There's no mistaking a gout attack'a fact former New York Yankees" pitcher David Wells knows all too well: "I woke up one morning with [the feeling of] somebody drilling a hole in my right big toe," he recalls. Unfortunately, being jolted awake by intense pain in a single joint'usually the big toe'is a hallmark of gout. "Often the toe will be so sore you won't even be able to put weight on it," says rheumatologist Madelaine Feldman, MD, an associate clinical professor of medicine at Tulane University School of Medicine in New Orleans.
How it happens
Gout, a form of inflammatory arthritis, occurs when a substance called uric acid builds up in the blood faster than the kidneys can eliminate it, explains Dr. Feldman. Eventually, the excess forms crystals that settle in the joints, and the body tries to get rid of them by releasing chemicals that cause heat, swelling, redness'and most of all, pain."
Why you must take control
If left untreated, gout may progress through three stages: The first is known as acute gout'the sudden attack that causes joint pain and inflammation. It usually lasts for three to five days, and then the pain goes away. "It's important to get treatment to lower the uric acid level," stresses Dr. Feldman. If you don't, it could progress to the second stage, intercritical gout. Symptoms during this stage can last for weeks, and although the pain may not be as intense, it never completely goes away as it does after an acute attack.
The final stage, chronic gout, may develop after several years'10 or more. "It is marked by persistent joint pain but not as much inflammation," says Dr. Feldman. "Often, it is more difficult to treat, and the affected joints may eventually be destroyed." The most painful and disabling form of chronic gout is refractory chronic gout (RCG)'defined as having severe gout symptoms and high uric acid levels that don't respond to the usual treatments for chronic gout.
The good news? All stages of gout, including RCG, can be effectively treated with medication and lifestyle changes. Your top priority is to work with your healthcare team to find the treatment that can ease the pain of a sudden attack and prevent future ones. And the sooner you get tough on gout, the sooner you'll be able to get back in the game!
Why gout targets guys Women are protected from gout because the female hormone estrogen helps the body flush uric acid. In men, the disease tends to strike between ages 40 and 55, while women usually don't get it until after menopause, when estrogen levels drop. Even then, they account for only 1 in 3 gout sufferers over age 65.
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