Gout (Crystal Arthritis)

With gout, a type of arthritis, tiny mineral, or urate, crystals collect in certain joints, causing an intense inflammatory reaction. The crystals are composed of uric acid, a metabolic waste product normally excreted in the urine.

In people with a hereditary metabolic defect, uric acid builds up in the blood and other body fluids. Most people with this condition, called hyperuricemia, do not develop gout, but those who do experience recurring attacks in the affected joints may also suffer kidney stones.

Gout is primarily a male disease, and the big toe is its most common site, although it may affect other foot joints as well as the fingers, ankles, elbows, wrists, and knees. During an attack, the joint becomes painful, red, swollen, and hot to the touch. Attacks come on suddenly but pass quickly. The intervals between vary from a few days to years.

When gout goes untreated, attacks become increasingly frequent and eventually damage the affected joints and sometimes the kidneys and other internal organs. In addition, deposits of urate crystals, called tophi, may occur under the skin near affected joints, over the elbow, or on the outside edge of the ear. These may eventually break through the skin and become infected.

Diagnostic Studies and Procedures

A doctor can usually diagnose gout on the basis of the symptoms and the appearance of the afflicted joint. A definitive diagnosis can be established by examining a sample of the joint fluid under a microscope with polarizing lenses. During an acute attack of gout, the uric-acid crystals can be seen in the fluid, surrounded by white cells summoned by the immune system.

Medical Treatments

A combination of medical treatment and self-care can completely control gout. Doctors most often recommend colchicine to counter an attack. At the first sign, the drug is injected into a vein, or it may be taken orally every few hours for a day or two. It is highly toxic, however, and should be stopped as soon as diarrhea and other intestinal symptoms develop. By that time the attack is usually over.

Certain non-steroidal anti-inflammatory drugs, especially phenylbutazone (Buiazolidin) and indomethacin (Indocin), are sometimes prescribed as an alternative. These medications can also cause some adverse effects, including bone marrow suppression and bleeding. With most patients, acute attacks can be prevented with daily doses of a uricosuric agent, such as sulfinpyrazone (Anturane), to improve the body's elimination of uric acid, or allopurinol (Lopurin or Zyloprim), which reduces uric-acid production. If these drugs do not work, a doctor may prescribe a low daily dosage of colchicine and closely monitor the person for side effects.

Alternative Therapies

For those who cannot take anti-gout medication, other therapies may help.

Acupuncture. Acupuncture and acupressure may case the pain of an attack.

Herbal Medicine. For joint pain, some herbalists recommend applying Tire-weed oil or Balm of Gilead ointment. A mixture of burdock root, celery seed, yarrow, and thuya is advocated for gout and may be taken as an infusion, in capsule form, or as a tincture. A word of caution, although the anti-gout drug colchicine is derived from the autumn crocus, which is used by some herbalists, this plant is highly toxic. Use only the FDA-approved drug.

Homeopathy. Practitioners may prescribe guaiacum, benzinum actdum, belladonna, or for gout that moves from joint to joint, Pulsatilla nigricans. A hot compress with tincture of colchicine may also be applied to the affected joints.

Meditation. Stress can sometimes precipitate an attack of gout. Meditation, yoga, and other relaxation techniques can help prevent a flare-up.

Nutrition Therapy. Many specialists advise avoiding foods high in purine, a substance that raises the uric-acid level in the blood. These foods include organ meats (liver, kidneys, sweetbreads, and brains), sardines, anchovies, meat extracts, and dried peas, lentils, and other legumes. Red wine, beer, and some other alcoholic beverages may also trigger an attack.

Self-Treatment

Anyone with gout should drink at least two quarts of non-alcoholic beverages daily to dilute urine and prevent a buildup of uric acid. An overweight patient should shed excess pounds, since obesity aggravates gout. Do not go on a crash diet as an abrupt loss in weight can also precipitate an attack. Regular exercise helps keep joints mobile and flexible, but avoid stressing inflamed joints, which can lead to permanent damage.

Drugs, especially the diuretics used to treat high blood pressure, sometimes cause gout. If you are taking medication for other disorders and suffer an attack of gout, talk to your doctor about an alternative regimen.

Other Causes of Joint Pain

Pseudogout is quite similar to gout, except the attacks are usually less severe and the crystals are composed of calcium pyrophosphate dihydrate. Joint pain may come from another form of arthritis, such as osteoarthritis, rheumatoid arthritis, or lupus. Bunions and other foot disorders produce pain and toe deformity.