What is gout?

• Gout results from a build up or precipitation of uric acid crystals in the joint that causes pain and swelling. High levels of uric acid in the blood may be associated with a condition called hyperuricemia (pronounced high-purr-yur-eh-see-mee-ya).
• Uric acid is a naturally occurring waste product made in your body that is excreted (got rid of) by the kidneys.
• Hyperuricemia results from either too much uric acid being made or too little being excreted (in the urine).

How common is gout?

• Gout is more likely to occur in men than women, usually between the ages of 30 and 50. Women develop gout after the age of 60.
• Gout is usually experienced as sharp pain, swelling, tenderness and redness in the first joint of the big toe but can also affect the ankle, knee, foot, hand, wrist and elbow.

What causes gout?

• A family history of gout is common.
• Some medications such as certain diuretics (medication for high blood pressure) can prevent uric acid from leaving your body.
• Alcohol can also trigger a gout attack.
• Complications from other diseases, e.g. stroke, heart attack, etc., may also cause gout.

How do you know if you have gout?

• Gout is not diagnosed with a blood test.
• Your doctor may remove some fluid from the sore joint to be examined in a laboratory.
• 24-hour measurement of the amount of uric acid in your urine helps determine the cause of your gout and the type of treatment you need.

How is gout treated?
Rest, ice and medication help bring your gout under control. Changes to the way you live are also part of treatment.

Medication

• The most commonly prescribed medicine for a severe gout attack is a nonsteroidal anti-inflammatory drug (NSAID).
• NSAIDs may increase your risk of stomach upset and bleeding in the gut. Let your doctor know if you experience stomach pain, indigestion or black stools.
• Other prescribed medications are the recently approved cyclooxygenase-2 inhibitors (COX-2) class of medications. Like other NSAIDS, COXIBs have similar effectiveness to older NSAIDs in reducing pain and swelling. COXIBs do not prevent joint damage. They may be used if you are at risk of stomach upset or other gastrointestinal (GI) risk factors. Recent studies have suggested that COXIBs may be associated with an increased risk of cardiovascular side effects and this should be discussed with your doctor.
• Those who don’t do well with the NSAID may be given cortisone, often by injection into the joint.
• Medications such as allopurinol will be prescribed to reduce the amount of uric acid in the blood and urine, if necessary.
• Allopurinol is a long-term medication. Suddenly stopping and starting this medication can also trigger gouty attacks.
• Colchicine may also be used to prevent or treat acute attacks.

For medications prescribed by your doctor, it is important to know:

• Name(s) (generic and brand):
• How much to take:
• When to take it:
• How quickly will it work:
• For how long should it be taken:
• Side effects to look out for:

Diet

• If you are overweight or have high blood pressure you will need to lose weight and eat different foods.
• To keep low levels of uric acid certain foods such as coffee, chocolate, cocoa, tea, seafood, liver, kidneys, sweetbreads, meat extracts, gravy, peas, spinach, lentils and dried beans should be eaten less frequently.
• Very little alcohol (beer, wine, martinis) should be drunk as it stops uric acid from leaving your body and it is also a strong trigger for gouty attacks.

Heat/Cold

• Heat, for example a hot shower, helps relax aching muscles, joint pain and soreness. However, this should not be used for an acutely inflamed joint.
• Cold, for example an ice pack, helps numb an area.

Exercise

• Once the gout attack is under control exercise helps strengthen the joint as well as maintain a healthy weight.

Protect Your Joints

• Pace yourself by alternating heavy or repeated tasks with easy ones or rest.
• Position your body to avoid stress on joints.
• Use helpful devices in your daily tasks such as carts, enlarged handles, canes and grab bars during a gout attack.

Relaxation

• Relaxing the muscles reduces joint pain.
• Relaxation can include deep breathing exercises, listening to music, visualization, prayer, meditation or listening to relaxation tapes.

For More Information…

This fact sheet is just a brief look at gout. For more information or if you have any questions, ask your doctor or pharmacist, or call The Arthritis Society at 1-800-321-1433. You can also visit The Arthritis Society's Web site at www.arthritis.ca

Questions to ask your doctor at your next visit:

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This information is brought to you by an educational grant by McNeil Consumer Healthcare, the makers of TYLENOL* (acetaminophen)

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