Unlike most other types of arthritis which develop slowly, an attack of gout occurs suddenly, quite literally overnight. The attack happens when uric acid builds up in the bloodstream and forms urate crystals in the joints, causing inflammation and pain. Most commonly caused by the under-excretion of uric acid by the kidneys, the build-up may also be caused by the overproduction of uric acid by the body.  

There are several factors that can affect the level of urate in your body including genes, obesity, diuretics, a chronic blood disorder, kidney disease, organ transplantation, high levels of cholesterol and fats, high blood pressure, or type 2 diabetes.  

While a gout attack makes it glaringly obvious that a person is suffering from gout, many are unaware that in some people the condition quietly progresses unnoticed between flare-ups causing long-term damage to joints.  

SIGNS AND SYMPTOMS 

The signs and symptoms of gout are almost always acute, suddenly occurring without warning, often at night. A gout attack typically causes pain, swelling, redness, and inflammation in a single joint, most often the big toe.  

The pain is likely to be most severe within the first 12-24 hours after it begins. Most gout attacks stop after about a week. Mild attacks may stop after several hours or last for 1-2 days. Severe attacks may last up to several weeks, with soreness lasting for up to one month.  

Many people have a second attack of gout within six months to two years after their first attack, but there may be intervals of many years between attacks. Later attacks are likely to last longer and affect more joints. If untreated, the frequency of attacks usually increases with time.  

TREATMENTS 

Fortunately, gout symptoms can be controlled, and patients can lead productive lives. Successful treatment can reduce discomfort as well as long-term damage to the affected joints.  

To ease the pain during a gout attack, encourage patients to rest the joint that hurts. The application of a cold compress several times during the day may also decrease inflammation and pain.  

Medicines used to treat acute attacks 

• NSAIDs may control inflammation and pain e.g. ibuprofen, diclofenac, and naproxen. NSAIDs reduce the inflammation caused by deposits of uric acid crystals but have no effect on the amount of uric acid in the body. Do not recommend aspirin as it may change uric acid levels in the blood and may make the attack worse. 
• Colchicine isn’t a painkiller, however, it is often effective at decreasing inflammation caused by the crystals interacting with the joint lining and is most effective when taken within the first 12 hours of an acute attack. A low daily dose can prevent future attacks. 
• Corticosteroids may control gout inflammation and pain. It can also be injected into the joint and is usually used for cases of gout that do not respond to NSAIDs or colchicine. 

Patients suffering from gout will benefit in the long term from healthy changes to their lifestyle taking steps to decrease their uric acid level and keep it low.