What are Gout and Pseudogout?

What Is Gout?

Without warning and, for some reason, in the middle of the night, gout strikes. It’s an intense pain in a joint, most often the big toe, but sometimes other joints, including knees, ankles, elbows, thumbs, or fingers.

Attacks of gout can be unexpected and excruciatingly painful. With prompt treatment, the pain and inflammation usually disappear after a few days. But they may happen again at any time.

More than 8 million Americans have gout. Gout happens more often in men than in women. Men usually develop it between the ages of 30 and 50. Women are more prone to gout after menopause. It is rare in children and young adults. Men who are overweight or have high blood pressure are particularly prone to gout, especially if they are taking thiazide diuretics (water pills).

Gout is actually a form of arthritis. It is the body's reaction to irritating crystal deposits in the joints. The pain can be intense, but treatment usually works very well. Mild cases may be controlled by diet alone. Attacks of gout that come back again may require long-term medication to ward off damage to bone and cartilage and wearing down of the kidneys.

People with chronic gout may feel tiny, hard lumps building up over time in the soft flesh of areas like the hands, elbows, feet, or earlobes. These deposits are called tophi. They’re concentrations of uric acid crystals and can cause pain and stiffness over time. If similar deposits form in the kidneys, they can lead to painful and potentially dangerous kidney stones.

What Causes Gout?

Too much uric acid in the blood brings on gout. Uric acid comes from two places. It’s produced by the body and from your diet. Any extra uric acid usually filters through the kidneys and gets passed in urine. If the body produces too much uric acid or doesn’t get rid of it in urine, crystals of monosodium urate form in the joints and tendons. These crystals cause intense inflammation leading to pain, swelling, and redness.

What exactly causes gout? The most common factor is drinking too much alcohol, especially beer. Gout used to be known as "the disease of kings" since it was mainly seen in wealthy men who drank and ate too much. Now we know it can happen to anyone. It can be linked to injury or surgery, hospitalizations, stress, or diets high in meat and seafood, and certain drugs like antibiotics. Gout may also happen with some tumors or cancers. There is also a link between gout and kidney disorders, enzyme deficiencies, and lead poisoning. Gout may also happen with psoriasis. It is common in people with transplanted organs because of medications that are often needed. Gout may be passed down in your family. It is often associated with other common illnesses like high blood pressure, diabetes, and obesity. Repeat attacks of gout are common if the body's uric acid level is not kept under control.

How Can I Prevent Gout?

If gout runs in your family, men in particular should limit alcohol, fats, and foods that are more likely to increase uric acid level in the body. Those include meat, sardines, bacon, mussels, and yeast. Beer, especially, can also bring on a gout attack. Drinking plenty of liquids may help minimize the risk of kidney stones. Your doctor can do blood and urine tests to figure out your potential risk of a gout attack. It’s also a good idea for men who are at greater risk to keep an eye on their weight.

Medications can also help prevent gout attacks if you have them often. These drugs decrease the production of uric acid or increase the amount of uric acid you get rid of in urine. These medicines include allopurinol (Aloprim, Lopurin, Zyloprim), colchicine (Colcrys, Gloperba, Mitigare), pegloticase (Krystexxa), probenecid (Probalan), and rasburicase (Elitek).

If these medications aren’t effective, your doctor may prescribe febuxostat (Uloric). If you have heart issues, be very cautious taking febuxostat.

What Is Pseudogout?

Pseudogout is similar to gout but is generally less painful. It is caused by calcium pyrophosphate (CPP) crystals in the joints. The crystals can build up in the joint fluid. When that happens, it can cause a sudden attack of pain, similar to gout.

It’s not clear what causes the abnormal deposits of CPP crystals in cartilage. They may form because of unusual cells in the cartilage, or they may be the result of another disease that damages cartilage. CPP crystals may be released from cartilage during a sudden illness, joint injury, or surgery. The abnormal formation of CPP crystals may also run in the family.

While pseudogout can affect the big toe, it is more common in larger joints like the knee, wrist, or ankle. Less often, it can involve the hips, shoulders, elbows, finger joints, or toes.

Pseudogout is more common after age 60.

How Is Pseudogout Treated?

The type of pseudogout treatment depends on several factors, including your age, other medications you’re taking, your overall health, your medical history, and how severe the attacks are. Drugs to treat pseudogout include:

• Anti-inflammatory painkiller drugs, also called NSAIDs, generally are prescribed to treat sudden and severe pseudogout attacks. NSAIDs -- like ibuprofen and naproxen -- usually reduce inflammation and pain within hours.
• Corticosteroids (also called steroids) may be prescribed if you can’t take NSAIDs. Steroids also work by decreasing inflammation. They can be injected into the affected joint or given as pills.
• Colchicine, a gout drug, is sometimes used in low doses for a longer period of time to reduce the risk of repeated attacks of pseudogout.

Anti-inflammatory medications are usually continued until the pseudogout attack goes away. Symptoms are often better within 24 hours after treatment begins.

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