Gout

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What is gout?

Gout is a common form of arthritis caused by 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 excessive uric acid is produced by the body or if uric acid is not eliminated effectively by the kidneys, it can form deposits of crystals in the joints.

Uric acid crystals can cause intense and sudden inflammation, pain, redness, stiffness and burning in and around joints that can persist for several weeks. Gout often starts in one of the big toes, but it can also affect the fingers, wrists, elbows, knees, ankles, heels, and other joint areas.

Gout is most commonly seen in men older than age 40, but it can strike anyone, especially postmenopausal women. Pacific Islanders are far more susceptible to gout compared to other ethnic groups. Gout is not curable, but it can be successfully managed with medical therapy and lifestyle changes. Its symptoms resemble those of several other diseases, disorders and conditions, such as psoriatic arthritis and pseudogout.

Prompt diagnosis and treatment of gout can help control symptoms and reduce the risk of complications, such as disability. Seek prompt medical care if you have symptoms of gout, such as pain, redness, burning or swelling of a joint.

A serious complication of gout is kidney stones. Seek immediate medical care (call 911) if you have symptoms of a kidney stone, such as severe flank or abdominal pain, which may occur with bloody urine, reduced urination, or the inability to urinate.

Is pseudogout the same as gout?

As the “pseudo” in its name suggests, pseudogout is not actually gout—but it does have very similar symptoms. 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 (CPDD).

Pseudogout is linked to imbalances of minerals, including excess calcium or a lack of magnesium. It may also be associated with thyroid conditions such as hypo- or hyperthyroidism. Diagnosis of pseudogout takes these factors into consideration, and can include collecting a sample of joint fluid to look for the presence of calcium pyrophosphate dihydrate crystals.

Treatment for pseudogout is similar to that of gout, including over-the-counter pain relievers, resting the affected joint, and making lifestyle changes to minimize the risk factors associated with pseudogout flares.

What are the symptoms of gout?

Gout is a chronic disease that can cause symptoms in acute stages called attacks or flares. The first attack usually occurs at night and is usually limited to one affected joint. Gout flares can last from days to several weeks. Flares can occur regularly for some people, while for others they may occur every few months or even years apart.

Gout flares often include these symptoms in and around joints:

  • Burning or heat
  • Pain
  • Redness
  • Stiffness
  • Swelling
  • Tenderness

For many people, gout flares consistently affect a single lower-body joint at a time, such as the big toe, ankle, heel, or knee. Inflammation can also occur in a finger, wrist, elbow, or other joint area. The symptoms can range from mild to severe and often begin in the middle of the night.

Left untreated, acute gout flares can result in chronic gout or gouty arthritis. This can cause long-term damage to the joints and kidneys, debilitating joint pain, kidney stones, and painful clusters of uric acid under the skin called tophi. Seek prompt medical care if you have symptoms of gout, such as severe joint pain, swelling, burning or redness, or you notice changes in joint shape.

Seek immediate medical care (call 911) if you have symptoms of a kidney stone, such as severe flank or abdominal pain, which may occur with bloody urine, reduced urination, or the inability to urinate.

What causes gout?

Gout is caused by the metabolic problem, hyperuricemia. It is an excessive amount of uric acid in the blood. Uric acid is produced by the breakdown of waste products called purines. Hyperuricemia occurs when there is an overproduction of uric acid by the body or when the kidneys fail to effectively eliminate uric acid through urination. Hyperuricemia and gout may result as a complication of diuretic use, multiple myeloma, cyclosporine use, and chronic kidney disease.

Excess uric acid can build up and form crystals in and around joints, resulting in gout symptoms, such as inflammation, pain, redness, stiffness, and heat in and around joints. In fact, gout can be diagnosed by examining synovial fluid from the affected joint under a microscope to see if it contains the characteristic uric acid crystals.

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 known, but there are some known triggers and risk factors, such as joint injuries and certain medical conditions. There may also be genetic risk factors for gout, since it tends to run in families.

What are the risk factors for gout?

Research has identified several risk factors that can make you more prone to develop gout. Certain factors can be managed with lifestyle changes; others cannot be controlled, such as your family history and certain pre-existing diseases.

General risk factors for gout

Well-accepted risk factors for hyperuricemia and gout include:

  • Certain medications, such as diuretics, immunosuppressants (such as cyclosporine), and aspirin
  • Dehydration
  • Diet containing high levels of purines, including sweetbreads, game meats, alcohol, certain fish and shellfish, and organ meats, such as liver and kidney
  • Family history of gout
  • Male older than 40

Diseases and disorders that increase the risk of gout

Certain diseases, disorders and conditions can increase the risk of gout including:

  • Cardiovascular disease (due to atherosclerosis, or hardening of the arteries, or other causes)
  • Diabetes (chronic disease that affects your body’s ability to use sugar for energy)
  • Multiple myeloma
  • Myeloproliferative disorders
  • Sickle cell anemia (inherited disease characterized by abnormally shaped red blood cells that impair the delivery of oxygenated blood throughout the body)

Possible triggers of gout include:

  • Joint injuries and infections
  • Severe infection or illness
  • Sudden weight loss
  • Surgery

Reducing your risk of gout flares or attacks

If you have recurring gout flares, your healthcare provider may suggest these lifestyle changes to help prevent the occurrence of future flares:

  • Decreasing your consumption of high-purine foods and beverages, such as sweetbreads, game meats, alcohol, certain fish and shellfish, and organ meats such as liver and kidney
  • Increasing your water intake
  • Participating in a regular exercise program
  • Reducing excessive stress

What are the diet and nutrition tips for gout?

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 (such as excess weight), minimize triggers for gout flares, and slow the progression of joint damage from gout.

Recommended tips for eating well with gout include:

  • Avoiding organ and gland meats, such as liver or kidney, which are high in purine
  • Choosing low-fat or fat-free dairy products
  • Drinking plenty of water, which helps flush out excess uric acid from your body
  • Eating moderate levels of fish, while keeping an eye on high-purine seafood like shellfish, sardines, anchovies and tuna
  • Getting protein primarily from plants, including beans, soy and legumes
  • Including complex carbohydrates, such as whole grains and fresh fruits and vegetables
  • Limiting alcohol, particularly beer and distilled liquors
  • Limiting portions of red meat, such as beef, lamb or pork
  • Taking a vitamin C supplement, which can help reduce uric acid levels

Ask your healthcare provider for guidance before making significant changes to your diet or taking supplements.

How do doctors diagnose gout?

Because the symptoms of gout can mimic those of other types of arthritis, an accurate diagnosis is a critical step toward finding effective gout treatment. Your primary care provider will likely refer you to a rheumatologist, a doctor who specializes in various types of arthritis, to make a gout diagnosis and discuss treatment options.

Doctors diagnose gout through an assessment of your symptoms and medical history, physical examination of the affected joints, and imaging tests. These activities help your doctor rule out other possible causes of your symptoms.

To diagnose your condition, your doctor or other licensed healthcare practitioner will ask you several questions related to your symptoms, including:

  • How long has your joint been affected?
  • How severe is the pain and how long does it last?
  • Are you experiencing any other symptoms, such as redness, swelling, or limited range of motion?
  • 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 must 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:

  • 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 (urate) crystals, which can be directly visualized using a microscope. Crystals may also be found under the skin in deposits known as tophi, which indicate advanced gout.
  • Blood test, to measure levels of uric acid in the blood, though this is not necessarily a direct indicator of gout
  • X-rays, to evaluate joint damage and rule out other possible causes of joint symptoms
  • Imaging scans, including ultrasound and dual-energy computerized tomography (DECT), to detect and visualize urate crystals in or around the joints

What are the treatments for gout?

Gout is a chronic disease that cannot be cured, but there are several helpful and widely accepted therapies available. The goals of gout treatment include managing the pain of current flares, lessening the severity and frequency of future flares, and preventing the onset of chronic gout.

Flare pain management

The following medications and therapies are often used to ease the pain and reduce the inflammation of gout flares:

  • Colchicine (Colcrys), which is more effective the closer it is taken to the onset of the flare
  • Cold compresses applied directly to the affected joints
  • Corticosteroids, such as prednisone, taken orally or injected directly into the affected joints
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve)
  • Rest

Medications used to treat severe gout

If you have recurring gout flares and increasingly severe gout symptoms, your healthcare provider may prescribe medications to lower your uric acid levels, such as:

  • Allopurinol (Lopurin, Zyloprim)
  • Colchicine (Colcrys) in lower doses than are prescribed during a flare
  • Febuxostat (Uloric)
  • Probenecid (Benemid)

Prescription-strength NSAIDs, such as indomethacin (Indocin), may also be used in severe gout to treat pain and inflammation.

Lifestyle changes that help manage gout

Your healthcare provider may also suggest these lifestyle changes to help prevent gout or the occurrence of future flares:

  • Decrease your consumption of high-purine foods and beverages.
  • Increase your water intake.
  • Maintain a healthy weight and lose weight if needed. (Excess weight stresses joints.)
  • Participate in a regular exercise program.
  • Reduce excessive stress.

Cherry juice to help manage gout

Many people with gout or experiencing a gout attack drink cherry juice or consume cherries. The use of cherry juice for gout has been around since the 1950s, based on a study of 12 patients with gout. Since that time, several studies in animals have pointed to a role for cherries and cherry products in lowering uric acid levels. More recent studies showed that people with gout who consumed cherry juice concentrate experienced fewer flares, but there was no effect on uric acid levels. Overall, evidence supporting cherries for gout is weak. Larger, more controlled studies are necessary to confirm the absolute effectiveness of cherries and cherry compounds with gout, and the correct therapeutic dose.

The American College of Rheumatology advises against consuming cherry juice or extract for a gout attack. If you are interested in non-medication therapy, talk with your doctor about eating cherries, drinking cherry juice concentrate, or taking cherry-containing supplements. Daily cherry juice concentrate may be appropriate as an add-on therapy for people who are also on urate-lowering therapy to prevent gout attacks.

How does gout affect quality of life?

The painful attacks of gout and its long-term implications for developing more severe arthritis can have a significant impact on daily quality of life. This can include someone’s ability to work, sleep, perform household tasks, or enjoy social activities.

Following your prescribed treatment plan and working with your doctor to manage triggers is an essential step in controlling your gout. Making healthy lifestyle choices—including reaching and maintaining a healthy weight, eating a balanced diet, and getting regular exercise—can help reduce your risk of gout flares and slow the progression of joint damage long-term.

What are the potential complications of gout?

Over time, acute gout flares can evolve into chronic gout or gouty arthritis. This occurs when repeated gout flares cause long-term damage to joints or kidneys, resulting in:

  • Disability
  • Joint deformities and loss of joint mobility
  • Kidney stones
  • Tophi, which are uric acid crystals that clump together and lodge in the tissues around your joints

You can help minimize your risk of chronic gout and other complications by following the treatment plan you and your healthcare provider design specifically for you.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 1
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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