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How Do I Know If I Have Gout?

Because other diseases may masquerade as gout, it is important to see a doctor for any kind of joint pain.

Blood and urine tests may or may not be useful. You can have a high level of uric acid without having gout, or you may have normal uric acid levels at the time of a gout attack. To confirm the presence of uric acid crystals, the doctor often has to draw fluid from the affected joint and look for uric acid crystals in the laboratory. X-rays are not particularly helpful for confirming a diagnosis of gout.

What Are the Treatments?

Anyone who experiences a gout attack quickly realizes that the first order of business is to ease the pain. Clothing or other covering only aggravates the discomfort of the swollen, sensitive joint. Most doctors advise keeping the foot or affected joint bare, even when sleeping. The next stage of treatment is usually a painkiller, typically a nonsteroidal anti-inflammatory drug (NSAID).

Controlling gout means lowering the amount of uric acid in the blood.

The immediate symptoms of gout will usually disappear in a few days or a week. Nonetheless, each instance of suspected gout should be diagnosed and treated by a doctor. Left untreated, uric acid deposits can eventually cause irreversible damage to the kidneys and other tissues.

For a gout attack, many doctors recommend oral doses of ibuprofen or naproxen, available in both prescription and nonprescription versions, or other anti-inflammatory drugs. If you are taking aspirin, your doctor may recommend that you stop it temporarily. Aspirin can slow the elimination of uric acid and make gout worse. But if you take a low dose of aspirin to prevent other problems, check with your doctor before stopping it.

Corticosteroid medications or injections — or simply steroids — in the affected joint may be helpful in reducing pain and inflammation in severe attacks or chronic cases. However, steroids can have undesirable side effects and must always be given by a doctor.

Many doctors' favorite gout treatment is the anti-inflammatory agent colchicine. It can reduce the risk of recurrent attacks and is most effective if taken within the first 12 hours. CAUTION: Colchicine may cause adverse side effects or interact with a number of antidepressants, tranquilizers or antihistamines. And because of the risk of birth defects, pregnant women should not take it.

Once you've had an attack of gout, it's important to take steps toward preventing another attack.

Your doctor will probably advise you to cut out certain protein-rich foods, especially those high in purines, chemicals essential for the body's production of uric acid. These foods include red meats, organ meats, anchovies, shellfish, fatty fish, asparagus, spinach and most dried beans. You should drink plenty of liquids but avoid alcohol, which slows elimination of uric acid. Obese patients may be put on a stricter regimen.

After the pain of a gout attack begins to resolve, the next step is to lower the level of uric acid in the blood. The goal of lowering blood uric acid is to slowly dissolve deposits of uric acid in the joint. Lowering the body's level of uric acid can be done through the diet and, if necessary, by drugs.

The most common drug used to prevent gout attacks is allopurinol. It decreases the production of uric acid in the body. Side effects of allopurinol include rashes, drowsiness and disorientation, and it can have adverse reactions with other medications, particularly blood thinners and diuretics. If you have another gout attack, your doctor may recommend that you stop the allopurinol temporarily since the drug can worsen such an attack.

Some people with gout have high uric acid levels in their blood because their kidneys are not able to get rid of uric acid quickly enough. Drugs like probenecid and sulfinpyrazone increase the excretion of uric acid in the urine — thus lowering the level left in the blood. But like other medications used to combat gout, they may cause adverse interactions with other drugs or complications with existing ailments such as blood disorders, ulcers and kidney problems.

In many cases, prompt treatment with appropriate drugs solves the problem permanently. People with recurring gout attacks may have to remain on drugs to prevent these attacks — sometimes for life.

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