Cortisone gout

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Gout is a painful form of arthritis. Gout "attacks" are caused by the release of monosodium urate crystals into a joint leading to inflammation, pain, and swelling.

In individuals with gout, either too much uric acid is made or not enough is eliminated by the kidney. While gout usually begins in a single joint- typically the great toe, foot, ankle, knee, wrist, or elbows- it may affect multiple joints over time. Gout usually affects men older than 40 years. It is unusual in women until they have entered menopause. This is particularly true if they are on thiazide diuretic therapy.

Alcohol, aspirin, certain medicines, and foods (liver and other organ meats, sardines, anchovies) may cause levels of uric acid to rise in individuals, making them more prone to developing gout. The only way to diagnose gout with certainty is to place a needle into the affected joint, remove the joint fluid and look for the gout crystals under a microscope.

Individuals who have an attack of gout notice rapidly developing pain, swelling, heat, and redness in the affected joint. The pain can be so intense that even lightly touching the joint will cause severe pain. Even the weight of a bed sheet can’t be tolerated. The pain is usually continuous and more painful if the joint is moved. Everyday activities such as walking, dressing, and lifting may be difficult.

Attacks may occur at any time; however, events such as injuries, surgery, an acute illness, or ingestion of alcoholic beverages can trigger attacks. Once the attacks are treated, the symptoms usually resolve within hours to a few days. If attacks are not treated, they may last several days. Between attacks, the symptoms resolve completely. Individuals with higher uric acid levels in their blood are more prone to recurring attacks that also come more frequently. Persistently elevated uric acid levels for many years can cause deposits of uric acid in nodules under the skin. These are called "tophi." Some individuals with gout are also prone to developing kidney stones.

There are two ways to approach the therapy for gout: treatment of attacks and prevention of attacks. Preventive treatment is necessary in individuals with tophi, kidney stones, and frequent attacks.

Attacks of gout are usually treated with non-steroidal anti-inflammatory drugs (NSAIDs). Potential side effects of NSAIDs include stomach upset, ulcers, constipation, diarrhea, headaches, dizziness, difficulty hearing, and skin rash. Colchicine is another anti-gout type of drug that is particularly effective early in the attack. Potential side effects of colchicine include stomach cramps, nausea, vomiting, and diarrhea.

Occasionally, a more potent anti-inflammatory medicine such as prednisone, a cortisone-like medicine, is necessary. This may be given orally, intramuscularly, or injected directly into the inflamed joint. Potential side effects of cortisone-like medicines are increased appetite, weight gain, difficulty sleeping, easy bruising, and stomach upset. Removal of the joint fluid from the affected joint, followed by a cortisone injection is a common and effective treatment for gout affecting one or two joints. Cortisone injections usually provide the most rapid and complete relief of pain and swelling. Aside from the discomfort of the injection, there are very few side effects from cortisone injections.

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