Gout

Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.

Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.

Symptoms

The signs and symptoms of gout almost always occur suddenly — often at night — and without warning. They include:

• Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
• Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
• Limited range of motion. Decreased joint mobility may occur as gout progresses.

When to see a doctor

If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage.

Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.

Causes

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Risk factors

You’re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

• Diet. Eating a diet that’s high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
• Obesity. If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases your risk of gout.
• Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
• Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels.
• Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
• Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
• Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing gout.

Complications

People with gout can develop more-severe conditions, such as:

• Recurrent gout
• Advanced gout
• Kidney stones

Tests and diagnosis

Tests to help diagnose gout may include:

• Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
• Blood test. Your doctor may recommend a blood test to measure the levels of uric acid and creatinine in your blood.
• X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation.
• Ultrasound. Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus.
• Dual energy CT scan. This type of imaging can detect the presence of urate crystals in a joint, even when it is not acutely inflamed. This test is not used routinely in clinical practice due to the expense and is not widely available.

Treatments and drugs

Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences.

Medications to treat gout attacks

Drugs used to treat acute attacks and prevent future attacks include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as ibuprofen and naproxen sodium, as well as more-powerful prescription NSAIDs such as indomethacin or celecoxib.
• Colchicine. Your doctor may recommend colchicine a type of pain reliever that effectively reduces gout pain. The drug’s effectiveness is offset in most cases, however, by intolerable side effects, such as nausea, vomiting and diarrhea.
• Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or they can be injected into your joint.

Corticosteroids are generally reserved for people who can’t take either NSAIDs or colchicine.

Medications to prevent gout complications

If you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications.

Options include:

• Medications that block uric acid production. Drugs called xanthine oxidase inhibitors, including allopurinol and febuxostat, limit the amount of uric acid your body makes. This may lower your blood’s uric acid level and reduce your risk of gout.
• Medication that improves uric acid removal. Probenecid improves your kidneys’ ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased.

Lifestyle and home remedies

Medications are the most proven, effective way to treat gout symptoms. However, making certain lifestyle changes also may help, such as:

• Limiting alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, drink plenty of nonalcoholic beverages, especially water.
• Limit intake of foods high in purines, such as red meat, organ meats and seafood.
• Exercising regularly and losing weight. Keeping your body at a healthy weight reduces your risk of gout.

Prevention

During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

• Keep your fluid intake high
• Limit or avoid alcohol.
• Get your protein from low-fat dairy products
• Limit your intake of meat, fish and poultry
• Maintain a desirable body weight