Gout is an inflammatory form of arthritis caused due to buildup of uric acid in the joints. It is a painful condition affecting the joints anywhere in the body. Gout in elbow is a painful arthritic condition affecting the elbow joint due to excess uric acid in the body, which gets accumulated in the elbow joint. When gout attacks the elbow joint, it causes sudden severe pain in elbow, swelling and sometimes redness around the joints and surrounding tissues.
What is Gout in Elbow?
Gout is a condition that develops due to excess production of uric acid in the body, which is accumulated in the blood. The uric acid in the blood then reaches in the joints and forms uric acid crystals in the joints. The body reacts to these uric acid crystals like foreign bodies and an inflammatory process begins in the joint. In case of gout in elbow, there occurs swelling, pain, tenderness and warmth in the elbow joint. It can begin suddenly and the clinical picture can appear like an infective type of arthritis. Hence proper diagnosis is required and gout can be managed with medicines and diet, early treatment can help to a great extent.
Gout can affect different joints and tissues in the body. The commonest in joints is the big toe, but small joints in hands and large joints like the elbows, the hips, the knees or the ankles can be also get involved. Gout in fingers is also noted. Other joints tissues that support the joint, like tendons can get affected.
- The tendon sheaths, which are the protective bands mainly involved in providing nutrition to the tendons attached to the bones, can get inflamed too.
- Other structure called bursa, which are tiny sacs with slight fluid in them are present in the body to provide cushioning of the joints. In gout these too can get inflamed causing excess accumulation of fluid in them, swelling and severe pain called bursitis. In gout in elbow, the bursa present at the tip of the elbow called olecranon bursa is commonly involved.
- Increased levels of uric acid in the blood can also cause formation of uric acid crystals or stones in kidneys and even cause damage to the kidneys.
What is the Outlook of Gout in Elbow?
Gout can affect every individual in a different manner. In many cases, the first episode of gout pain in elbow may be followed by a period of no pain for the next few month or years, before the next attack strikes. Preventive medication and appropriate diet regimen can help in protecting from gout in elbow, which if taken properly can delay the progression of the disease.
For those, who do not receive timely diagnosis and treatment, there may be early recurrence of episodes and may become more frequent over a period of time. If recurrent and severe attacks of gout in elbow continue they can cause formation of nodules called tophi, in many parts of the body, which can cause permanent damage to the joints. Also, if gout is left untreated for a longer period, it can cause damage to the kidneys, and can also increase the risk of high blood pressure, kidney failure, diabetes, heart diseases or stroke.
What Causes Gout in Elbow?
Normally, uric acid is produced in the body and is present within normal limits. It remains dissolved in the blood, which circulates in the body, is processed by the kidneys and excreted in the urine as a normal component of urine. Gout in elbow is mainly caused by excess uric acid in the blood. This could be a result of over production in the body or improper excretion from the body. In either cases, the excess uric acid remains present in the blood, which then begins to form crystals that get deposited in the elbow joints. This causes inflammation in the elbow joints and other tissues.
What causes gout in elbow is an important thing that needs to be understood. While it is possible that people with increased levels of uric acid in the blood may not always develop gout, it is possible that some people may be at an increased risk. Certain risk factors of gout in elbow have been identified.
- Genetic factors can play a role in increasing a person's risk of gout in elbow. People having first degree relatives with gout can be at increased risk, due to genetic make-up and sometimes also due to the dietary habits in the family.
- While gout is seen both in men and women, it may be seen more commonly in men during their middle ages, while in women mostly after menopause.
- Dietary factors are an important factor and increased intake of alcohol and rich foods can increase the risk of gout. Foods that cause gout are mainly those containing purines, which on consumption produce uric acid in the body. These foods include certain meats, shellfish, bread and other yeast containing products.
- Being overweight or obese increases the risk of gout along with other metabolic disorders and risk of joint problems.
- Trauma to elbow joint increases the risk of further damage to the joint due to gout in some individuals.
- Certain medications that are used for controlling high blood pressure, like diuretics or aspirin taken for heart disease, some immune suppressant medications can sometimes increase the risk of gout.
- Other medical illnessess like kidney disorders, diabetes, high blood pressure, anemias, etc. that can affect regular excretory function can increase the risk of gout due to possibility of ineffective excretion of uric acid. Some enzyme defects that can affect effective breakdown of purines too can increase risk of gout. Some studies suggest a link between very low levels of thyroid hormone or hypothyroidism and increased risk of gout.
What are the Signs and Symptoms of Gout in Elbow?
Symptoms of gout in elbow generally appear suddenly, when a person might wake up in the morning to find a suddenly swollen and painful elbow joint. Usually, the complaints begin from great toe, however, any joints including the elbow can be affected. There is severe pain in the inflamed joint and immense tenderness. Even the slightest touch of the bedsheet can cause severe pain in the inflamed elbows due to gout.
On examination, the elbow joint may appear red, warm and swollen as if puffed up. Movement of the elbow joint may be very painful and difficult to perform. Stiffness and inability to move is also common symptoms of gout in elbow. The skin over the affected elbow joint looks shiny, red and there may also be peeling and flaking over the skin. Skin may feel itchy and painful.
These signs and symptoms are often seen during acute attacks of gout in elbow and can similarly affect other joints and tissues in the body.
If such episodes continue, deposition of uric acid crystals in other joints can show sudden, painful swelling on other joints, tendons and other tissues as well. Deposition of uric acid under the skin can make it appear like nodules called Tophi. Other complaints like formation of kidney stones due to excess accumulation of uric acid in the kidneys may also be noted in some people.
How is Gout in Elbow Diagnosed?
Gout is diagnosed based on the personal history, which includes medical illnesses, ongoing medications and other treatments, history of infections, injuries, kidney disorders, etc. Past history includes information about past illnesses, surgeries and treatments taken in the past. Family history to understand familial predisposition, presence of gout in close family members and other medical details are noted.
Characteristic features like sudden onset of arthritis, which shows redness, swelling, warmth and severe pain in the elbow joint, which may have developed just in a day, involvement of a single joint or varying joints, without any symmetry, more attacks of acute arthritis, may raise a suspicion that the form of arthritis could be gout. Hence detailed investigations are needed to confirm gout and rule out other forms of arthritis.
Confirmatory factors to diagnose gout in elbow include elbow joint inflammation with sudden, severe pain, swelling, redness and warmth along with high levels of uric acid in the blood and presence of uric acid crystals in the inflamed elbow joint.
Investigations help to diagnose gout and include some of the following tests.
Blood tests to detect levels of uric acid in the blood are ordered. Higher values are suggestive of greater chances of gout. However, during an inflammatory attack, it is possible that due to excess accumulation of uric acid in the inflamed elbow joint, the blood levels may be normal. It is ideal to test uric acid levels again when there is no joint inflammation and in between episodes, so that if they are high a treatment plan can be decided. However, not all who have high uric acid levels develop gout and uric acid levels in people having gout may be variable.
Other blood tests like CBC, ESR, CRP, may also be done to detect inflammation and understand its severity; to rule out possibility of septic or infective arthritis, or other forms of arthritis; RF, rheumatoid factor to rule out rheumatoid arthritis and other tests to rule out autoimmune disorders.
Imaging studies like X-rays, CT scans and MRI can help to detect changes in the bone, elbow joint deformities and damage occurring to other tissues like tendons, bursa and others. Performing these tests may be also useful in monitoring the progress of the gout in elbow and efficacy of the treatment plan, wherein damage to the joints and tissues needs to be studied.
Joint Fluid Analysis
Gout in elbow causes sufficient amount of swelling around the elbow joint. The elbow becomes tender to touch, severely painful and becomes stiff. Elbow joint fluid aspiration is performed as a diagnostic procedure to aspirate the excess fluid accumulated in the elbow joint.
The aspirated fluid is sent for laboratory testing, where fluid analysis is done to detect the presence of uric acid crystals, which can confirm the diagnosis of gout. Fluid analysis also helps to detect the presence of pus cells, white blood cells, bacteria, which can help to rule out other forms of arthritis including septic arthritis and tuberculosis.
Aspiration of fluid also helps to relieve pain, pressure and reduces the swelling.
What is the Treatment for Gout in Elbow?
Treatment of gout in elbow is aimed at relieving pain, reducing swelling and associated symptoms during acute attacks, prevent further episodes of gout attack, protect the elbow joint and other tissues in the longer run and minimize the risk of permanent damage to the elbow joint.
Some of the treatment modalities for gout in elbow include:
Medical Management of Gout in Elbow
Acute attacks of pain, swelling and inflammation of the elbow joint are treated with non-steroidal anti-inflammatory medicines (NSAIDs) that can provide relief in the joint symptoms. These medicines can cause irritation of the gastric mucosa and the one that suits an individual should be taken. Another medicine named Colchicine is commonly used during acute pain episodes for the treatment of gout in elbow. Although this drug is approved for treatment of gout in elbow, it too does have some side-effects.
Steroids are another class of medicines that can help to fight inflammation and bring quick relief o pain caused due to gout in elbow. There are oral and injectable steroids, which can also be taken directly into the inflamed elbow joint for immediate relief of symptoms.
All medications and their side-effects should be discussed with the treating physician to plan the most effective and safe treatment plan for gout in elbow.
Pain Management of Gout in Elbow
In acute attacks of elbow pain due to gout, pain management aims at reducing the pain and swelling in the elbow joint. Resting the affected elbow joint is essential until the acute gout attack subsides. Sometimes, light compression of the elbow joint can help in reducing the swelling and also allows the joint to rest, but care should be taken and not kept for too long, not too tight or not while sleeping.
Applying cold compresses, ice packs rolled in a cloth and gently rubbing over the inflamed area can help. Elevation of the joint and keeping the elbow joint raised above the heart level can help to reduce the swelling and pain.
Preventive Treatment of Gout in Elbow
Apart from acute episodes of Gout in Elbow for which anti-inflammatories and pain management is required, preventive treatment for elbow gout is necessary to prevent future episodes of pain and inflammation.
For people who have acute attacks of gout, serum uric acid levels after the acute attacks have subsided are also checked. Those who have higher levels of blood uric acid may be given medicines to control the amount of uric acid in their blood within normal limits. This can help to prevent excess accumulation of uric acid crystals in the joints and protect the joints from damage.
Some of the medicines aimed at preventing repeated attacks of gout in elbow and protecting joint from destruction include:
- Allopurinol – It controls the production of uric acid in the body.
- Probenecid – It helps to increase the excretion of uric acid from the kidneys, thus flushing out more uric acid and preventing it from getting accumulated in the joints.
- Febuxostat – It is a treatment, which can be given in persons who may not be able to take the above treatments. It aims at reducing uric acid levels in the body.
- Colchicine – It helps to control inflammation during pain episodes and also prevents inflammatory episodes by controlling white blood cells from attacking uric acid crystals in the joints. It thus prevents the initiation of the inflammatory reaction in the elbow joint.
Surgical Management of Gout in Elbow
Surgical Management for Gout in Elbow is an option considered only in some cases, where medical management, preventive treatment, diet and all other treatment modes have failed. It may also be considered when there is sufficient amount of elbow joint damage and there is a need to restore the elbow joint function with the help of surgery.
- Surgery for Tophi Removal - In advanced cases of gout in elbow, nodules like lumps develop under the skin, called tophi. These are excess uric acid depositions, which gets accumulated under the skin around the joint. Sometimes these nodules are large enough to affect the movement of elbow joint and can be very painful. Tophi in gout in elbow can be formed around the elbow joint, tendons, bursae and even affect other joints like toes, fingers and large joints. While the nodules are very painful when moving the joints, there is a risk that the nodules can break and drain the fluid into the joint space or tissue area; sometimes the tophi can get infected as well. Hence, in severe cases, in order to prevent further joint damage and risk of infection, it is advisable to remove the nodules. In such cases, surgery is performed for removal of Tophi.
- Surgery for Elbow Joint Fusion – This surgery is performed in chronic gout in elbow, which has caused great deal of elbow joint damage and permanent elbow joint destruction. With this surgery of joint fusion, smaller joints are fused together, which helps to limit movement of the deformed joints. It can help to relieve chronic pain due to gout in elbow.
- Surgery for Elbow Joint Replacement in Gout – Surgery for elbow joint replacement involves removing the damaged elbow joint and replacing it with an artificial joint. The joint replacement surgery is aimed at providing relief in joint symptoms, reducing elbow pain and maintaining joint flexibility, movement and function of the elbow joint.
What are the Complications of Gout in Elbow?
Gout in elbow results from excess uric acid in the blood, which gets accumulated in the elbow joints and other tissues. When serum uric acid levels remain high for a longer period, repeated attacks of pain and inflammation in the joints are noticed. This can eventually cause damage to the joints, destruction and can affect the joint function. If timely treatment for gout in elbow is not received, there are chances that other joints and tissues may also get involved and frequency of acute inflammatory attacks can increase.
Uric acid forms crystals, which get deposited in the joints and also in the surrounding tissues, tendon sheaths or bursae that support the joints, can result in formation of nodules under the skin over the joint, called tophi, which are chalky colored nodules that slowly affect the joint functioning. These tophi can also appear in areas other than the joints and can be seen on the ears as well.
Repeated severe episodes of gout, involvement of more joints and appearance of tophi can affect the joint functioning and also cause permanent joint damage, which may then need surgery to restore joint function or the joint may have to be replaced.
Circulation of excess uric acid in the blood, can affect the filters of the kidneys and increase the risk of kidney stones. If continued for long, it can even affect kidney functioning and can increase chances of kidney damage or kidney failure.
Gout in elbow can have good results if acute gout attacks are treated appropriately, timely diagnosis of gout in elbow is made and preventive treatment is initiated at the earliest.
How to Prevent Gout in Elbow?
Gout in elbow is a form of arthritis occurring due to improper metabolism of uric acid in the body. Hence, by avoiding factors that cause disturbances in excess accumulation, over production of uric acid, gout can be prevented in most cases. While medications aim at controlling the excess accumulation and protecting the joints and tissues from damage, certain preventive measures, lifestyle management and diet too can help in management of gout.
Lifestyle measures play an important role in prevention of gout. Maintaining an ideal weight, particularly in overweight and obese individuals is important. Healthy diet and regular exercise can help to remain fit.
Exercises that focus on weight reduction, general health and joint and muscle strengthening should be performed. Regular exercises not only help to reduce stress and maintain energy levels, but also helps to improve joint function, reduce stiffness and improve flexibility of the joints. Gout in elbow can be improved with medications and exercises of the elbow joint, strengthening of muscles of the arm and forearm.
Diet for Gout in Elbow
Diet has been a long known contributing factor for gout in elbow. Persons having gout can control their symptoms and manage gout by following a proper diet plan and avoiding certain foods. Gout is often believed to be triggered by an excess consumption of foods rich in purines and high fatty foods. Intake of alcohol, red meat, and rich fatty foods can cause an increase in complaints for those suffering from gout in elbow. Sugary drinks, caffeinated beverages and intake of high protein rich foods which are also high in fats can cause more trouble.
The best diet for gout includes eating healthy, nutritious food in moderation, avoiding any excesses. Limiting intake of excess sugar and salt is important. Watching the calorie intake is also necessary, especially for those who are over-weight, so as to aid in weight management. Foods to avoid in gout include meat, seafood, fatty fish, oysters and other shellfish as they are rich in purines.
For adequate intake of proteins, it is important to take foods which are low in fat, like low fat milk and dairy products. Berries, cherries are believed to help in reducing uric acid levels in the body and can be consumed in moderation. Drinking plenty of water is necessary as it helps to flush out excess uric acid from the body and relieve symptoms of elbow joint pain and inflammation.