Gout is a painful form of arthritis that causes swollen, stiff joints. It is caused by a buildup of uric acid. Gout can be treated with medication and lifestyle changes.
Gout is a complex form of arthritis. It is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.
Gout can affect anyone, but men are more likely than women to be affected.
Gout happens when uric acid builds up in your body. Uric acid comes from the breakdown of substances called purines. Purines occurs naturally in your body and it is found in foods such as liver, dried beans and peas, and anchovies. Uric acid normally dissolves in the blood and passes out of the body in urine. Sometimes, uric acid can build up and form needle-like crystals. When these crystals form in your joints, it is very painful. The crystals can also cause kidney stones.
Often, gout first attacks your big toe. It can also attack ankles, heels, knees, wrists, fingers, and elbows. At first, gout attacks usually get better in days. Eventually, attacks last longer and happen more often.
An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.
Gout is classified as acute or chronic. Acute gout often affects only one joint, and chronic gout involves repeat episodes of pain and inflammation and more than one joint may be affected.
Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.
Gout causes pain, swelling, redness, heat, and stiffness in joints.
In acute gout, one or a small number of joints are affected, usually the big toe, knee, or ankle joints. The pain starts suddenly, often during the night. Pain is often described as throbbing, crushing, or excruciating. The joint appears warm and red and it is usually very tender and swollen. The symptoms may be accompanied by a fever. The attack may go away in a few days, but it may return from time to time. Future attacks often last longer and affect more joints.
Most people will have no symptoms after a first gout attack, but they are likely to have another attack in the next 6-12 months.
Some people may develop chronic gout. This is also called gouty arthritis. This condition can lead to joint damage and loss of motion in the joints. People with chronic gout will have joint pain and other symptoms most of the time.
Tophi are lumps below the skin around joints or other places such as the finger tips and ears. Tophi can develop after a person has had gout for many years. These lumps may drain chalky material.
Gout occurs when urate crystals accumulate in your joints, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.
Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats, and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. However, sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
The exact cause is unknown. Gout may run in families. The problem is more common in men, in women after menopause, and people who drink alcohol. A gout attack can be brought on by stressful events, alcohol or drugs, or another illness.
You are more likely to have gout if you:
- Have family members with the disease
- Are a man
- Are overweight
- Drink too much alcohol
- Eat too many foods rich in purines
- Have an enzyme defect that makes it hard for the body to break down purines
- Are exposed to lead in the environment
- Have had an organ transplant
- Use some medicines such as diuretics such as hydrochlorothiazide, aspirin, cyclosporine, or levodopa
- Take the vitamin niacin
Gout may also develop in people with:
- Kidney disease
- Sickle cell anemia and other anemias
- Leukemia and other blood cancers
To diagnose gout, your doctor will ask about your symptoms, medical history, and family history of gout.
Tests to help diagnose gout may include:
- Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
- Blood test. Your doctor may recommend a blood test to measure the levels of uric acid and creatinine in your blood.
- X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation.
- Ultrasound. Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus.
Living With Gout
People with gout can take several steps to help themselves stay healthy and prevent gout attacks. They can:
- Take the medicines prescribed by your doctor.
- Tell your doctor about all the medicines and vitamins you take.
- Plan follow-up visits with your doctor.
- Maintain a healthy, balanced diet. Eat whole grains, dairy products, vegetables, buts, legumes, and fruits. Avoid foods that are high in purines, such as red meat, organ meat, and seafood. Limit alcoholic beverages and drinks sweetened with fructose. Instead, drink plenty of water. Drinking coffee and taking vitamin C supplements may help some people.
- Exercise regularly and maintain a healthy body weight. Ask your doctor about how to lose weight safely. Fast or extreme weight loss can increase uric acid levels in the blood. Keeping your body at a healthy weight reduces your risk of gout.
Treatment for gout usually involves medications. The goal of gout therapy is to treat acute attacks and prevent future attacks as well, as to reduce the risk of complications from gout, such as the development of tophi from urate crystal deposits.
Drugs used to treat acute attacks and prevent future attacks include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs should be taken when gout symptoms begin. Common NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin) or celecoxib (Celebrex). You may take a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks.
- Colchicine. Your doctor may recommend colchicine (Colcrys, Mitigare), a type of pain reliever that effectively reduces gout pain, swelling, and inflammation. After an acute gout attack resolves, your doctor may prescribe a low daily dose of colchicine to prevent future attacks.
- Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or they can be injected into your joint. Corticosteroids are generally reserved for people who cannot take NSAIDs or colchicine.
If you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications. Options include:
- Medications that block uric acid production. Drugs such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) limit the amount of uric acid your body makes. This may lower your blood's uric acid level and reduce your risk of gout.
- Medication that improves uric acid removal. Probenecid (Probalan) improves your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased.