If you have pain, swelling, and redness in your big toe, you might have gout, a common type of inflammatory arthritis. You may also experience limited range of motion. Usually, the pain is most severe in the first 4 to 12 hours and then subsides. Later attacks may last longer. Gout happens when you have high levels of uric acid in your blood system, which activates your immune system and causes swelling in the joints. You can also experience gout in your instep, ankle, knee, wrist, fingertip, and other joints. Gout can also lead to kidney stones. If left untreated, gout can cause joint damage.
You are more likely to have an attack of gout if you eat a lot of red, organ meats such as liver or heart; beans; shellfish; fructose-sweetened drinks; and alcohol, especially beer. Other risk factors include obesity, a family history of gout, taking certain medications such as water pills, recent trauma to the joint, and having kidney disease. Gout is more likely to affect men between the ages of 30 and 50 and in women after menopause.
Mount Sinai has extensive experience in diagnosing and treating gout. Usually, we diagnose the condition by testing the fluid in your joint. If we find uric acid crystals in your joint fluid, the diagnosis of gout is confirmed. The test is called synovial fluid analysis. We may also use blood tests and imaging tests such as X-rays, ultrasound, and dual energy computed tomography scans.
Treatments We Offer
We usually treat gout attacks with medication, often nonsteroidal anti-inflammatory drugs. This might be ibuprofen (such as Advil or Motrin IB), naproxen sodium (Aleve), or a stronger prescription-level medication such as indomethacin (Indocin) or celecoxib (Celebrex). If you have gout in many joints, we may also prescribe corticosteroids, either pills or injections.
If you have several attacks in a year, we may also give you medications to prevent complications with gout. These could include drugs that block production of uric acid, called xanthine oxidase inhibitors, and ones that improve removal of uric acid, termed uricosuric medications. Both types of medications may cause side effects.
When the attack is over, we will try to decrease your risk of repeat attacks. We may recommend changes in your diet or medications. If this does not help, or if you are unable to make these changes for medical or other reasons, we might prescribe ongoing preventive medication such as colchicine (Colcrys or Mitigare).
Why Mount Sinai
Mount Sinai rheumatologists are experts in the latest diagnostic and treatment approaches for rheumatic diseases. In fact, we have had helped to develop many of them.
In the early 1950s, The Mount Sinai Hospital established one of the first gout clinics in the United States. In 1961, Alexander Gutman, MD, and Tsai-Fan Yu, MD, developed allopurinol, which is still the standard treatment for gout. Thanks to this discovery, gout is one of the easiest types of arthritis to treat effectively.
Mount Sinai researchers continue to explore new and improved ways to treat this condition. Peter Gorevic, MD, Professor of Medicine (Rheumatology) at the Icahn School of Medicine, helped develop pegloticase as an effective treatment for people with chronic gout that does not respond to other approaches.