Gout: Symptoms, Causes, Treatment, and Prevention
Overview
Gout is a form of inflammatory arthritis that causes sudden, severe attacks of pain, swelling, redness, and tenderness in the joints. It most commonly affects the joint at the base of the big toe but can occur in any joint. Gout occurs when urate crystals accumulate in your joint, causing inflammation and intense pain.
Gout affects approximately 4% of American adults (about 9.2 million people), with men being three times more likely to develop it than women. It typically affects men between the ages of 40 and 50 and women after menopause. The prevalence of gout has been increasing in recent decades, likely due to dietary factors and an aging population (CDC, 2020).
While gout can be extremely painful, it is treatable, and there are ways to reduce the risk of recurrent attacks.
Symptoms
Gout symptoms often appear suddenly, frequently at night, and include:
- Intense joint pain: Gout usually affects the large joint of your big toe but can occur in your feet, ankles, knees, hands, and wrists. The pain is likely to be most severe within the first 4 to 12 hours after it begins.
- Lingering discomfort: After the 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: As gout progresses, you may not be able to move your joints normally.
Some people may develop chronic gout, which can lead to joint damage and loss of motion in the affected joints. Tophi, which are lumps of urate crystals, may form under the skin around joints or in other areas like the ears.
Causes and Risk Factors
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.
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 rich in meat and seafood and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk.
- Obesity: If you're overweight, your body produces more uric acid, and your kidneys have a harder time eliminating it.
- Medical conditions: Certain diseases and conditions increase your risk of gout, including untreated high blood pressure, diabetes, metabolic syndrome, and heart and kidney diseases.
- Certain medications: Low-dose aspirin, some diuretics (water pills), and anti-rejection drugs used in organ transplant patients 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 are also 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 can sometimes trigger a gout attack.
Diagnosis
Gout can be difficult to diagnose because its symptoms, when they appear, are similar to those of other conditions. While hyperuricemia (high uric acid levels) is commonly associated with gout, it can also be present without causing gout. Similarly, some people with gout do not have elevated uric acid levels in their blood.
To diagnose gout, your doctor will likely:
- Review your medical history and symptoms: Your doctor will ask about your symptoms, diet, and any family history of gout.
- Perform a physical exam: Your doctor will examine the affected joints for signs of inflammation and tenderness.
- Order lab tests:
- Blood test: To measure the levels of uric acid in your blood. However, as mentioned, this test can be misleading.
- Joint fluid test: Your doctor may use a needle to draw fluid from your affected joint. When examined under a microscope, the fluid may reveal urate crystals.
- Recommend imaging tests:
- X-ray: 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.
Treatment Options
Gout treatment typically involves medications to treat acute attacks and prevent future attacks, as well as lifestyle changes to help reduce uric acid levels in the blood.
Medications
Medications used to treat gout include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Such as ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve), can help relieve gout pain. Stronger NSAIDs are available by prescription. NSAIDs carry risks of stomach pain, bleeding, and ulcers.
- Colchicine: A type of pain reliever that effectively reduces gout pain. However, its effectiveness may be offset by side effects such as nausea, vomiting, and diarrhea, especially if taken in large doses.
- Corticosteroids: Such as prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form or injected into your joint. Side effects may include mood changes, increased blood sugar levels, and elevated blood pressure.
- Medications that block uric acid production: Such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), limit the amount of uric acid your body makes. Side effects may include a rash, nausea, and reduced kidney function.
- Medications that improve uric acid removal: Such as probenecid (Probalan), help your kidneys remove uric acid from your body. Side effects may include a rash, stomach pain, and kidney stones.
Lifestyle and Home Remedies
In addition to medical treatment, these self-care tips may help manage gout:
- Stay hydrated: Drink plenty of fluids, particularly water, to help flush uric acid from your body.
- Limit or avoid alcohol: Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
- Get your protein from low-fat dairy: Low-fat dairy products may actually protect against gout, so these are your best-bet protein sources.
- Limit intake of meat, fish, and poultry: Small amounts may be tolerable, but pay close attention to what seems to cause your gout symptoms.
- Maintain a desirable body weight: Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. However, avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.
Living with Gout
Living with gout involves managing symptoms and preventing future attacks. Here are some tips to help you manage gout on a daily basis:
- Take your medications as prescribed: It's essential to follow your doctor's instructions for taking medications to manage gout and prevent future attacks.
- Stay active: Regular physical activity can help maintain a healthy weight and improve overall health. Low-impact exercises, such as walking, swimming, or biking, are good options.
- Elevate and ice affected joints: During a gout attack, elevating and applying ice to the affected joint can help reduce pain and swelling.
- Wear comfortable shoes: If gout affects your feet or toes, wearing comfortable, supportive shoes can help reduce pressure and pain.
- Monitor your diet: Keep track of what you eat and drink to identify any triggers that may cause gout attacks. Maintaining a food diary can be helpful.
- Stay connected: Join a support group or connect with others who have gout to share experiences and tips for managing the condition.
Prevention
You can take steps to prevent gout and future gout attacks by making certain lifestyle changes and managing any underlying health conditions. Here are some strategies to help reduce your risk:
- Limit purine-rich foods: Foods high in purines include red meat, organ meats, certain types of fish (such as anchovies, sardines, mackerel, and tuna), and beverages sweetened with fruit sugar (fructose).
- Choose healthier beverages: Limit alcohol intake, especially beer, and avoid sugary sodas. Instead, opt for water, low-fat milk, and tart cherry juice, which may help prevent future attacks.
- Exercise regularly and maintain a healthy weight: Regular physical activity and maintaining a healthy weight can help lower uric acid levels and reduce the risk of gout.
- Stay hydrated: Drinking plenty of water helps your kidneys flush out uric acid.
- Consider vitamin C: Some studies suggest that vitamin C may help lower uric acid levels. Talk to your doctor about whether a vitamin C supplement might be helpful for you.
- Manage underlying health conditions: Properly managing conditions such as high blood pressure, diabetes, and kidney disease can help reduce your risk of gout.
Complications
If left untreated, gout can lead to several complications, including:
- Recurrent gout: Some people may experience gout attacks multiple times a year. Medications may help prevent gout attacks in people with recurrent gout.
- Advanced gout: Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi. Tophi can develop in several areas, such as your fingers, hands, feet, elbows, or Achilles tendons along the backs of your ankles. Tophi usually aren't painful, but they can become swollen and tender during gout attacks.
- Kidney stones: Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.
- Joint damage and deformity: Chronic gout can lead to joint damage and deformity, which can limit your range of motion and make daily activities difficult.
Early diagnosis and treatment of gout can help prevent these complications and improve your quality of life.
When to Seek Emergency Care
Seek emergency medical care if you experience any of the following:
- Sudden, intense joint pain that is unbearable, especially if it is your first gout attack.
- Fever and chills accompanying joint pain, which may indicate an infection.
- Joint pain that is accompanied by other severe symptoms, such as difficulty breathing, chest pain, or signs of a stroke.
- Severe joint pain and swelling that does not improve with prescribed medications.
- Signs of kidney stones, such as severe pain in your side and back, below the ribs, pain that radiates to the lower abdomen and groin, painful urination, or blood in your urine.
If you have been diagnosed with gout and experience frequent attacks, consult your healthcare provider to adjust your treatment plan and prevent further complications.