What to know about gout

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The main symptom of gout is intense joint pain that reduces to discomfort. The area may be inflamed and discolored.

The symptoms often begin during the night, which can interrupt sleep. The affected joint may feel swollen, stiff, or warm.

Gout frequently develops in the joint at the base of the big toe — one of the metatarsophalangeal joints. But it can also develop elsewhere at the front of the foot or in the ankles, knees, elbows, wrists, or fingers.

It can be acute, with symptoms that come on suddenly. Or gout can be chronic, with more frequent flares and lasting symptoms.

For someone with acute gout:

• Only 1–3 joints are usually affected.
• Symptoms only appear during flares.
• Flares may last a few days to a week.
• When flares subside, the symptoms abate.

For someone with chronic gout:

• Two or more flares occur per year.
• It may affect more than one joint.
• There may only be short breaks between flares.
• Permanent joint stiffness, deformity, and damage are possible.

An excess of uric acid in the body, or hyperuricemia, is the main cause of gout.

Treatment typically involves prescription medication. These drugs can help treat the symptoms, prevent future flares, and reduce the risk of complications, such as kidney stones and acid crystals forming white growths in the affected areas, an issue called tophi.

Common treatments include nonsteroidal anti-inflammatory drugs and corticosteroids, which also combat inflammation. These reduce swelling and pain in the areas that gout affects.

Excessive uric acid levels typically stem from an overproduction of uric acid or issues that affect how the kidneys excrete this substance. Some medicines reduce uric acid production and improve the kidney’s ability to remove uric acid from the body.

Without treatment, an acute gout attack is at its worst 12–24 hours after it begins. A person can expect to recover within 1–2 weeks without treatment, but there may be significant pain during this period.

Tests and diagnosis

Gout can often be challenging to diagnose, as its symptoms are similar to those of other conditions.

Most people who develop gout have high levels of uric acid, but this may not be detectable during a flare-up. As a result, a person does not need to have hyperuricemia to receive a gout diagnosis.

Still, high levels of uric acid in the blood or uric acid crystals in joint fluid are the main diagnostic criteria for gout.

To assess this, a rheumatologist orders a blood test and may also extract fluid from an affected joint for analysis.

In addition, they can use an ultrasound scan to locate uric acid crystals around affected joints or within growths. X-rays cannot detect these signs, but healthcare professionals may use them to rule out other causes of the symptoms.

As joint infections and gout can cause similar symptoms, doctors may also look for bacteria in a joint fluid sample to rule out a bacterial cause.

Uric acid crystals

Uric acid is a normal part of body waste. It is created when chemicals called purines break down. These chemicals exist in many foods and drinks, including shellfish, liver, and alcohol. Uric acid is also created in the body when DNA breaks down.

The body usually excretes this acid through waste. But if the kidneys are not functioning well, or too much uric acid is produced, it can collect in the blood.

Uric acid levels can also rise due to the use of aspirin, diuretics, or niacin or frequent consumption of high-purine foods and drinks.

High levels of uric acid can form crystals in the joints, and this is the cause of gout.

The types refer to the various stages of gout.

Asymptomatic hyperuricemia

A person can have elevated uric acid levels without any symptoms. While people do not need treatment at this stage, high uric acid levels in the blood can cause “silent” tissue damage.

As a result, a doctor may recommend ways to reduce the buildup of this acid.

Acute gout

This involves uric acid crystals in a joint suddenly causing acute inflammation and intense pain. This attack may last between 3 days and 2 weeks. Stress and excessive alcohol consumption can contribute to these attacks, or flares.

Interval or intercritical gout

This is the period in between attacks of acute gout. As gout progresses, these intervals become shorter. Between these periods, uric acid crystals may continue to build up in tissues.

Chronic tophaceous gout

This is the most debilitating type and may result in permanent damage to the joints and kidneys. At this stage, people may have chronic arthritis and develop tophi in cooler areas of the body, such as the joints of the fingers.

Chronic tophaceous gout typically occurs after many years of acute gout attacks. However, it a person receives effective treatment, gout is unlikely to reach this stage.

Pseudogout

One condition that can be easy to confuse with gout is calcium pyrophosphate deposition, known as pseudogout. The symptoms are very similar to those of gout, although the flare-ups are usually less severe.

The major difference between gout and pseudogout is that the joints are irritated by calcium pyrophosphate crystals rather than uric acid crystals. Pseudogout requires different treatments than gout.

Hyperuricemia, an excess of uric acid in the blood, is the main cause of gout.

The body produces uric acid during the breakdown of purines. These are chemicals found in high amounts in certain foods and drinks, such as alcohol, turkey and goose, liver, and seafood.

People trying to limit their intake of purines may wish to opt for duck or chicken instead and should avoid organ meats altogether.

Typically, uric acid is dissolved in the blood and excreted in urine via the kidneys. If the body produces too much uric acid or does not excrete enough, it can build up and form needle-like crystals. These trigger inflammation and pain in the joints and surrounding tissues.

Several factors can increase the risk of hyperuricemia and gout, including:

• Advanced age: Gout is more common in older adults and rarely develops in children.
• Sex: In people younger than 65, gout is four times as prevalent among males as females. It is three times as prevalent in males after the age of 65.
• Genetics: A family history of gout can increase a person’s risk.
• Dietary choices: Alcohol interferes with the removal of uric acid from the body, and a high-purine diet increases the amount of uric acid in the body. Consuming alcohol and having this type of diet can increase the risk of gout.
• Lead exposure: Studies have suggested a link between chronic lead exposure and an increased risk of gout.
• Medications: Certain medications can increase the levels of uric acid in the body. These include some diuretics and drugs containing salicylate.
• Weight: Being overweight or obese and having high levels of visceral body fat are linked with an increased risk of gout. None of these factors directly causes the condition, however.
• Other health conditions: Renal insufficiency and other kidney conditions can reduce the body’s ability to remove waste, leading to elevated uric acid levels. Other conditions associated with gout include high blood pressure and diabetes.

Complications

Gout can progress, causing permanent damage to the joints and kidneys, and it is also linked with kidney stones.

Gout flare-ups, or attacks, happen when uric acid builds up in the body and begins to form needle-shaped crystals within joints.

This usually happens in one joint at a time and may be triggered by:

• certain foods
• alcohol
• medications
• trauma and stress
• some illnesses

A flare-up usually subsides within 2 weeks. The frequency varies from person to person, and an attack may reoccur every few weeks or years. Without treatment, gout flare-ups may last longer and happen more frequently.

A person may be more likely to develop gout if they:

• have high levels of uric acid
• have a family history of gout
• are older
• drink alcohol
• eat purine-rich foods
• drink beverages with high fructose corn syrup
• have certain health conditions, including high blood pressure, chronic kidney disease, overweight, or obesity
• take certain medications

The following lifestyle and dietary strategies can help reduce flare-ups or prevent gout from developing:

• drinking 2–4 liters of fluids a day
• avoiding alcohol
• maintaining a moderate weight
• having a low-purine diet

To help manage flare-ups, a person should limit their intake of foods and drinks high in purines to ensure that uric acid levels stay low.

High purine foods and drinks include:

• red meats
• game meats
• glandular meats, such as kidneys, livers, and sweetbreads
• seafood
• shellfish
• alcohol
• foods and drinks with high fructose corn syrup

However, cutting out altogether purines is not necessary. A moderate consumption of purine-rich foods can help manage uric acid levels and gout symptoms and benefit overall health.

Gout is a type of inflammatory arthritis, and anyone with gout may benefit from general arthritis self-care strategies. These include staying active, maintaining a moderate weight, and doing low-impact exercises to support joint health.

Gout is a common form of arthritis, affecting roughly 4% of the U.S. population, and it is more prevalent in males than females. It can lead to intense pain, swelling, and stiffness in and around certain joints.

Hyperuricemia — excess uric acid in the blood — is the main cause of gout. This may happen if the body produces too much uric acid or if the kidneys do not excrete it effectively.

A doctor typically recommends prescription medications to treat gout by reducing inflammation and helping to regulate uric acid levels. Self-care strategies also help, including limiting the intake of alcohol and foods high in purines and staying well hydrated.