Gout Medical Services

Gout Center of Excellence

Onsite Ultrasound to Diagnose & Monitor the Disease

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Gout

Gout is a type of inflammatory arthritis characterized by severe joint pain, tenderness, and redness. Uncontrolled gout is a very common yet underdiagnosed condition. About 9.2 million adults in the United States have gout, but only 3.3 million receive treatment for gout. Untreated gout can cause irreversible joint damage, leaving lasting damage.

Gout attacks can be triggered by local trauma to the joint, dietary ingestion of high-fat foods, dehydration, starvation, intake of diuretic medication, initiation of urate-lowering therapy with allopurinol or febuxostat, low-dose aspirin, high fructose corn syrup, alcohol (especially beer). Gout can affect any joint in the body but typically starts in the big toe because this joint is the most distal from the heart and the coolest joint. Gout typically starts overnight and achieves maximal inflammation over 12-24 hours.

If left untreated most patients will develop a second episode of gout within two years. Over time, if left untreated the intercritical period (pain-free period between attacks) shortens. If untreated, recurrent gout attacks tend to afflict multiple joints at one time. This can progress to chronic tophaceous gout that involves clumps of uric acid crystals depositing over many joints and tissues in the body. These gout crystals erode into the bones and cause chronic damage.

Risk Factors:

Certain medications such as diuretics and medications used to prevent organ transplant rejection may increase risk. Estrogen is protective against gout and women do not typically develop gout until after menopause.

Age
Obesity
High fructose corn syrup

Male gender
Renal impairment
Alcohol

Diagnosis

Gout is readily diagnosed by a gout expert – often by eliciting classic historical facts from the patient. Ultrasound done in this office is a painless test that can clearly image the gout crystals in the joint. The afflicted patient often has an elevated serum uric acid – but it might be low or normal during a flare-up – and this does not rule out the diagnosis. The cause of gout is the precipitation of monosodium urate crystals in the joint and surrounding tissues.

Treatment

There are two main objectives in the treatment of gout – resolve the acute attack and prevent future attacks. Treatment of acute attacks includes NSAIDs (Advil, Aleve, Motrin, etc.), colchicine, and steroids. Long-term treatment with urate-lowering medication is necessary to prevent the development of chronic gout. This involves several options including allopurinol, febuxostat, or uricosuric agents. Pegloticase is the only biologic on the market for gout and is a uricase enzyme that rapidly dissolves uric acid and allows fast resolution of tophi.