Gout

What is gout?

Gout, sometimes called gouty arthritis, is a common type of inflammatory arthritis. With gout, uric acid crystals build up and form needle-like structures in the joints. These crystals cause swelling, intense pain and joint damage from arthritis.

Gout is common in the joints of the feet, especially the big toe, but it can also affect other joints such as the other toes, knees, ankles, elbows, wrists and fingers. Gout may also develop in your kidneys, the membranes around your tendons and your bursa (tiny sacs between bones and other tissues).

What are the symptoms of gout?

Gout symptoms usually appear suddenly. The pain may wake you up at night. The joint can be so sensitive that the weight of your sheet or the pressure of a sock causes pain.

With gout, you might notice:

Sudden and severe joint pain
Swelling
Redness or discoloration
Tenderness
Warmth - it can feel like your joint is burning
Stiffness
An ache or discomfort that lasts for a few days to a few weeks after the intense pain at the beginning
Reduced range of motion over time

You’re more likely to have gout attacks at night. Certain foods, alcohol and stress can trigger them. Symptoms usually come and go. Some people have flares often, and others may go years without having a flare. Most likely, once you have a gout attack, you’ll have another one within a year.

What are the stages of gout?

There are several stages of gout:

Hyperuricemia: Uric acid crystals are beginning to develop but you don’t have symptoms. Some people never develop symptoms.
Gout attacks: The time when you experience gout symptoms.
Interval/intercritical gout: The time when you’re not having a gout flare.
Tophi: Deposits of crystals form under the skin, typically in your fingers, hands, elbows, ankles or feet. They are usually only uncomfortable or painful during a gout flare.

What Is pseudogout?

Pseudogout (or calcium pyrophosphate dihydrate deposition disease (CPPD)) is another type of crystalline arthritis where crystals affect the joints. However, in CPPD, the crystals are made from calcium phosphate, not uric acid. It’s more common in your wrist or knee than in your big toe. CPPD is treated very differently than gout as CPPD does not respond to most gout medication.

What causes gout?

You can develop gout if your body either produces too much uric acid (hyperuricemia) or doesn’t get rid of enough uric acid. Your body naturally creates uric acid when it processes purines (chemical compounds found in some foods).

Your body contains some purines naturally, and you create more of them when you eat or drink purine-rich foods or beverages, such as:

Red meat, deli turkey, organ meats such as liver and kidneys and game meats such as venison and goose
Gravy or meat sauce
Seafood such as anchovies, codfish, haddock, herring, mussels, sardines, scallops, trout and tuna (although many health experts believe the health benefits of eating seafood may outweigh the risks of gout)
Alcohol (especially beer)
Drinks sweetened with fructose (sugar from fruits) or high fructose corn syrup

Normally, your kidneys process uric acid, and it leaves your body in your urine. When this process doesn’t work correctly, however, the uric acid forms crystals in your joints.

You’re at higher risk for gout if you:

Are male. Men are three times as likely to have gout as women, and it most commonly affects men between ages 30 and 50.
- When women get gout, it usually starts after menopause. That’s because the estrogen in their bodies before menopause helps protect them from gout.
Have a diet that’s heavy in the foods and drinks that cause gout.
Drink alcohol, especially beer.
Have a family history of gout or genetic factors that make it easier for you to develop gout.
Are overweight or obese (your body makes more uric acid and doesn’t process it as well when you are overweight).
Have medical conditions such as kidney disease or poor kidney function, metabolic syndrome, diabetes or insulin resistance, high blood pressure, heart disease, congestive heart failure, kidney disease, psoriasis, hemolytic anemia or certain cancers.
Have rare conditions that don’t allow your body to make the enzyme that helps process uric acid (Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome)
Take certain medications such as low-dose aspirin, niacin, cyclosporine, immunosuppressants, thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors or beta blockers.
Have an imbalance in your gut bacteria (microbiome).
Recently had surgery, an infection, a serious illness or experienced trauma.

How is gout diagnosed?

Any time you have sudden intense pain, you should contact your health care provider. If you have a fever, see your provider right away or visit an urgent care center or emergency room. Fever with joint pain could mean you have an infection.

If you think you may have gout, it’s very important to consult a health care provider as soon as possible. Your provider needs to see you while you’re having a gout flare to give you an accurate diagnosis. Symptoms usually peak in 12 to 24 hours and then slowly go away.

You may want to see a rheumatologist (a doctor who specializes in treating arthritis and inflammatory conditions). That’s because gout’s symptoms are sometimes the same as other inflammatory diseases. Once you’ve seen a rheumatologist for diagnosis and treatment, your primary care provider can help you manage your gout.

When gout is diagnosed early and treated properly, you can avoid future flares and even keep it in remission. But untreated gout can affect more joints and lead to more pain and damage to your joints.

Here are some of the ways your doctor may diagnose gout:

Physical exam.
Medical history review, including notes on other family members who have gout.
Joint fluid analysis: This test is the best way to diagnose gout. For this test, your doctor uses a needle to remove fluid from your joint. The lab can then look at the fluid under a microscope to check for crystals.
Blood tests: Blood tests can measure the level of uric acid in your blood. However, some people have high uric acid levels and don’t have gout. Other people have symptoms of gout without high levels of uric acid.
X-rays, MRI or CT scans: These imaging tests can show crystals or rule out other causes of pain and inflammation.
Ultrasound: This test uses sound waves to look for crystals in your joints.
Dual-energy computerized tomography (DECT): This test uses X-rays taken from different angles to check for crystals.

How can you treat gout?

To help control gout, your doctor may prescribe medications that can help relieve pain, lower inflammation and manage gout symptoms.

These medications treat the pain of acute attacks:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin) and naproxen sodium (Aleve) or prescription NSAIDs, such as celecoxib (Celebrex) or indomethacin (Indocin or Tivorbex).
- Some people develop stomach pain, ulcers or bleeding from these drugs. NSAIDs are not recommended for people who take blood thinners or have a history of bleeding.
Colchicine (Colcrys, Gloperba or Mitigare), which is effective at relieving pain but can cause nausea, vomiting or diarrhea. Taking lower doses may minimize side effects.
Corticosteroids, which you can take as a pill or have injected into your joint. People who take corticosteroids may experience increases in blood sugar and blood pressure as well as mood changes.

If possible, stopping certain medications (such as diuretics) can also help prevent gout flares.

If you have gout flares several times a year or have joint damage, tophi (crystals that form under your skin), kidney stones or kidney disease, your doctor may recommend:

Allopurinol (Aloprim, Lopurin or Zyloprim) or febuxostat (Uloric) to help lower uric acid levels. Side effects of these medications include fever, rash, nausea, hepatitis and liver, kidney or heart problems.
Probenecid (Probalan) to improve uric acid removal. Side effects include kidney stones, stomach pain and rash.

How can you manage gout?

Preventing gout attacks and managing the condition is very important so that you don’t damage your joints. To keep your gout under control, stay in close communication with your health care provider, have regular check-ups and take your medications as prescribed.

Gout flares usually last for a week or two. Your health care provider can offer advice on managing your pain and taking medication during flares. It can help to:

Rest the affected joint.
Apply ice packs for 15 to 20 minutes several times a day.
Elevate the affected foot.

To reduce the risk of flares and manage gout long-term, you may want to:

Follow the Mediterranean diet or the DASH diet.
Avoid foods that are high in purines (see list above).
Eat more fruits (especially cherries) and vegetables. One study found that people who ate cherries had fewer gout flares. Eating cherries and taking allopurinol was even more effective.
Choose low-fat dairy, since dairy proteins help your body get rid of uric acid.
Avoid alcohol (especially beer).
Avoid drinks sweetened with high-fructose corn syrup.
Stay well hydrated to help your kidneys perform at their best.
Maintain a healthy body weight — losing weight can help manage gout if you’re overweight or obese.

Exercise can help keep your joints healthy. Try to get 150 minutes of physical activity a week, but don’t push your joints too hard. If exercise makes your joints sore or achy, try switching to low-impact options like walking, cycling and swimming.

It can also be helpful to pay attention to what’s going on in your life when you have a gout flare. You may be able to pinpoint certain things that make your gout worse, then make changes that lower your symptoms.

What are the complications of gout?

People with gout are also more likely to have:

Joint damage
Tophi, which can damage bone and body tissues and cause your joints to become misshapen
High blood pressure
Narrowing of the arteries
Osteoarthritis
An increased risk of prostate cancer
Kidney stones, since the same crystals that cause gout can also collect in your urinary tract
Kidney diseases
Diabetes
Obesity
Erectile dysfunction (ED)
Heart problems, including heart attack and congestive heart failure
Depression

You can avoid many of the complications of gout by talking to your provider and following their treatment plan.