Gout: Everything You Need to Know
It is possible to treat painful episodes of gout by avoiding certain foods that can trigger the condition. However, as gout shares some symptoms with other types of arthritis, it can be difficult to diagnose.
Read on to find out more about the condition. This guide includes information about how to recognize symptoms of gout, how to treat the condition, and when to contact a doctor.
Key facts about gout
- Gout affects around 8.3 million adults in the U.S.
- It is more likely to affect males than females.
- Symptoms include swelling, pain, and heat around the affected joint.
- The big toe is often the first joint that gout affects.
- Medication and dietary changes can help manage symptoms of gout.
Read the full article and view our gout hub for more information.
Gout is a common form of arthritis that occurs when there is a buildup of uric acid crystals in the joints. Uric acid is a substance in the blood that is produced by the breakdown of waste products called purines. If the body produces too much uric acid, or if the kidneys do not effectively eliminate uric acid, it can form deposits of crystals in the joints.
Around 90% of people with gout have kidneys that do not remove uric acid effectively. About 10% of people who experience gout have bodies that make too much uric acid.
Gout typically affects one joint at a time, and it will often appear in the big toe first. Other areas gout can affect include the:
As the “pseudo” in its name suggests, pseudogout is not actually gout. However, it does have very similar symptoms, as both cause intense pain and swelling in a joint due to the buildup of crystals in the affected area.
However, while gout is due to an excess of uric acid, pseudogout results from the presence of calcium pyrophosphate dihydrate crystals. The medical name for pseudogout is calcium pyrophosphate deposition disease.
Unlike with gout, in which diet modification is important, diet is not as closely linked to pseudogout.
Treatment for pseudogout is similar to that for gout, including taking over-the-counter pain relievers, resting the affected joint, and making lifestyle changes to minimize the risk factors associated with pseudogout flares. Learn more about pseudogout here.
Gout tends to happen in acute stages called attacks or flares. Gout flares can last from days to several weeks, and then you may experience periods of remission wherein you may not have any symptoms for weeks, months, or even years.
Symptoms of gout include:
- joint swelling
- intense pain
- heat around the affected joint
Your first flare of gout will usually affect your big toe, but you may also experience symptoms in other joints. It can often start suddenly at night, and the pain may be severe enough to wake you up.
Although gout is a chronic condition for which there is currently no cure, it is possible to manage it with a combination of medications and self-care. The goals of gout treatment include managing the pain of current flares and lessening the severity and frequency of future flares.
You can treat a gout flare with anti-inflammatory medications, such as ibuprofen and colchicine. Colchicine works best at the beginning of a flare.
Your doctor may prescribe corticosteroids to decrease inflammation, relieve pain, and slow down damage to the joints. You can take corticosteroids orally, or your doctor can inject cortisone at the site of the inflammation.
As excess uric acid levels are the main cause of gout, your doctor may prescribe medications to manage hyperuricemia. These might include:
- xanthine oxidase inhibitors to prevent your body from producing urate
- uricosuric agents to help the kidneys to flush out urate
- uricase, which breaks down urate for easier removal from the body
Alongside taking medication, practicing self-care can help alleviate some symptoms of a gout flare. This can include:
- staying hydrated and drinking lots of water to help to flush out uric acid
- applying a cool compress to the affected area to reduce swelling and inflammation
- using a cane to relieve pressure from inflamed joints
- elevating your swollen foot or toe when possible so that it is higher than your chest
- cutting out the big toe section from socks to reduce pressure
A healthy, balanced diet is beneficial for many chronic conditions, including gout. Eating nutritious foods and avoiding unhealthy items can help manage some of the risk factors for gout, minimize triggers of gout flares, and slow the progression of joint damage from gout.
Your doctor will be able to help you to put together your DASH eating plan. It will typically include:
- whole grains
- low fat or fat-free dairy
- nuts and seeds
- vegetable oils
With the DASH diet, you will avoid:
- fatty meats
- full fat dairy
- beverages sweetened with sugar
- foods high in sodium
- foods made with tropical oils, such as coconut oil and palm oil
Other diet tips
Other tips to help you have a balanced diet and reduce your risk of gout flares include:
- avoiding alcohol
- avoiding sodas and other beverages containing high fructose corn syrup
- reducing animal protein and substituting for plant-based protein
- avoiding red meats and organ meats rich in purines, such as:
- avoiding seafood and shellfish, such as:
Contact your doctor before making any significant changes to your diet.
Gout occurs as a result of hyperuricemia. The breakdown of waste products called purines produces uric acid, and hyperuricemia occurs when there is an overproduction of uric acid by the body or when the kidneys are unable to effectively eliminate uric acid through urination.
Excess uric acid can build up and form crystals in and around the joints, resulting in gout symptoms. These include inflammation, pain, flushing, stiffness, and heat in and around the joints.
Although hyperuricemia is a cause of gout, it is not the same as gout. You may have hyperuricemia and not have gout. The exact cause of hyperuricemia is not always known, and there are many possible causes.
As the symptoms of gout can mimic those of other types of arthritis, getting an accurate diagnosis is a critical step toward finding effective gout treatment. Your doctor will likely refer you to a rheumatologist, or a doctor who specializes in various types of arthritis, to make a gout diagnosis and discuss treatment options.
To diagnose your condition, your doctor will ask you several questions related to your symptoms. These might include:
- How long have you experienced symptoms for?
- Which joints do the symptoms affect?
- How severe is the pain, and how long does it last?
- Are you experiencing any other symptoms?
- When do your symptoms occur?
- What type of diet do you eat?
- Do you have a family history of gout?
For an accurate diagnosis, your doctor will test your affected joint during a gout flare. The presence of uric acid crystals in the joint confirms a diagnosis of gout.
Tests doctors use to diagnose gout include:
- a joint fluid test, in which the doctor uses a needle to draw a sample of fluid from the affected joint and evaluate it for uric acid crystals, which can be directly visualized using a microscope
- Crystals may also occur under the skin in deposits known as tophi, which indicate advanced gout.
- a blood test to measure levels of uric acid in the blood, though this may not be a direct indicator of gout
- X-rays to evaluate joint damage and rule out other possible causes of joint symptoms
- imaging scans, including ultrasound scans and dual-energy CT scans, to detect and visualize urate crystals in or around the joints
Several risk factors may make you more prone to developing gout. Males are more likely to develop gout than females, and the condition typically begins in middle age.
Other risk factors for gout include:
- having high urate levels
- having a family history of gout
- eating a diet rich in purines
- consuming beverages that contain high fructose corn syrup
- drinking alcohol
Some conditions may also increase the risk of gout. These include:
- metabolic syndrome, which includes:
- chronic kidney disease
- hemolytic anemia
- Kelley-Seegmiller syndrome
- Lesch-Nyhan syndrome
Some medications can also increase your risk of developing gout. These include:
- low dose aspirin
Ensure that your doctor is aware of any medications you are taking, particularly if they may be contributing to the development of gout.
The main complications of gout include:
- damage to the joints
- kidney stones
Tophi are uric acid crystals that build up under the skin and appear as small white or yellow lumps. They are typically painless and can form anywhere in the body. The most common places where tophi occur include the:
Tophi do not usually develop until several years after the first flare of gout. They are typically a sign of severe gout.
If you do not receive treatment for gout, the condition can become more frequent and prolonged. This increases the risk of sustaining permanent damage to the joints.
Contact your doctor as soon as you notice symptoms of gout. Starting treatment as early as possible will help reduce your risk of needing surgery to repair or replace damaged joints.
Kidney stones and the decline in kidney function can occur as a result of high levels of uric acid. Uric acid stones may remain in the kidney, or they may pass down into the ureter via the urinary tract. Stones can cause pain, infection, and difficulties with urination.
A recent analysis of cases of kidney stones found that around 5.3% of kidney stones were uric acid stones. The most common component, however, was calcium oxalate, which accounted for 77.5% of kidney stone cases.
If you have uric acid kidney stones, your doctor may prescribe medications to reduce acid in the blood and make the urine less acidic. You may need to undergo surgery to remove larger stones.
There are steps you can take to help prevent or reduce the severity of a gout flare. These can include:
- lowering urate levels by eating a diet that includes:
- whole grains
- low fat or fat-free dairy
- avoiding foods high in saturated fat
- limiting foods and beverages sweetened with sugar
- exercising regularly and maintaining a moderate body weight
- drinking plenty of water to help flush out uric acid
Some people also recommend cherry juice for preventing or reducing the severity of a gout flare. However, research published in Rheumatology suggests that tart cherry concentrate does not reduce levels of serum urate in people with gout.
Here are some other questions that people have asked about gout. These questions have all been answered by Dr. Margaret R. Li, M.D., FACR.
What causes high levels of uric acid?
There are various causes of hyperuricemia resulting from an overproduction of uric acid. These include genetic disorders with enzyme defects, drugs such as chemotherapy, diet-related disorders such as vitamin B12 deficiency, alcohol use, and medical conditions such as blood disorders and certain cancers.
There are also disorders and factors that are associated with decreased uric acid clearance, including underlying kidney disease, medical conditions such as endocrine disorders, and medications such as laxatives or diuretics.
What is the best type of cherry juice for gout?
Some anecdotal reports and small case studies have suggested that cherries and cherry juice concentrate may reduce gout flares because of the anti-inflammatory and antioxidant effects of anthocyanin. However, more studies are needed in this area to make any formal recommendations.
How long does gout last if left untreated?
If a gout flare is untreated, it can last days to a few weeks. With untreated gout, flares can become more frequent and severe, and episodes may last longer, eventually involving more than one joint at a time. Tophaceous gout can occur and cause joint deformities as well as increased risks of kidney stones and cardiovascular disease.
- 6 Symptoms Never to Ignore with Gout
- 9 Tips for Coping with Gout Pain
- Recovery After a Gout Flare-Up: What to Expect
- Treatment Options for Severe Gout
Gout is a type of inflammatory arthritis that occurs as a result of excess uric acid depositing uric crystals in the joints. This typically begins in the big toe and often affects one joint at a time. Males are more likely to experience gout than females.
The symptoms of gout can be similar to those of other types of arthritis, but testing joint fluid and conducting blood and imaging tests can help with diagnosis. Following a gout diagnosis, treatment typically involves taking medications and making changes to your diet.
Contact your doctor if you experience symptoms of gout. Early diagnosis and treatment can help reduce your risk of complications, such as kidney stones and permanent joint damage.