The most common cause of inflammatory arthritis, gout was historically known as ‘the disease of lords and lord of diseases’ because of its predilection to afflict the wealthy with access to rich meat and wine. However, we know now that gout is really an inherited disease and runs in families.
Gout occurs because of the body’s inability to adequately get rid of excess uric acid. When it builds in the soft tissues over time, it leads to ‘joint attacks’ that tend to increase in intensity and frequency over time.
Symptoms and Course of Disease:
Patients often describe a gout attack as ‘the worst pain’ they’ve ever felt.
Early attacks may start while the patient is sleeping and can often target the great toe.
The joint becomes hot, swollen, red, and very tender.
The attack can be so painful that the patient cannot even bear the bedsheet touching the toe.
If the attack is not ‘broken’ or ablated during the first 12-24 hours, often it will run its entire course over 5-10 days before resolving spontaneously.
It may then return after a number of weeks or months.
Importance of Treatment:
Gout is often undertreated, even mismanaged for years, often leading to irreversible joint damage and other complications of hyperuricemia (excess uric acid in the blood), which may include kidney damage, risk of increased heart attacks and strokes, and uric acid crystal deposition (tophi) in the skin and soft tissues around joints.
In most cases, gout is a highly treatable condition with medications that have little to no side effects in most patients. Treatment target is to lower uric acid below a serum concentration of 6.0 mg/dl or more, depending on the patient’s clinical situation.
However, it is important to note that high uric acid levels without any symptoms rarely need treatment. Please ask your rheumatologist if you have any questions regarding this.