Gout is a form of inflammatory arthritis that causes pain and swelling in and around the joints. Although the condition is more common among adults, it can also affect children. Doctors refer to gout in children as “pediatric gout.”
This article describes what gout is, its prevalence in children and teenagers, and the risk factors for developing the condition. It also provides information on the diagnosis, treatment, and outlook of pediatric gout.
Gout is a type of inflammatory arthritis where an excess of uric acid in the body causes sharp crystals of uric acid to form inside the joints. The affected joints may become painful, swollen, and stiff.
Pediatric gout is gout that affects children and teenagers. It is very rare in this age group and is typically the result of an underlying medical condition.
However, the research suggests that gout can occur at birth but becomes more common as people get older.
Gout usually starts in the big toe, but it can also affect other joints in the body. Gout symptoms are localized to the affected joints and may include:
- severe pain
Gout occurs as a result of hyperuricemia, the medical term for excessive uric acid levels in the blood. Uric acid forms when the body breaks down chemical compounds called purines. These compounds exist naturally in the body and in the foods that people eat.
As with adult cases, pediatric gout
To diagnose gout, a doctor will ask about a person’s symptoms, take a full medical history, and conduct a physical examination of a person’s body.
They may also conduct further diagnostic tests, which can include the below.
Fine needle aspiration
A doctor may use a needle to draw fluid from an affected joint. They will then examine the fluid with a microscope to check for urate crystals and other atypical factors that may indicate hyperuricemia.
Doctors may recommend a blood test to measure uric acid levels in the blood. In adults, high uric acid levels are those exceeding 7 milligrams per deciliter. In children, uric acid levels can vary during their development.
Uric acid levels gradually increase from birth throughout childhood. Males experience a more sudden rise in uric acid levels around age 12 compared with females of the same age.
It is also possible to have high uric acid levels and not have gout.
According to a 2019 review, research has shown a link between pediatric gout and the following conditions:
- kidney transplant
- Down syndrome
- glycogen storage disease
- methylmalonic acidemia, where the body is unable to break down certain proteins or fats
The review also lists the following risk factors for high uric acid levels:
A 2019 review outlines various treatments for gout in children. Some examples are below.
Obesity is a risk factor for gout. Children who have gout associated with obesity may benefit from maintaining a moderate weight through diet and regular physical activity.
Health experts state that some children may need to reduce their intake of foods that are high in purines. A nutritionist or dietician can offer advice on high-purine foods to avoid. Examples of such foods include certain types of seafood and animal organ products. Additionally, soda drinks containing fructose may also produce more purines when the body breaks them down.
Below are some medications that may help treat pediatric gout or its underlying cause. However, some may be off-label and may have significant side effects. Always consult a doctor before starting on any medications.
Xanthine oxidase inhibitors
Doctors may use drugs called xanthine oxidase inhibitors (XOIs) to treat certain diseases that have associations with pediatric gout. One common example of XOI for gout is allopurinol. However, this medication may also cause severe side effects affecting the skin, including the rare and serious skin disorder Stevens-Johnson syndrome.
Febuxostat is a newer XOI. It may be effective in lowering uric acid levels in children, particularly those with kidney disease.
Uric acid oxidase
Uric acid oxidases (UAOs) are drugs that may help prevent or treat hyperuricemia in children.
Rasburicase is a UAO that may work more quickly and effectively than allopurinol. However, it can have severe side effects, such as hypersensitivity and hemolysis, the latter of which involves the destruction of red blood cells.
Treatments for flare-ups
The following treatments may help reduce pain and swelling from a gout flare-up:
- applying ice to the affected joint
- elevating the affected joint
- avoiding any activities that place pressure on the affected joints
- reducing stress, which can worsen a gout attack
- drinking plenty of fluids and avoiding sodas
Without treatment, gout can cause severe and potentially debilitating pain and may even lead to chronic arthritis.
Getting a diagnosis and following an appropriate treatment plan is important for addressing the underlying cause, managing the symptoms, and preventing complications.
Gout is a form of inflammatory arthritis where a buildup of uric acid in the blood leads to sharp uric acid crystals forming in the joints. The condition can be very painful. Without treatment, it may lead to chronic arthritis.
Gout is more common in adults than in children. Pediatric gout is very rare and may result from an underlying medical condition, such as obesity, metabolic syndrome, or kidney disease. There is little information on managing this specific condition in children.
Treating gout depends partly on the underlying cause. Options include lifestyle changes, such as maintaining a moderate weight, avoiding foods high in purines, and taking medications to reduce uric acid levels. Following an appropriate treatment plan is important for managing symptoms and reducing the risk of complications.