Gout is a common form of arthritis that causes sudden and severe attacks of pain, swelling, redness and tenderness in the affected joint, usually starting in the big toe. These acute gout attacks often occur at night, and the pain can be debilitating.
Causes of gout
Gout is the most common type of inflammatory arthritis. Normally, blood moves uric acid to the kidneys, and the uric acid exits the body in urine.
In people with gout, their bodies either make too much uric acid, or they eat foods and drinks that cause excess acid levels, or their kidneys can’t remove uric acid properly.
Risk factors for gout
According to the Arthritis Foundation, you are more likely to develop gout if you:
- Are male, as men are 3 times more likely than women to develop gout.
- Have family members who have gout. It is a proven hereditary condition.
- Take certain drugs, such as water pills, aspirin, cyclosporine, niacin and levodopa.
- Have high blood pressure.
- Eat a lot of high-purine foods, such as:
- Liver, kidney, sweetbreads and other organ meats.
- Red meat.
- Seafood, including anchovies, sardines, mackerel, herring, mussels, scallops, trout, haddock and tuna.
- Broths, consommés and gravy.
- Caviar or roe.
- Dried peas and beans.
- Are obese.
- Have a kidney disease or your thyroid gland doesn’t work properly, or a condition that causes cells to turn over quickly, like psoriasis.
- Have another type of inflammatory arthritis, such as rheumatoid arthritis or psoriatic arthritis.
- Drink more than 2 alcoholic drinks a day, especially beer, as it is high in purine.
- Drink a lot of sugary drinks.
- Had gastric bypass or transplant surgery.
Signs and symptoms of gout
(and when to see your primary care provider)
The signs and symptoms of gout almost always occur suddenly, and often at night, including:
- Extreme joint pain. Gout usually affects the large joint of the big toe, but it also occurs in the ankles, knees, elbows, wrists and fingers. It can affect any joint.
- Inflammation and redness.
- Limited range of motion. As gout progresses, you may not be able to move your joints normally.
- Lingering discomfort. Milder discomfort may last from a few days to a few weeks after the severe pain goes away.
Suspect gout? See your PCP. You should see your primary care provider during your first suspected gout flare. Your provider can properly diagnosis your symptoms, and develop a treatment plan to help relieve pain and prevent flares.
Gout symptoms can be confused with another type of arthritis called calcium pyrophosphate deposition (CPPD), so a proper diagnosis is critical.
Untreated gout can lead to worsening pain and joint damage. If you have gout symptoms and also have a fever, get medical care immediately as you may have an infection.
Treating a gout attack
A gout attack may only happen once, or the next one may not happen for months or even years.
When gout strikes
If you’re having a gout attack, you should see your primary care provider.
In the meantime, you can try these steps at home to help alleviate the pain and swelling:
- Drink plenty of fluids, but no alcohol or sweet drinks like soda.
- Eat a gout-friendly diet, which means no foods with purines.
- Ice and elevate the painful joint.
- Reduce stress.
A typical attack lasts from a few days to 2 weeks. Your doctor will likely recommend medications to relieve pain and reduce inflammation, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids (oral or injections), indomethicine or colchicine.
Your treatment plan
Your primary care provider will also create a treatment plan for you to follow after the gout flare. The goal is to reduce your uric acid levels to prevent any future attacks.
Your plan may include:
- Dietary changes. You should avoid high-purine foods, sugary drinks like soda, and alcohol, especially beer. You should get more of your protein from low-fat dairy products, as they have a protective effect against gout.
- Hydration. Drink lots of water.
- Maintain a healthy weight.
- Medications. Drugs called xanthine oxidase inhibitors (XOIs) block uric acid production. These include allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric). Drugs called uricosurics improve uric acid removal. These include probenecid (Probalan) and lesinurad.
Possible complications of gout
People with gout can develop more severe conditions, such as:
Advanced gout. If left untreated, gout may cause deposits of crystals to form under the skin in nodules, called tophi, usually in the fingers, hands, feet, elbows or Achilles tendons. Tophi can become swollen and tender.
Kidney stones. Crystals may collect in the urinary tract, causing kidney stones. Medications can help reduce the risk.
Center for Disease Control and Prevention (CDC). Gout (https://www.cdc.gov/arthritis/basics/gout.html)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Gout (https://www.niams.nih.gov/health-topics/gout)
MedlinePlus: National Library of Medicine. Gout (https://medlineplus.gov/gout.html)