Gout

What is gout?

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

Gout most commonly affects your big toe joint. But it can affect other joints, including your:

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

Gout symptoms come and go (recur) in episodes called flares or gout attacks. A healthcare provider will suggest medications and changes to your diet that will lower your uric acid levels and minimize how often you experience gout attacks in the future.

What are gout symptoms?

Gout attacks are very painful and can happen suddenly, often overnight. During a gout attack, symptoms in your affected joints may include:

• Intense pain.
• Discoloration or redness.
• Stiffness.
• Swelling.
• Tenderness, even to a light touch (like a bedsheet covering your affected joint).
• 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. You might have some flares that last longer than others, and some might cause more severe symptoms. Between attacks, you might not experience any gout 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 chemicals called purines found in certain foods and drinks. Your kidneys usually filter uric acid out of your blood, and 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 (hyperuricemia), 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.Having temporarily high uric acid levels doesn’t mean you’ll definitely develop gout. Many people with hyperuricemia never get gout.

Gout risk factors

Gout can affect anyone. People assigned male at birth (AMAB) are three times more likely to develop gout. People assigned female at birth (AFAB) 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.
• Hypertension (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 — especially animal flesh, shellfish and foods that contain organ meat.
• Drink alcohol regularly.
• Take a diuretic medication (water pills).
• Take immunosuppressants.

Which foods cause gout?

Eating or drinking foods high in purines are more likely to lead to high uric acid levels in your body that cause gout, including:

• Sugary drinks and sweets: Standard table sugar is half fructose (fruit sugar), which breaks down into uric acid. Any food or drink with high sugar content can trigger gout.
• High fructose corn syrup: This is a concentrated form of fructose. Packaged food products and processed snacks can contain lots of high fructose corn syrup.
• Alcohol: Even though not all alcoholic drinks are high in purines, alcohol prevents your kidneys from eliminating uric acid, pulling it back into your body, where it continues to accumulate.
• Organ meats: These include liver, tripe, sweetbreads, brains and kidneys.
• Game meats: Specialties such as goose, veal and venison all contain high levels of purines.
• Certain seafood: Herring, scallops, mussels, codfish, tuna, trout and haddock.
• Red meat: Beef, lamb, pork and bacon.
• Turkey: Especially processed deli turkey.
• Gravy and meat sauces.

How is gout diagnosed?

A healthcare provider will diagnose gout with a physical exam. They’ll ask you about your symptoms and examine your affected joints. Tell your provider when you first noticed symptoms like pain and swelling in your joint and how often the symptoms come and go.

What tests will be done to diagnose gout?

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.
• Magnetic resonance imaging (MRI).
• A CT (computed tomography) scan — specifically a dual-energy CT scan.

Other common tests to diagnose gout include:

• Blood tests to measure the uric acid in your blood.
• Joint aspiration — using a needle to remove a sample of fluid from inside a joint.

How is gout treated?

Treating gout is usually a combination of managing your symptoms during a flare and reducing how often you consume high-purine foods and drinks.

Gout medication

Your healthcare provider might suggest medications to help manage your symptoms, including:

• NSAIDs: Over-the-counter (OTC) NSAIDs, like ibuprofen and naproxen, can reduce pain and swelling during a gout attack. Some people with kidney disease, stomach ulcers and other health problems shouldn’t take NSAIDs. Talk to your provider before taking NSAIDs.
• Colchicine: Colchicine is a prescription medication that can reduce inflammation and pain if you take it within 24 hours of a gout attack.
• Corticosteroids: Corticosteroids are prescription medications that reduce inflammation. Your provider might prescribe oral (by mouth) pills. They may also inject corticosteroids into your affected joints or into a muscle near your joint (intramuscularly).

Your provider might prescribe medications to help lower your uric acid levels. The most common medications that lower uric acid include:

• Allopurinol.
• Febuxostat.
• Pegloticase.
• Probenecid.

Low purine diet for gout

Your healthcare provider may suggest you follow a low-purine diet. A low-purine diet encourages you to consume fewer foods and drinks with high purine content. This will help reduce uric acid in your body. It also encourages you to eat some select foods that may reduce your uric acid levels.

Can gout be cured?

There’s no cure for gout. You’ll experience fewer attacks once you work with a healthcare provider to find treatments that manage your symptoms and lower your uric acid levels.

Can I prevent gout?

The best way to prevent gout is to limit how often you consume high-purine foods and drinks. Make sure you drink plenty of water to help your kidneys function better and avoid dehydration.

Getting regular exercise can help reduce stress on your joints and reduce your risk for obesity and other health conditions that make you more likely to develop gout.

What can I expect if I have gout?

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

Some people with gout experience more severe or more frequent attacks right after starting treatment as the uric acid in their body adjusts to new medications or changes in their diet.

What’s the outlook for people with gout?

Most people with gout eventually find a combination of treatments and lifestyle tweaks to manage their symptoms and reduce how often they experience gout attacks. Gout is treatable, People who have a blood uric level lower than 6 mg/dL are much less likely to experience gout attacks.

Untreated gout can lead to permanent joint damage. The buildup of uric acid in your joints and soft tissue is called tophus. Some people with gout can also develop other health problems, including:

• Severe arthritis and changes to the shape of your joint (joint deformity).
• Tophi (the plural form of tophus — a buildup of uric acid in the joints and soft tissue).
• Kidney stones.
• Heart disease.

How can I manage a gout attack?

When you have a gout attack, you can manage your symptoms by:

• Avoiding alcohol and sweet drinks.
• Drinking plenty of water.
• Elevating your affected joints above the level of your heart as often as you can.
• Icing your joints. Wrap an ice pack in a thin towel or put a cold compress on your joint for 15-20 minutes at a time a few times a day.
• Limiting stress on your joint by avoiding intense exercise or physical activities.

When should I see my healthcare provider?

Visit a healthcare provider if you experience sudden intense pain in any of your joints, especially if your joint is also swollen and your skin is red or discolored. Gout shares many symptoms with infections that need to be treated right away.

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

What questions should I ask my doctor?

• Do I have gout or another type of arthritis?
• What can I do to prevent future gout attacks?
• Which foods and drinks should I avoid?
• Will I need medication to treat gout?

What are the first signs of having gout?

A gout attack usually happens suddenly and without much warning. You’ll probably notice a sudden, intense pain in your affected joints. Gout attacks often develop overnight, so you might notice symptoms when you wake up in the morning. It’s common to go from having no symptoms to experiencing severe symptoms all at once during a gout attack.

If you haven’t been diagnosed with gout or gout symptoms before, visit a provider as soon as possible to make sure you don’t have an infection or another condition that’s causing your joint pain and swelling.

If you’ve been diagnosed with gout and you notice a flare starting, take the medication that your healthcare provider prescribed to help you manage your symptoms right away.

A note from Cleveland Clinic

Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals that collect in your joints, causing pain, swelling and other symptoms. Talk to your healthcare provider about medication and changes in your diet that can help you manage your symptoms and reduce how often you experience attacks in the future.