What Is Gout?

Gout is a painful form of inflammatory arthritis and can occur when there is a buildup of uric acid in the body. The extra uric acid forms sharp crystals in your joints, causing swelling and pain, and usually occurs in the joint of the big toe. However, gout can also occur in the joints of the knees, elbows, ankles, feet, hands, or wrists. Flare-ups, or gout attacks, can be extremely painful and can be acute or chronic. Symptoms of gout come on suddenly and tend to last 12-24 hours before subsiding. Treatment usually consists of pain management and changing your diet.

Signs and Symptoms

Gout episodes tend to occur suddenly and most often at night. Symptoms are severe and painful for the first 12-24 hours. Lingering discomfort can last for up to 1-2 weeks.

The most common symptoms include:

• Intense joint pain
• Swelling
• Redness or discoloration of the skin over the joint area
• Stiffness of the joint or limited range of motion of the joint
• Extreme tenderness, even to light touch (a bedsheet over the affected joint)
• A burning sensation or the joint feeling warm or hot
• Lingering discomfort
• General feeling of unwellness
• Fever
• Chills

Causes and Risk Factors

The cause of gout is having an excessive buildup of uric acid (hyperuricemia) in the body. Not everyone who has hyperuricemia develops gout. When there is an excessive buildup of uric acid, the body formulates sharp crystals (urate crystals) that develop in the joints, typically in the big toe.

Your body makes uric acid when it breaks down chemicals known as purines, which are found naturally in the body, as well as in certain foods and drinks. The kidneys are responsible for filtering uric acid out of the body, but sometimes if there is an excess amount of uric acid in the body, your kidneys cannot filter it out quickly enough, which can lead to developing gout.

Common foods and drinks that contain purines include:

• Red meat
• Organ meat
• Some seafoods (anchovies, sardines, mussels, scallops, trout, and tuna)
• Alcoholic beverages, especially beer
• Drinks sweetened with fruit sugar (fructose)

Risk factors for developing gout tend to include things that would increase the level of uric acid in the body. Risk factors include:

• Being male
• Being a female who has gone through menopause

Certain health conditions that increase your risk include:

• Obesity
• Diabetes
• Congestive heart failure
• Hypertension (high blood pressure)
• Kidney disease
• Metabolic syndrome
• Blood cancer

Other risk factors that increase your chances of developing gout:

• Family history of gout
• Consuming red meat, organ meat, or shellfish
• Drinking alcoholic beverages regularly, especially beer
• Consuming drinks that contain fructose
• Immunosuppressants
• Low dose Aspirin
• Certain medications used to control blood pressure (diuretics, ACE inhibitors, and beta blockers)
• Anti-rejection medications (medicine used for organ transplant recipients)
• Recent surgery or trauma

Diagnosis

A diagnosis of gout is made once the doctor has conducted a physical examination and gathered information regarding your symptoms, and a medical history. Sometimes a doctor may recommend further testing to make a diagnosis.

Testing may include:

• X-rays
• MRI’s (magnetic resonance imaging)
• Ultrasound
• DECT (dual-energy computerized tomography)
• Blood tests (to measure the level of uric acid)
• Joint aspiration (collects a sample of fluid from the joint)

Treatment

There are two main focuses of treatment for managing gout. The first treatment focuses on managing the pain and the second treatment focuses on reducing the amount of uric acid in the body. Typically, medication is used as the primary method of treatment. Secondarily, your doctor may recommend changing your diet to improve symptoms.

Medications used to manage pain and inflammation:

• Non-steroidal anti-inflammatory drugs (NSAID’s). This type of medication can be over-the-counter options or stronger options that must be prescribed. NSAID’s do carry a risk of stomach bleeding, ulcers, and pain.
• Colchicine. This is an anti-inflammatory medication. Side effects may cause vomiting, diarrhea, or nausea.
• Corticosteroids. These medications may be injected or taken in pill form and help to alleviate pain and inflammation of gout. Side effects may include mood changes, increased blood sugar levels, and elevated blood pressure.

Medications that control uric acid in the body:

• Medications that block production of uric acid. Depending on the specific medication, side effects may include fever rash, hepatitis, and kidney problems. They might also include rash, nausea, reduced liver function, and may increase the risk of heart-related death.
• Medications that improve uric acid removal. These medications help your kidneys to do a better job at removing uric acid from the body. Side effects may include rash, kidney stones, or kidney pain.

Prevention & Lifestyle Changes

Prevention of gout focuses on limiting purine-rich foods and drinks, maintaining a healthy weight, and adequately hydrating. It is important to stay hydrated for optimal kidney functioning.

Diet and lifestyle changes:

• Adopting a low-purine diet. Lowering your intake of foods and drinks that contain purine will help to reduce your risk of developing gout, or for symptoms to recur. This would include reducing or eliminating red meat, organ meat, shellfish, beer, and drinks that contain fructose.
• Exercising regularly and maintaining a healthy weight. Regular low-impact exercises on the joints (walking, swimming, biking) and maintaining a healthy weight can lower your risk of developing gout or for recurring symptoms of gout.

Learn More about Gout

Research on gout is ongoing. Gout is an extremely painful form of inflammatory arthritis, but it can be managed with medications along with diet and lifestyle changes. Small lifestyle changes such as adding regular exercise into your schedule and staying hydrated can reduce your risk of developing gout. It is important to contact your healthcare provider if you notice symptoms of gout so your doctor can start you on a treatment plan to help reduce your symptoms.