Gout

Gout is a painful, recurrent disorder characterized by deposition of crystals in the joint fluid as well as other tissues. The crystals that deposit are called monosodium urate and occur when the level of urate in the blood exceed the level at which urate can remain dissolved in the blood. Approximately 4% of United States adults suffer from gout. Risk factors for gout include older age, obesity, elevated urate levels, consumption of alcohol or high fructose corn syrup (found in sweetened drinks such as soda), diet rich in certain animal products (such as red meat and shellfish), and certain medication (such as thiazide diuretics). Males tend to be affected more than females and there seems to be a genetic predisposition. Gout flares are episodic acute severely painful events that progress rapidly. The joint is typically, swollen, red and extremely sensitive to touch (even the weight of the bedsheet on the joint can be intolerable). Nearly any joint can be involved however the base of the big toe is the most commonly involved. Gout can also involve areas outside of the joint such as the bursa or tendons (known as tophi). Diagnosis of gout requires a thorough history and physical exam. The first episode typically requires sampling of the joint fluid to ensure absence of infection and visualize the crystals under microscope. X-Ray and basic blood tests can be helpful but may be uninterpretable in the setting of an acute gout attack. In between gout flares, the goal of treatment is to reduce the risk of gout by reducing dietary factors contributing to gout and in some cases medications to reduce urate levels. During an acute gout flare, treatment revolves around reducing inflammation and pain. Medications such as colchicine can be helpful if within the first 48 hours. Otherwise, non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen can be helpful. Some patients may require oral steroids and some patients may require steroid injections into the affected joint.

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Reference:
Neogi T. In The Clinic: Gout. Ann Intern Med. 2016. Jul 5; 165 (1)