthritis (sometimes called metabolic arthritis) results from an excess of uric acid in the body.  A build up of uric acid in the blood is called hyperuricemia.  Not all people with hyperuricemia develop gout.  It is when uric acid crystals begin to form that a painful gout attack can strike. Fortunately, gout attacks can be controlled or prevented by simple changes to lifestyle and the use of certain medications.

Signs and Symptoms

Gout often affects the large joint in the big toe, but it can also occur in the ankle, knee, foot, hand, wrist, and elbow.  The joints of the lower limbs are more commonly affected than those of the upper limbs. The signs and symptoms almost always occur suddenly, often at night, and without any warning.  Unexpected intense pain in the affected joint is usually the first sign of gout.  Other signs include swelling, redness, warmth and stiffness in one location. Some people also experience a fever as part of a gout attack.  Often, people who develop gout will do so during the night while sleeping, with no signs or symptoms of an attack before going to bed.  The pain of gout can be intolerable.  The swelling can feel as if the affected joint is on fire.  Many people have described the onset of gout as an excruciating experience.  More than half of the people who have had an acute attack of gout will have a recurrence within the year.  As time passes, attacks can become more frequent, longer lasting, and can involve more joints than affected in the initial gout attack.

Kidney stones and tophi are two of the most common long-term effects of gout.  People with gout have high levels of uric acid in their bodies.  This excess uric acid can form into crystals when it has no place to go inside the body.  Uric acid crystals can collect in the urinary tract of people who suffer from gout and cause kidney stones to develop.  Doctors can prescribe medication to assist in reducing the risk of kidney stones.  Tophi occurs when deposits of uric acid crystals form under the skin over time.  These deposits in soft tissue appear as whitish or yellowish nodules and can become swollen and tender to the touch during recurrent flares of gout.  Tophi can lead to destruction of the joint, persistent pain, and has even been linked to carpal tunnel syndrome.  A long-term treatment plan is necessary in order to maintain control of gout and its impacts on overall health.

Medications for Pain Relief and Treatment of Inflammation

Relieving the pain of a gout attack when it comes is the first thing on the mind of every person who suffers from this condition.  The pain can be excruciating and needs to be dealt with immediately for most people.  Over the counter anti-inflammatory drugs and analgesic painkillers such as Aleve® (Naproxen) and Ultram® (Tramadol) are medications that can be used without a doctor’s prescription.  Nonsteroidal anti-inflammatory drugs (NSAIDs), specifically indomethacin, are commonly the first medication prescribed by doctors to treat acute gout. Other NSAIDS such as Mobic® (Meloxicam), Naprelan® (Naproxen Sodium), and Naprosyn® (Naproxen) can be equally effective. NSAIDs are initially prescribed at maximum dosage and reduced as symptoms subside. NSAIDs which are COX-2 inhibitors, such as Celebrex®, may be useful for patients with gastrointestinal concerns.  Corticosteroids such as prednisone and deflazacort can be used for patients who cannot take NSAIDs.  

Medications for Controlling Uric Acid Levels

Allopurinol (brand name - Zyloprim) is prescribed for chronic gout and works by affecting the system that manufactures uric acid in the body. It is used to prevent gout attacks, not to treat them once they occur.

Probenecid (brand names - Benemid, Probalan) is prescribed for chronic gout.  It is used to prevent attacks related to gout, not treat them once they occur. It acts on the kidneys to help the body eliminate uric acid. Probenecid is known as a uricosuric agent.

Losartan, (brand names - Cozaar and Hyzaar), is not specifically a gout medication but is an angiotensin II receptor antagonist, antihypertensive drug that may help control uric acid levels. Fenofibrate, (brand name - Tricor), is not a specific gout medication but it is a lipid-lowering drug that may also help control uric acid levels.