Gout refers to a common and intricate type of arthritis that can occur in everyone. It is usually accompanied by sudden and intense episodes of pain, redness, swelling, and tenderness in one or several joints, most frequently affecting the big toe.
A gout attack can strike abruptly and wake you at night when sleeping with a feeling that the big toe is burning. The affected joint becomes hot, swollen, and too tender such that the weight of a bedsheet can be unbearable.
While gout symptoms can appear and disappear, there are approaches to manage them and prevent flare-ups.
By Able Health I Medically reviewed by Dr. Alireza Estedlal
Page last reviewed: February 2024 I Next review due: February 2026
What is gout?
Gout is a type of inflammatory arthritis causing swelling and pain in the joints. It occurs due to an accumulation of uric acid in the body.
Although the big toe joint is most commonly affected, gout can also impact other joints such as knees, feet, ankles, hands and wrists, and elbows.
Gout symptoms are intermittent and tend to recur in episodes known as gout attacks and flares. Medical doctors may recommend medications and dietary changes to reduce the levels of uric acid and lessen the future frequency of gout attacks.
The different stages of gout
Gout advances in four distinct stages, each with unique features and implications:
Stage 1, asymptomatic hyperuricemia: In this initial stage, uric acid levels are high, but symptoms aren’t present. This phase could linger for several years without causing any noticeable gout symptoms or signs.
Stage 2, acute gouty arthritis: This stage is associated with sudden and severe gout attacks. Several factors, like alcohol drinking or trauma to the impaired joint, can trigger these attacks. If not treated, acute gouty arthritis could advance to the third stage.
Stage 3, inter critical gout: During this phase, there are remission periods between gout flares. Even though there are no associated symptoms, uric acid levels can collect in the joints and bloodstream.
Stage 4, chronic tophaceous gout: In the final stage, uric acid crystals build up in the joints, forming tophi, which are rigid nodules that occurbeneath the skin and lead to joint abnormalities. This phase is normally characterized by chronic discomfort and major joint damage.
Gout Symptoms
Gout signs and symptoms nearly always appear suddenly and mostly during the night. They are:
Severe joint pain: Typically, gout affects the large toe, although it may also develop in any joint. Ankles, elbows, knees, wrists, and fingers are other mostly affected joints. The pain might be most intensein the first 4 to 12 hours following onset.
Lingering pain: Once the most intensediscomfortgets better, some joint pain might linger from a few days to several weeks. Attacks occurring later are likely to affect more joints and last for a longer period.
Inflammation and redness: The impaired joint becomes swollen, warm, tender, and red.
Restricted range of motion: While the gout continues to progress, joint movement may become restricted.
Causes
Gout often occurs due to the accumulation of urate crystals in the joints, leading to inflammation and severe gout attackpain. These crystals form as a result of high uric acid levels in the bloodstream. Uric acid is produced when the body breaks down purines, which are substances naturally present in the body.
In addition, purines are present in some foods, such as organ meats like liver and red meat. Seafood rich in purine are anchovies, mussels, sardines, scallops, tuna, and trout. Alcoholic drinks, particularly beer and beverages sugared with fructose (fruit sugar), also cause higher uric acid levels.
Uric acid normally dissolves in the blood and is excreted through the kidneys into the urine. However, the body sometimes makes excess uric acid, or the kidneys eliminate too little. In such cases, uric acid can accumulate and form sharp, needle-like urate crystals within the joints or nearby tissues, causing discomfort, inflammation, or swelling.
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Having high uric acid levels in the body increases the likelihood of developing gout. Other factors that contribute to the rise in uric acid are:
Diet: Consuming a diet full of red meat, shellfish, and beverages sugared with fructose increases uric acid levels, raising the risk of developing gout. Intake of alcohol, particularly beer, also elevates this risk.
Weight: Being overweight causes the body to produce extra uric acid, making it harder for the kidneys to eliminate.
Health conditions: Some conditions are likely to contribute to gout occurrence. Examples are diabetes, untreated high blood pressure, metabolic syndrome, obesity, and heart and kidney diseases.
Medicines: Low-dose aspirin, and medications for managing hypertension, such as thiazide diuretics, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors, are likely to elevate the levels of uric acid. Also, anti-rejection drugs recommended for those who have had an organ transplant can increase uric acid levels.
Family history: A family history of gout increases the possibility of developing the condition.
Age and gender: Gout is more common in men, mainly due to the low uric acid levels in women. However, females’ uric acid tends to increase to the level of males after menopause. Men are at a higher risk of developing gout between 30 and 50 years, while women experience the condition after menopause.
Recent trauma or surgery: Having a recent surgery or trauma can contribute to a gout attack. Also, in some cases, getting a vaccine can provoke a flare-up.
Who is at risk of developing gout?
Particular demographic groups have increased risks of developing gout. Men are highly susceptible to gout compared to women, mainly after reaching 40 years. Nevertheless, the condition is more likely to occur in women after menopause. Moreover, persons with family members who have had gout are at higher risk of this disorder.
Lifestyle behaviors also significantly contribute to the occurrence of gout. Factors that increase risk are excessive consumption of alcohol, obesity, a purine-rich diet, and health problems like diabetes and high blood pressure. It is thus essential for people in these high-risk groups to understand their vulnerability to gout and take preventive measures.
Complications
Individuals with gout are likely to experience more serious conditions like:
Recurrent gout: While some might not experience signs and symptoms of gout again, others can suffer from the condition many times a year. Medications are likely to prevent these attacks in those with recurrent gout. However, without treatment, gout could lead to joint erosion and destruction.
Advanced gout: If not treated, gout could lead to the formation of urate crystal deposits underneath the skin in nodules known as tophi. These nodules can occur in different areas, including fingers, hands, elbows, feet, or Achilles tendons alongside the backs of the ankles. While tophi are not often painful, they can swell and become sensitive during gout attacks.
Kidney stones: Sometimes, urate crystals can accumulate in the urinary tract in those who have gout, leading to kidney stones. Drugs can help lower this risk.
The Role of Diet in Gout Development
Diet plays a significant role in the development and control of gout. Foods full of purines, like organ meats, red meat, shellfish, and some fish types, can increase uric acid levels and contribute to the possibility of gout attacks. Therefore, persons with gout should limit their consumption of such purine-rich foods.
Some foods, on the other hand, can assist in preventing gout attacks. Vegetables, fruits, low-fat dairy products, nuts, and whole grains are examples of low purines foods that can help reduce levels of uric acid in the body. Generally, maintaining a healthy diet that incorporates these vital foods while keeping off those likely to trigger gout attacks is essential in people with the condition.
Gout Diagnosis: How is it done?
Gout diagnosis is usually determined by the associated symptoms and the look on the affected joints. Some of the diagnostic tests doctors can use include:
Joint fluid test: Providers perform this test using a needle to obtain fluid from the affected joint. When viewed under a microscope, urate crystals might be noticeable in the fluid.
Blood test: A blood test can be ordered to check the levels of uric acid in the blood. However, the outcomes can sometimes be false. Some individuals have increased uric acid levels, yet they don’t experience gout symptoms, while others have the symptoms without unusual uric acid levels in the blood.
X-ray imaging: Joint X-rays can help rule out other causes of joint inflammation and pain.
Ultrasound: Ultrasound utilizes sound waves to identify urate crystals within joints or tophi.
Dual-energy computerized tomography (DECT): DECT combines X-ray pictures captured from multiple angles to provide a better view of the urate crystals in the joints.
Gout Treatment: Medications and Lifestyle Changes
Medications for treating gout come in two forms, each focusing on different aspects of the condition. The first type aims to reduce inflammation and pain during gout attacks. On the other hand, the second type lowers uric acid levels in the blood, preventing complications associated with gout.
The appropriate medication for you is based on the symptoms’ severity and frequency, plus any other medical condition you might have.
Medications to treat gout attacks
Medications designed to address gout flare-ups and prevent attacks in the future are:
Nonsteroidal anti-inflammatory drugs (NSAIDs): These comprise over-the-counter medicines like ibuprofen (Motrin IB, Advil) and naproxen sodium (Aleve), along with the stronger prescription NSAIDs, including indomethacin (Tivorbex, Indocin) and celecoxib (Celebrex). These NSAIDs can cause side effects such as bleeding, stomach pain, or ulcers.
Colchicine: The provider can prescribe colchicine (such as Gloperba, Colcrys, Mitigare), which is an anti-inflammatory medication that effectively eases gout discomfort. However, it may cause side effects like diarrhea, nausea, or vomiting, and this can offset its usefulness.
Corticosteroids: Corticosteroids like prednisone can help manage gout inflammation and discomfort. These can be taken in the form of pills or administered through injection into the joint. The side effects of these drugs can include high blood sugar levels, mood changes, and increased blood pressure.
Medications to prevent gout complications
If you have multiple gout attacks every year or if your attacks are painful but occur less frequently, the doctor might prescribe medication to lower the likelihood of complications associated with gout. Drugsto reduce uric acid levels in the body may also be recommended if you have existing joint damage visible on X-rays or the presence of tophi, kidney stones, or chronic kidney disease.
Medications to block uric acid production: Medications like allopurinol (Lopurin, Aloprim, Zyloprim) and febuxostat (Uloric) are helpful in limiting the level of uric acid the body produces. Side effects of allopurinol are fever, hepatitis, rash, or even kidney disorders. Similarly, febuxostat side effects are nausea, rash, or decreased liver function, and it may also increase the possibility of heart-related fatality.
Medications that improve uric acid removal: Medications like probenecid (Probalan) are essential in enhancing the kidneys’ capacity to eliminate uric acid from the body. The side effects may include stomach pain, rash, or kidney stones.
Natural remedies for gout relief
Medications are generally the most effective method of treating gout attacks as well as preventing repeated flares. On the other hand, lifestyle decisions also play a crucial role, and you might want to consider the following measures:
Choosing healthier beverages: Lower your intake of alcoholic beverages and fruit sugar-sweetened drinks. Instead, you can consider drinking a lot of nonalcoholic infusions, particularly water.
Avoiding foods rich in purines: Foods like red meat and organ meats (including liver) are particularly full of purines. Seafood rich in purines are anchovies, mussels, sardines, scallops, trout, and tuna. If you are susceptible to gout, go for low-fat dairy products as an alternative protein source.
Exercise frequently and cut weight: Maintaining a healthy weight lowers the risk of developing gout. You should, therefore, engage in low-impact activities like walking, cycling, and swimming since they are gentler on the joints.
Gout Prevention
The ideal gout prevention method involves limiting the consumption of high-purine foods and beverages. Also, drinking plenty of water is vital to ensure that the kidneys are functioning well and prevent dehydration.
In addition, exercising regularly can minimize pressure on the joints and lower the possibility of obesity as well as other medical problems that can contribute to gout.
Gout and Joint Pain: What You Need to Know
Gout varies from other forms of joint discomfort in many ways. As opposed to osteoarthritis or rheumatoid arthritis causing chronic joint pain with time, gout attacks are abrupt and extreme. The affected joint might swell, turn red, and become tender.
If not treated, gout effects on the overall joint health could be major. Gout attacks may significantly damage the joints and nearby tissues, resulting in deformities and restricted movement. Because of this, it’s important to see a healthcare provider for symptom evaluation and prevention of long-term impairment to the joint.
Management of joint pain caused by gout comprises a combination of lifestyle changes and medical treatment. Medications are essential in reducing inflammation and pain during attacks. On the other hand, lifestyle adjustments, like regular physical activity and maintaining a healthy weight, help boost joint health and avoid future attacks.
