Dr. Simeon Margolis
Gout: More Common in Men
by Simeon Margolis
Intense pain, tenderness, redness, and swelling of the great toe are the most common first symptoms of gout. You may have seen images in movies and elsewhere of a well-dressed older man sitting in an arm-chair with a bandage-swathed foot resting on a stool — nursing a case of gout. The depiction is partly correct. Gout affects both men and women but it's almost two times more common among men–and the disorder grows more frequent with advancing age. Once known as a rich man's disease, however, gout is recognized to affect people from all walks of life. Gout is becoming more common and is estimated to affect about 6 million adults in the U.S. at some point in their lifetimes.
Excess uric acid causes joint pain, kidney disease, and kidney stones
Uric acid is a normal product of body metabolism that is transported in the blood for excretion in the urine. Gout occurs most often when blood levels of uric acid become elevated (hyperuricemia). But not all people with high blood uric acid levels suffer from gout. Hyperuricemia results from inadequate excretion of uric acid in 90% of cases and from its overproduction in 10%. While factors such as a diet and alcohol consumption can probably raise uric acid levels, they are not thought to trigger an acute attack; the true cause of an attack is not known.
It's when deposits of uric acid crystals form within joints that the inflammation and pain occur. Besides the big toe, other joints that can be affected are the knees, wrists, and fingers. In addition to its acute ill effects in joints, uric acid can cause kidney stones, kidney damage, and hard deposits in the skin and joints, called tophi. Extensive tophi in joints can lead to chronic arthritis.
Treatment of acute joint pain
Prompt treatment of acute gouty arthritis usually brings pain relief within a day. NSAIDs, such as naproxen or indomethacin (but not aspirin), should be continued for two weeks. If these drugs are not tolerated or are ineffective, other options are prescription drugs. These include colchicine or glucocorticoids by mouth or injected into the affected joint.
Prevention of further attacks
Preventive measures are critical because the majority of untreated patients will suffer a second attack within two years. Useful lifestyle measures include weight loss and limiting consumption of alcohol, fructose-sweetened drinks, meat and seafood. After a second attack, however, medications are prescribed either to increase uric acid excretion in the urine (probenecid or sulfinpyrazone) or to inhibit the enzyme that makes uric acid (allopurinol or febuxostat). Lowering uric acid levels may also slow kidney disease and tophi formation. Since new joint attacks occur if the drugs are stopped, they must be taken continuously and for a long time.
Other risks of gout
Since gout increases the likelihood of hypertension, diabetes, and cardiovascular disease, people with gout need to be especially careful to follow lifestyle measures and medications to prevent and/or control these disorders.