Gout

Gout is a type of inflammatory arthritis that causes pain and swelling in your joints. It happens when there’s a buildup of uric acid in your body.

Gout most commonly affects your big toe joint. But it can also develop in your:

• Knees
• Ankles
• Feet
• Hands and wrists
• Elbows

Gout symptoms come and go. These episodes are called flares or gout attacks. A healthcare provider will suggest medications to lower your uric acid levels. You may have to avoid certain foods and drinks, too. You should have fewer gout attacks once you find treatments that work for you.

Symptoms of gout

Gout attacks are very painful and can happen suddenly. They often develop overnight. It’s common to go from having no symptoms to experiencing severe symptoms all at once.

During a flare, symptoms in your affected joints may include:

• Intense pain and tenderness, even to a light touch (for example, bedsheets may feel unbearable)
• Skin discoloration
• Stiffness
• Swelling
• Warmth, or a feeling like the joint is “on fire”

How long does a gout attack last?

Gout attacks usually last a week or two. Some flares last longer than others. And some might cause more severe symptoms. Between attacks, you might not experience any symptoms.

What causes gout?

A buildup of excess uric acid in your body causes gout. Your body naturally makes uric acid when it breaks down substances called purines in certain foods and drinks. Your kidneys usually filter uric acid out of your blood. Then, it leaves your body when you pee.

Sometimes, your body makes too much uric acid. Or your kidneys don’t remove it from your blood fast enough. When your body has high levels of uric acid, uric acid crystals can build up and settle into your joints. The sharp crystals clump together and cause sudden episodes of pain, swelling and other symptoms.

You won’t automatically get gout as soon as you have high uric acid levels. In fact, many people have high levels and never experience symptoms. But the longer you have too much uric acid in your body, the more likely it is that you’ll develop gout.

Gout risk factors

Gout can affect anyone. It’s three times more common in males. Females usually don’t experience gout until after menopause. People with certain health conditions are more likely to develop gout, including:

• Overweight or obesity
• Congestive heart failure
• Diabetes
• High blood pressure
• Kidney disease
• Blood cancer

You’re more likely to experience gout if you:

• Have a biological parent or grandparent who has gout
• Eat a lot of animal proteins
• Drink alcohol regularly
• Take diuretics (water pills)
• Take immunosuppressants

Gout complications

Untreated gout can lead to permanent joint damage. It can also increase your risk of other issues, including:

• Tophi, lumps of uric acid in your joints and soft tissue
• Severe arthritis
• Changes to your joints’ shape
• Kidney stones
• Heart disease

How doctors diagnose gout

A healthcare provider will diagnose gout with a physical exam. They’ll ask you about symptoms you’ve experienced and examine your affected joints. Tell your provider when you first noticed pain, swelling or other issues. Let them know if the symptoms come and go.

Your healthcare provider might use a few imaging tests to take pictures of your affected joints. These tests can also show if gout has caused any changes in your joints. You might need:

• X-rays
• Ultrasound
• A CT scan, especially a dual-energy CT scan

Your provider might use blood tests to check how much uric acid is in your blood. They may do a joint aspiration to remove a sample of fluid from inside your joint. They’ll examine the fluid sample for uric acid crystals.

Gout treatments

Treating gout is a combination of managing symptoms during a flare and helping reduce how often you have attacks. You’ll probably need to take some medications and reduce how often you consume high-purine foods and drinks.

Your healthcare provider will suggest medications to manage symptoms during a gout flare, including:

• NSAIDs: Over-the-counter NSAIDs, like ibuprofen and naproxen, can reduce pain and swelling during a gout attack. You may not be able to take them if you have kidney disease, stomach ulcers or other health conditions. Talk to your provider before taking NSAIDs.
• Colchicine: This is a prescription medication that can reduce inflammation and pain, especially if you take it at the first sign of a gout attack starting.
• Corticosteroids: These are prescription anti-inflammatory medications. Your provider might prescribe pills you take by mouth. They may also inject medicine into your joints or a nearby muscle joint.

You may need medication to help lower your uric acid levels. Common examples include:

• Allopurinol
• Febuxostat
• Pegloticase
• Probenecid

Your healthcare provider may suggest you follow a low-purine diet. This is an eating plan that can help you consume fewer foods and drinks with high purine content. It also encourages you to eat some foods that may reduce your uric acid levels.

When should I see my healthcare provider?

Talk to your healthcare provider if you’re having more frequent gout attacks. Or if your symptoms are more severe than they used to be.

If you haven’t been diagnosed with gout, visit a provider if you experience sudden, intense joint pain. That’s especially true if your joint is also swollen and your skin is discolored. Gout shares many symptoms with infections that need immediate treatment.

What can I expect if I have gout?

You should expect to have flares of symptoms that come and go. Flares might happen more often if you don’t get gout diagnosed and treated by a healthcare provider.

You may have more frequent gout attacks right after starting medications to lower your uric acid levels. That’s normal. You can reduce this risk by taking colchicine or NSAIDs.

If you notice a flare starting, take the medication that your healthcare provider prescribes to help you manage symptoms right away.

Can gout be prevented?

Avoiding foods and drinks high in purines can help you lower your gout risk. Examples of high purine foods and drinks include:

• Anything sweetened with sugar or high fructose corn syrup
• Alcohol
• Organ meat, like liver, tripe and kidneys
• Game meat, like goose, veal or venison
• Certain seafood, including scallops, mussels, tuna and cod
• Red meat
• Turkey
• Gravy and sauces that contain meat