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Frequently Asked Questions about Gouty Arthritis

What is gouty arthritis?

Gout is a painful form of inflammatory arthritis caused by an accumulation of uric acid crystals in the joints. Crystals form when there are supraphysiologic levels of serum uric acid.

How common is gout?

Gout affects more than 8.3 million people in the United States today; a sharp increase from only 5 million suffers just a few years ago.

What symptoms would my patient suffer?

Gout is characterized by sudden, severe pain in the affected joint. Half of all first-time gout attacks occur in the large joint of the patient’s great toe, but many other joints can be affected as well, particularly the forefoot, ankle, knee and wrist. Tenderness, redness, stiffness and/or swelling of the joint occur.

The first gout attack can seem like an isolated incident, but will recur within a year in at least 20 percent of individuals.

How do I diagnose gout?

Gout is usually classified in four stages: asymptomatic hyperuricemia, acute gout attack, intercritical gout and chronic tophaceous gout.

Asymptomatic Hyperuricemia– Asymptomatic hyperuricemia is considered an early stage of gout where the patient’s uric acid levels are elevated. This elevation may or may not lead to gout, but the risk for developing gout increases as the level of uric acid increases. This stage does not usually require treatment.

Acute Gout Attack – The patient suffers from sudden severe pain and swelling in the affected joint, often awakening the patient from sleep. The pain and swelling will resolve, even without treatment, after three to 10 days, and another attack may not occur for months or even years.

Intercritical Gout – This stage refers to the symptom-free period between gout attacks. Even though the patient is not experiencing acute gout, this period should not be ignored. This is a good point to talk to your patient about medications that may aggravate their condition; dietary and other lifestyle adjustments, including alcohol consumption and weight loss that would help manage gout; and therapeutic options to prevent or treat future attacks.

Chronic Tophaceous Gout – At this point, gout is a chronic form of arthritis in the patient. An ongoing destructive inflammatory process is active, and if it not treated, often leads to deformity of the affected joint. The risk for kidney damage is also increased at this stage.

When should I consider referring my patient to a rheumatologist?

You should refer patients to a rheumatologist when the patient has difficult-to-control gout. Difficult-to-control gout is that which is not prevented by a good trial of urate lowering therapy accompanied by prophylactic anti-inflammatory agents until a serum urate level of 6.0 mg/dL is achieved and the patient is flare free for several months.

How frequently should I perform uric acid level testing?

When initiating urate lowering therapy, uric acid levels should be checked approximately once per month until a serum urate level of 6.0 mg/dL is achieved and sustained. After that, yearly testing is adequate unless the renal status of the patient changes or the patient begins taking urate elevating medications.

What are the key risk factors for gout?

• Hyperuricemia
• Metabolic syndrome
• Binge drinking, particularly beer
• Family history of gout
• Persons who have received transplants and are on cyclosporin

How can I counsel my patients on lifestyle changes to help manage gout?

Advise patients to normalize weight, lipids and blood pressure; as well as to avoid high-purine foods and drinks, especially beer; and high-fructose sweetened drinks.

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