Gout

What is gout?

Gout is a type of arthritis that causes inflamed, painful joints. The symptoms are caused by deposits of uric acid crystals in the joints. Gout used to be associated with kings who overindulged in rich food and wine. In truth, anyone can get gout. Gout affects more men than women. It's often linked with obesity, high blood pressure, high cholesterol, and diabetes.

What causes gout?

Gout is caused by a buildup of uric acid in the joints. This is from too much uric acid in the body. Too much uric acid may be caused by several things. It may be caused by the body making too much uric acid. Or the kidneys may not get rid of enough uric acid. It may also be caused by eating a lot of foods that are high in purines. Purines turn into uric acid in the body.

Foods high in purines include:

Alcoholic drinks and sugary drinks high in fructose
Certain meats, such as game meats, kidney, brains, and liver
Dried beans and dried peas
Seafood, such as anchovies, herring, scallops, sardines, and mackerel

Gout attacks may be triggered by any of these:

Drinking alcohol
Eating a lot of protein-rich foods
Emotional stress
Tiredness (fatigue)
Illness
Surgery

Who is at risk for gout?

You are at higher risk for gout if you:

Are a man
Are a postmenopausal woman
Have kidney disease
Have high blood pressure, high cholesterol, or diabetes
Have family members with gout

What are the symptoms of gout?

Gout causes sudden attacks of symptoms that often occur without warning. The attacks may happen again and again. Severe, chronic gout may lead to deformity. Symptoms can occur a bit differently in each person. Common symptoms include:

Hard lumps of uric acid crystal deposits under the skin (tophi)
Severe, sudden pain in one or more joints, often the joint in the big toe
Skin that is red or purple, tight, and shiny over the joint
Swollen joint or joints
Warmth in the joint area
Chills
Fever
General feeling of illness

Some symptoms of gout can be like other health conditions. Make sure to see your healthcare provider for a diagnosis.

How is gout diagnosed?

The process starts with a health history and a physical exam. Your healthcare provider may take a fluid sample from the joint (arthrocentesis) and check it for uric acid crystals.

How is gout treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. Treatment may include these lifestyle changes:

Not having alcoholic drinks
Controlling any other chronic diseases you may have
Drinking more nonalcoholic fluids
Eating less protein-rich foods
Losing weight, if obesity is an issue

You may also need medicines, such as:

Colchicine. This is a medicine to ease the pain and inflammation of an acute attack of gout. This medicine can also be used to prevent gout when you start taking medicine to lower your uric acid level.
Corticosteroids. These reduce inflammation of an acute attack of gout.
Medicines to block how much uric acid your body makes. These will help prevent gout attacks.
Medicines to lower the uric acid level in the blood to prevent gout attacks
NSAIDs (nonsteroidal anti-inflammatory drugs) to ease pain and inflammation of an acute gout attack. These medicines can also be used to prevent gout when you start taking medicine to lower your uric acid level.

In some cases, you may need surgery to remove extremely large uric acid crystals (tophi).

Talk with your healthcare provider about the risks, benefits, and possible side effects of all medicines.

What are the possible complications of gout?

People with gout have a higher risk for kidney stones. This is because of crystal deposits in the kidneys. They can also have kidney damage. Crystal deposits in the joints can cause some disability because of stiffness and pain.

Living with gout

You can reduce the risk for future flare-ups of gout and decrease their severity by making lifestyle changes and taking medicine as prescribed. If you are given medicine to take when a flare-up occurs, start taking it at the first sign of symptoms. Or get medical attention at the first sign of symptoms. To help prevent episodes of gout:

Talk with your healthcare provider before taking any new medicine, including over-the-counter medicines.
Drink plenty of water.
Don’t drink alcohol.
Exercise regularly.
Lose weight if needed.
Don’t eat foods that are high in purines.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about gout

Gout causes inflamed, painful joints because of uric acid crystal deposits at the joints.
Gout can also cause uric acid crystal deposits that cause lumps under the skin.
Gout can be triggered by eating foods high in purines and drinking alcohol.
Treatment of gout is aimed at reducing pain and the risk of future flare-ups.
Gout can be managed with medicines and lifestyle changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your healthcare provider if you have questions.