Gout

Gout, the most prevalent type of inflammatory arthritis, impacts over 9 million Americans. It arises from an inflammatory reaction to monosodium urate (MSU) crystals, which form due to elevated uric acid levels in the blood, a condition known as hyperuricemia.

Excess uric acid can crystallize into needle-like structures that settle in joints, causing sudden and severe joint pain. This often affects the big toe—a condition known as podagra—but can also impact other joints such as the toes, ankles, knees, elbows, wrists, and fingers.

Gout is more common in men, but post-menopausal women are equally affected due to the loss of estrogen’s protective effects. Several factors contribute to gout, including genetics, reduced kidney function, aging, other health conditions (such as psoriasis, cancer, obesity, and high blood pressure), and diet. Foods high in purines, like alcohol, red meat, organ meats, and shellfish, can trigger gout because purines break down into uric acid. Certain medications, like diuretics, can also precipitate gout. Other triggers include infections, severe illnesses, recent surgeries, and joint trauma.

A diagnosis of gout involves a detailed medical history and physical examination by a rheumatologist. Blood tests measuring serum uric acid (sUA) levels can confirm hyperuricemia. Imaging techniques like x-rays, musculoskeletal ultrasound, and dual-energy CT (DECT) scans can identify gout deposits (tophi) and joint damage. Additionally, examining joint fluid under a microscope can reveal the characteristic crystals.

Gout can be effectively managed. Discussing the best treatment plan with your healthcare provider is crucial, considering the frequency and severity of your symptoms and personal preferences.

Treatment options include:

• Lifestyle modifications: Adopting a low-purine diet, exercising regularly, and losing weight can naturally reduce uric acid levels.
• Anti-inflammatory medications: These include non-steroidal anti-inflammatory drugs (NSAIDs like ibuprofen or naproxen), colchicine, and corticosteroids (like prednisone).
• Urate-lowering therapies: Medications such as allopurinol, febuxostat, probenecid, and pegloticase lower uric acid levels in the blood.
• A treat-to-target approach is often used, aiming to reduce serum uric acid levels to below 6 mg/dL, or even 2-3 mg/dL in cases with significant tophi. With proper treatment, patients may never experience another gout attack, and existing tophi can resolve completely.

If you suspect you have gout, consult with the providers at ASC to discuss your symptoms. With appropriate care, gout doesn’t have to be a persistent issue.