Gout

Was this helpful?
(12)

Introduction

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.

Symptoms

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.

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.

Causes

What causes gout?

Gout is caused by a metabolic disorder called hyperuricemia. Hyperuricemia 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. Gout may result as a complication of diuretic use, multiple lyeloma, 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.

Gout triggers

The following triggers can increase uric acid levels, which may lead to hyperuricemia and gout:

  • Cancer chemotherapy

  • Certain medications, such as diuretics, immunosuppressants (such as cyclosporine), and aspirin

  • Dehydration

  • Foods and beverages containing high levels of purines, including sweetbreads, game meats, alcohol, certain fish and shellfish, and organ meats such as liver and kidney

  • Joint injuries and infections

  • Severe infection or illness

  • Sudden weight loss

  • Surgery

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; whereas, some risk factors cannot be controlled, such as your family history and certain preexisting diseases.

General risk factors for gout

Well-accepted risk factors for gout include:

  • Cancer chemotherapy

  • 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

  • Female gender past menopause

  • Male gender older than age 40

  • Obesity

Diseases and disorders that increase the risk of gout

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

Reducing your risk of gout flares or attacks

If you have recurring gout flares, your health care 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

Treatments

How is gout treated?

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), or indomethacin (Indocin)

  • Rest

Medications used to treat severe gout

If you have recurring gout flares and increasingly severe gout symptoms, your health care 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)

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), or indomethacin (Indocin), may also be used in severe gout to treat pain and inflammation.

Lifestyle changes that help manage gout

Your health care 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.

  • Participate in a regular exercise program.

  • Reduce excessive stress.

What are the possible 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:

  • Constant and debilitating joint pain

  • 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 health care provider design specifically for you.

Was this helpful?
(12)
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 14
  1. Gout. Arthritis Foundation. http://www.arthritis.org/conditions-treatments/disease-center/gout/
  2. Gout. Centers for Disease Control and Prevention. http://www.cdc.gov/arthritis/basics/gout.htm
  3. Gout. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Gout/default.asp
  4. Gout. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/
  5. Becker MA, Chohan S. We can make gout management more successful now. Curr Opin Rheumatol 2008; 20:167
  6. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013
  7. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013
Explore Gout
Recommended Reading
Next Up
Answers to Your Health Questions
Trending Videos