Gout is a common form of inflammatory arthritis that affects around 3.9% of the population. Approximately 9.2 million people in the US are diagnosed with gout, affecting men and older adults more frequently.
Table of Contents
What is Gout?
Gout is a type of inflammatory arthritis that usually only affects one joint at a time, most often the big toe joint. Symptoms of gout typically flare up for a week or two and then resolve. Symptom flares happen when high urate levels build up in your body, forming needle-shaped crystals in and around the joint. This leads to inflammation, pain, and arthritis of that joint.
Signs And Symptoms
Gout flares usually start suddenly and can last days or weeks before resolving. These flares are followed by long periods of remission in most people, lasting weeks to years. Gout flares often start at night and the intense pain may be bad enough to wake you up. The pain is most severe within the first 12 to 24 hours after it begins. Gout usually occurs in only one joint at a time, most often the big toe. Other commonly affected joints are the smaller toe joints, the ankle, and the knee.
Gout flares can be triggered by certain foods, alcohol, medications, physical trauma, or illness. If left untreated, flares may last longer and start to happen more often. Tophi can also develop in the body if gout is not treated properly. Tophi develop when there is a buildup of crystals that cause hard lumps to form under the skin around joints and other organs. Tohpi start out as painless, but over time they can become painful and may cause bone and soft tissue damage as well as misshapen joints.
Symptoms of gout in the affected joints include:
- Pain that is usually severe and starts suddenly, lasting up to 24 hours
- Lingering discomfort after the most severe pain subsides, lasting a few days to weeks
- Heat or warmth, described as the joint being “on fire”
- Impaired movement in the joint
- Tenderness to the touch, even light pressure
Gout may also affect other areas of the body including:
- Bursae which are cushion-like fluid-filled sacs between bones and other soft tissues
- Tendon sheaths, which are membranes that surround tendons
- Kidneys due to high uric acid levels, leading to stones and sometimes kidney damage
Summary: The most common symptom of gout is pain in the big toe that is severe and starts suddenly. The affected joint may also be warm, swollen, and red with stiffness and impaired ability to move.
Stages of Gout
Gout can move through several stages involving periods with symptoms, the time between gout attacks, and the progression of the disease. These stages involve:
- Hyperuricemia: the stage before symptoms develop where elevated levels of urate are in the blood and crystals are forming in the joint
- Gout flare: attacks of intense pain and swelling in the affected joints
- Interval or inter critical joint: time between gout attacks when symptoms are in remission
- Tophi: late-stage gout when crystals build up in the skin or other areas of the body causing damage to the joints and other internal organs such as the kidneys
Summary: Gout typically progresses through several different stages including abnormal blood tests before symptoms occur, flares of pain followed by remissions, and late-stage gout involving hard lumps forming under the skin around the joint.
The breakdown of chemicals called purines (found in certain food and drinks) causes the body to make uric acid, a normal byproduct that gets filtered through the kidneys and exits the body through urine. When the body produces too much uric acid or the kidneys do not filter it well, uric acid crystals can concentrate in the joints. These sharp needle-like crystals cause the symptoms of gout such as pain and swelling around an affected joint.
There are many different risk factors for gout, including lifestyle factors, other health conditions, and medications. Gout is more common in men than women and usually develops in middle age. Women do not typically develop gout before menopause which is why gout is more prevalent in women at a later age than men. Gout rarely affects young people, but if it does the disease tends to be more severe.
Some of the most common risk factors for gout include (1):
- Having high urate levels (though this does not always lead to symptoms of gout)
- Having a family history of gout which increases the risk of developing the disease
- Male gender, men are three times more likely than women to develop gout
- Increasing age, men over the age of 40, and women after menopause
- Recent surgery or trauma can sometimes trigger a count attack
- An imbalanced microbiome is implicated in most inflammatory diseases including gout
- Drinking alcohol, the risk of developing gout is greater as alcohol intake increases
- Eating foods that are rich in purines (red meat, organ meat, and some kinds of seafood such as anchovies, sardines, mussels, scallops, trout, and tuna)
- Drinking beverages containing high-fructose corn syrup (for example, soda)
These health conditions may increase your risk of developing gout:
- Obesity which causes the body to produce more uric acid, and kidneys have a more difficult time filtering it out
- Metabolic syndrome (a group of conditions that include high blood pressure, high blood sugar, abnormal cholesterol levels, and excess body fat around the waist)
- Congestive heart failure
- Chronic kidney disease
- High blood pressure
- Conditions that cause your cells to turn over rapidly including psoriasis, hemolytic anemia, and some cancers
- Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome (rare conditions that cause impaired regulation of urate levels)
These medications can increase your risk of developing gout (2):
- Diuretics, which help your body eliminate excess fluid
- Low-dose aspirin
- Niacin (vitamin B3), when taken in large amounts
- Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers which help to lower blood pressure
- Cyclosporine, which is an immunosuppressant for people who have organ transplants or autoimmune disease
Summary: There are several different risk factors for gout including male gender, increasing age, a diet high in purines, certain health conditions, and medications.
How Is Gout Diagnosed?
People with gout usually seek treatment from a primary care provider due to sudden or severe pain in a joint. Your doctor may also send you to a rheumatologist who specializes in gout and other types of arthritis.
Your doctor will take into consideration several things when confirming a diagnosis of gout including (3):
- Symptoms: you will be asked to describe your symptoms, how often they happen, and how long they last
- Medical history: including other any other conditions and family history
- Physical examination: observation of the affected joint to look for swelling, redness, and warmth
- Blood work: a test can measure the amount of uric acid in the blood
- Imaging: x-rays, ultrasound, and/or MRI may be required to confirm gout and rule out other conditions
- Aspiration: a needle is used to pull fluid from the joint and look for uric acid crystals (confirming gout) or a different problem (such as bacterial infection)
Summary: Gout is diagnosed through a combination of medical history, physical examination, blood work, imaging, and joint aspiration. Most people with gout see a rheumatologist who is a doctor specializing in arthritis.
With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis. Most people can avoid gout flares and decrease the severity of their symptoms. It is even possible to become resolve symptoms entirely with treatment.
Medication is one of the most common options for treating gout. Medications are used to help manage the pain of a flare, lower uric acid levels, and prevent tophi and kidney stones from forming. There are also certain medications that should be avoided in those with gout. Diuretics and some immunosuppressants can lead to elevated uric acid levels and worsen symptoms of gout.
Drugs that help to control symptoms include:
- Non-steroidal anti-inflammatory drugs (NSAIDs): this class of medication is used to control pain and swelling. They can be prescribed by your doctor or over the counter. Examples include Ibuprofen, Aspirin, Naproxen, and Meloxicam.
- Colchicine: this medication is an anti-gout agent and an anti-inflammatory. Colchicine is used to treat and prevent gout attacks. It can reduce inflammation and pain if taken within 24 hours of a gout attack (4).
- Corticosteroids: steroids are powerful anti-inflammatories and can quickly relieve pain and swelling. These can be given by mouth or with an injection.
Drugs that help lower levels of uric acid in the body to prevent or reduce future episodes of gout attacks include:
- Allopurinol: this drug is a xanthine oxidase inhibitor and works by reducing the production of uric acid in the body. This is the first choice for treating gout.
- Febuxostat: this drug is a xanthine oxidase inhibitor and is used in patients with gout who did not respond to allopurinol. This is the second choice for treating gout since it carries a higher risk of heart-related death (6).
- Pegloticase: this drug is an enzyme that helps to break down uric acid in the body. It is given by IV infusion and is the treatment for severe chronic gout that does not respond to allopurinol and febuxostat.
- Probenecid: this drug is a uricosuric and lowers high levels of uric acid in the body by helping the kidneys filter and dispose of it through urine.
Diets that are high in purines can trigger uric acid buildup and the symptoms of gout. It is best to limit the intake of purines to manage gout symptoms. Diet recommendations for those with gout include choosing healthier beverages and avoiding alcohol and sugary drinks as well as avoiding foods that are high in purines (5).
Foods and drinks containing high purine levels include:
- Alcohol, especially beer
- Red meat and organ meats (for example, liver)
- Seafood including anchovies, sardines, mussels, scallops, trout, and tuna
- Drinks and foods high in fructose (fruit sugar and soda)
- Protein from animal sources (all protein from animal flesh can potentially lead to elevated uric acid levels)
An overall healthy eating plan, such as the Mediterranean diet may also help prevent gout attacks. A healthy diet should emphasize fruits, vegetables, nuts, whole grains, and other unprocessed foods which help to significantly lower uric acid levels and the risk of gout. A healthy diet can also help prevent other risk factors for gout such as high cholesterol and heart disease.
Exercise is part of a healthy lifestyle and can help to manage the symptoms of gout. It is recommended that adults engage in at least 150 minutes of moderate physical activity per week (7). Any type of physical activity counts, as long as it is moderate intensity (enough to get your heart rate elevated). Low-impact activities are sometimes better tolerated by those with joint pain and can include walking, swimming, or biking.
Exercise can also help with weight loss. For people who are overweight or obese, losing weight reduces pressure on the joints. Reaching or maintaining a healthy weight can relieve pain, improve function, and slow the progression of arthritis.
Exercise has also been proven to help manage some of the risk factors for gout including diabetes, high blood pressure, and metabolic syndrome. Not only can exercise help treat gout after it has been diagnosed, but it can also help prevent gout from developing in the first place.
There are several lifestyle modifications that can help prevent and treat gout. One of the best ways to protect your kidneys from the effects of gout is to drink plenty of water. This helps you avoid dehydration and will help your kidneys function better to filter uric acid (8). The recommended amount of water intake per day is 15.5 cups (3.7 liters) for men and 11.5 cups (2.7 liters) for women.
Increasing physical activity and making it part of your daily routine is also an important part of managing gout. For people who are worried that physical activity may make their symptoms worse or are unsure how to exercise safely, participating in group classes or working with a physical therapist can help. Choosing activities that are easy on the joints, especially during a flare, such as walking, biking, and swimming is also recommended.
People with gout are at risk of developing more severe conditions. If left untreated, gout can also progress to a more severe form of the disease. The most common complications of gout include:
- Recurrent gout: some people may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. When left untreated, gout can cause erosion and destruction of the joint.
- Advanced gout: untreated gout causes deposits of uric acid crystals to form under the skin in nodules called tophi. Tophi most commonly develop in the fingers, hands, feet, elbows, or Achilles tendons. Tophi can become swollen and tender during gout attacks.
- Kidney stones: urate crystals may collect in the urinary tracts of people with gout, causing kidney stones. Medications can be used to help reduce the risk of forming these stones.
Summary: There are many different treatment options for people with gout including medication, diet, exercise, and lifestyle modifications. Limiting purines and eating an overall healthy diet can help manage the symptoms of gout.
Gout is a form of inflammatory arthritis that is caused by an excess of uric acid in the body that leads to the formation of needle-like crystals in the joint. Gout usually affects only one joint at a time, most commonly the big toe, but can also cause symptoms in the fingers, lesser toes, ankles, and knees. The most common symptom of gout is sudden and severe pain in the joint which is also accompanied by swelling, warmth, and loss of range of motion. There are several risk factors for gout including family history, sex, age, diet, health conditions, and medications. Gout can be treated successfully by a combination of medication, diet, exercise, and lifestyle modifications. It is important to effectively manage the symptoms of gout to avoid complications such as recurrent gout attacks, advanced gout, and kidney stones.