Symptoms of Gout: Acute and Chronic
Gout is a type of joint disorder or arthritis marked by the deposition of uric acid crystals in the joint. These crystals accumulate as a result of increased blood levels of uric acid coming from a high protein diet and a decrease in the ability of the kidneys to excrete the excess amounts.
Symptoms of gout include episodic attacks of pain and inflammation of joints commonly involving the large toe, the ankle, knees and fingers. The skin over the inflamed joint is usually red and shiny. Initial gout attacks usually occur at night and may last for several days to weeks. These may be followed by pain-free periods between attacks.
People who have other conditions like a disorder in metabolism or excretion, and those who have family histories of gout may have a chronic elevation in uric acid (hyperuricemia). Symptoms of gout may not be present all the time, but episodic attacks occur when triggered by high protein intake and joint injury. They may also have joint deformations due to the crystal deposition which then form into tophi.
Treatment Options for Gout
A rheumatologist is the ideal medical specialist who can properly evaluate and recommend treatment for gout. Confirmation of the diagnosis is essential since other types of arthritis may need different approaches in treatment.
Acute gout pain may be treated initially with potent nonsteroidal anti-inflammatory drugs (NSAIDs) like:
- Indomethacin (Indocin) – given in high doses for two to seven days; first choice of treatment in patients without kidney, liver or heart disease
- Ibuprofen (Motrin IB, Advil,)
- Naproxen (Aleve)
- Ketoprofen (Actron, Orudis KT)
- Diclofenac (Voltaren)
- Tolmetin (Tolectin)
Care should be taken when taking NSAIDs for long periods of time especially in the elderly who have reduced kidney and liver functions. Side effects and risk for complications include gastrointestinal bleeding, headache, tinnitus, skin rash and more. For these reasons, a drug called Arthrotec which is a combination of an ulcer-protective drug called misoprostol and the NSAID diclofenac may be used as an alternative.
Other medications that may be used for acute gout attacks are:
- Colchicine – highly effective and may be taken 48 hours of an attack; however, this drug has many serious adverse reactions including gastrointestinal, blood, nerve and muscle injuries. It must be avoided in elderly patients and in those with poor renal and liver functions.
- Corticosteroids like triamcinolone and prednisone are beneficial for elderly people and in those who cannot tolerate other drugs. These are especially effective for patients who have gout symptoms in multiple joints. Still, care must be taken because these can also have side effects like gastrointestinal bleeding and hypertension when taken chronically.
People with chronic elevations in uric acid levels may need additional drugs to reduce these levels and prevent acute gout attack. These are:
- Probenecid (Benemid, Probalan) and sulfinpyrazone (Anturane) help the kidneys eliminate uric acid but should only be taken by those with good renal function. Side effects include skin rashes, gastrointestinal problems, anemia and kidney stone formation. To avoid these, patients must ensure adequate fluid intake and proper dosage intake.
- Allopurinol (Lopurin, Zyloprim) and febuxostat (Uloric) normalize blood uric acid levels by blocking its production. These are often used at a long term basis especially in the elderly who are prone to produce uric acid in excess. Side effects like headaches, rashes, diarrhea and fever may be experienced.
- Low dose colchicines may be given to reduce symptoms of gout flare-ups.
In general, treatment of gout involves the avoidance of gout triggers like high purine diet, alcohol intake and joint injury. Lifestyle changes like weight reduction and diet restriction are also indicated. Most importantly, medical supervision is necessary for the proper use of drugs which may have serious side effects.
American College of Rheumatology, “Gout”, https://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gout.pdf
UMMC, “Gout – Treatment”, https://www.umm.edu/patiented/articles/what_general_guidelines_treating_gout_000093_7.htm