Joint pain and swelling in the big toe or elsewhere that comes on suddenly and for no apparent reason may not seem like a big deal if they last for only a few days and happen only every few months. But such symptoms are actually a good reason to see a doctor, because they may come from a form of arthritis called gout, which requires medical treatment to keep it from getting worse.

What is Gout?

Gout is an inflammatory disease that results from uric acid deposits in the joints and surrounding tissues. Uric acid is formed from the breakdown of purines, which are substances found in all human tissues and in many foods. Normally, it dissolves in the blood and passes through the kidneys and out of the body in the form of urine. But uric acid builds up in the blood of people with gout, because either their body is making too much uric acid or their kidneys are not eliminating enough of it. In this condition, called hyperuricemia (hi-per-yur-eh-SEE-me-ah), the uric acid forms sharp crystals that collect in the joints and in tissues around the joints. The crystals also sometimes build up in the kidneys, causing kidney stones. Hyperuricemia, which occurs more often in men than in women and most often in middle age, may run in families.

Other situations that may contribute to gout include having high blood pressure, diabetes, or high cholesterol levels; being overweight; abusing alcohol (especially beer and red wine); using certain drugs (particularly diuretics, or "water pills," and aspirin); and eating foods high in purines. Such foods include liver, dried beans, peas, anchovies, herring, mackerel, and meat gravies.

Most of the time, gout first causes pain in the big toe, but it can also affect the instep of the foot, heels, ankles, knees, wrists, fingers, and elbows. Gout can be extremely painful, causing joints to swell and become warm and tender.

Attacks of gout usually come on suddenly, typically at night after a stressful day, alcohol or drug use, or another illness. In the early stages of gout, attacks may occur every few months or years and last 3 to 10 days, but in the later stages, attacks usually occur more often and last longer. If left untreated over years, the disease can cause permanent damage to joints and kidneys.

How is Gout Diagnosed?

Because its symptoms are usually vague, gout can be difficult to diagnose. The doctor may insert a needle into the affected joint to get a sample of the fluid that lubricates the joint. A laboratory test may reveal uric acid crystals in the joint fluid. High levels of uric acid may be detected in the urine or blood. Uric acid deposits are sometimes visible as bumps under the skin and around the joints and the rim of the ear.

Occasionally, gout is confused with a condition called pseudogout, which causes many of the same symptoms as gout. However, pseudogout is caused by the collection of crystals of pyrophosphate dihydrate rather than uric acid. Testing the joint fluid can help the doctor tell which condition is involved.

How is Gout Treated?

Treatment is very important, not only to relieve the pain of gout but also to prevent future attacks and the formation of kidney stones. To treat an attack, doctors sometimes recommend use of a nonsteroidal antiinflammatory drug, such as ibuprofen (for example, Advil). A corticosteroid may be prescribed to be taken by mouth, or the doctor may inject it directly into the affected joint. If these drugs don't work, a drug called colchicine may help.

To help prevent future attacks, daily treatment with allopurinol or probenecid may be prescribed. People with gout need to drink lots of water to remove uric acid from the body. It also helps to exercise regularly, maintain a healthy body weight, and stay away from alcohol and foods high in purine.

In advanced cases of gout, in which the buildup of uric acid crystals is severe, surgery may be considered to remove the crystals and repair the joint. Fortunately, early treatment usually can prevent the condition from progressing to this stage.

For More Information On Gout:

American College of Rheumatology
1800 Century Pl,
Suite 250
Atlanta, GA 30345

Arthritis Foundation
PO Box 7669 Atlanta,
GA 30357

Making the Acetaminophen Antidote More Palatable

“The mainstay of therapy for acetaminophen (over-the-counter pain and fever reducer such as Tylenol) poisoning is administration of acetylcysteine (nutritional supplement that clears mucus), which can pose problems. Acetylcysteine smells like rotten eggs, and swallowing it can be a challenge. We have found that the oral solution can be made more palatable by diluting it to 5% with soda or juice. Other ways to improve palatability include diluting the solution even more, changing the diluent, chilling the solution, sipping slowly, using a straw, and drinking from a covered container.” - Anup Dev T. Salgia, DO, and Shawn David Kosnik, DO. Camp Lejeune, North Carolina