Important Information About Gout

Janet O’Mahony, M.D. an internal medicine doctor and a member of Mercy Personal Physicians Downtown in Baltimore, recently responded to questions from Costco Connection magazine about the risk factors, treatment and prevention of gout.

Gout is an inflammatory arthritis, which causes sudden pain and swelling in a single joint that resolves is a couple of weeks and the joint goes completely back to normal. This is caused by uric acid deposits in the joint space and comes on quite suddenly often while sleeping.  

This is more common in men, it runs in families, and certain medical conditions are higher risk, such has high blood pressure and kidney disease. It also becomes more common with age.  

The most common joints affected are the big toe, the ankle, the knee, and the wrist.  

When a patient has a gout attack, they want fast relief of the swelling and pain and may end up in urgent care or the emergency room if they have never had this before and do not know what is happening. Usually they will be prescribed NSAIDs if they are able to take those. But these meds are contraindicated in kidney disease, peptic ulcer disease, heart disease, and in people on blood thinners. Colchicine can used if started in the first 24 hours after an attack. Not everyone can take this drug either because it is contraindicated in liver and kidney disease and interacts with other medications. This drug can be started immediately by taking two tablets at onset of the pain and then one more pill an hour later. This drug can cause diarrhea as a side effect. We can also use prednisone to stop the inflammation and swelling in acute gout attacks. Most people can take this but it does raise glucose levels in diabetic patients.  

I encourage patients to get a refill of one of these medications to keep in the medicine cabinet, so if they have another attack, they can take something right away. Obviously, I would like them to consult with me first if possible, but taking the medication right away can shorten the suffering.  

For most people, these attacks are few and far between, but if attacks are happening more than twice a year, it can cause some joint damage and typically we start preventive medications. The first line medication we use is allopurinol. This medication prevents attacks by lowering uric acid levels in the blood stream. For people who can’t take allopurinol or when it is not working we can use febuxostat. These are both once-a-day oral medications. Typically, we check the uric acid levels on the medication to make sure they come down enough to prevent flares.  

– Janet O’Mahony, M.D.

Dr. Janet O’Mahony is an advocate for patient health and regularly contributes advice and feedback to media outlets, online resources and publications. Board certified in internal medicine, Dr. O’Mahony received her medical degree from University of Maryland School of Medicine in Baltimore. She completed her internship at the Baltimore VA Medical Center and her residency at Mercy Medical Center in Baltimore, Maryland.