Gout

Acute gout is a painful form of arthritis that causes a sudden, severe, and temporary attack of joint pain, swelling, and redness. It most often affects a single joint, with the big toe being the most common target. This condition occurs when high levels of uric acid in the blood lead to the formation of sharp, needle-like crystals in a joint.

Common causes and risk factors

High levels of uric acid in the blood, known as hyperuricemia, are the direct cause of gout. Certain factors increase the likelihood of uric acid buildup and can trigger a gout attack:

  • Diet: Eating large amounts of red meat, organ meats (like liver), certain kinds of seafood (sardines, anchovies, scallops), and foods or drinks sweetened with high-fructose corn syrup can increase uric acid levels.

  • Alcohol: Heavy alcohol consumption, especially beer, increases the risk of a gout attack.

  • Weight: Being overweight or obese causes your body to produce more uric acid and makes it harder for your kidneys to filter it out.

  • Medical conditions: Untreated high blood pressure, diabetes, heart disease, and kidney disease can all increase your risk.

  • Medications: Certain drugs, including diuretics (water pills) and low-dose aspirin, can raise uric acid levels.

  • Genetics: A family history of gout can make you more likely to develop the condition.

  • Age and gender: Gout is more common in men, though a woman's risk increases after menopause.

Signs and symptoms

A gout attack happens very quickly and often without warning, with symptoms typically peaking within 12 to 24 hours. The most common signs include:

  • Intense joint pain: The pain is severe and can be described as crushing or throbbing. It often starts during the night and can be so intense that even the weight of a bedsheet is intolerable.

  • Swelling and redness: The affected joint becomes swollen, tender, and appears red or purplish. The skin over the joint may also feel hot to the touch.

  • Limited movement: As the attack progresses, the affected joint can become stiff, making it difficult to move.

  • Lingering discomfort: After the most severe pain subsides, some dull joint discomfort may last for several days or weeks.

  • Fever: Some people may also experience a fever during a gout attack.

Diagnosis

Because other conditions can mimic the symptoms of gout, a doctor may use several methods to confirm a diagnosis.

  • Joint fluid test: The most certain way to diagnose gout is to use a fine needle to draw fluid from the inflamed joint. The fluid is then examined under a microscope for the presence of uric acid crystals.

  • Blood tests: A blood test can measure uric acid levels, though high levels alone don't guarantee a gout diagnosis. It is possible for uric acid levels to be normal or even low during an acute attack.

  • Physical exam: A doctor can often diagnose gout based on your symptoms, medical history, and a physical examination of the affected joint.

  • Imaging tests: In some cases, imaging like ultrasound or dual-energy CT (DECT) scans can detect uric acid crystals in the joints.

Treatment

Treatment for gout focuses on relieving the intense pain of an acute attack and preventing future attacks by managing uric acid levels.

To treat a flare-up:

  • Medication: A doctor may prescribe anti-inflammatory drugs to reduce pain and swelling, such as:

    • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.

    • Colchicine, a different type of anti-inflammatory medication.

    • Corticosteroids, which can be taken as a pill or injected directly into the joint.

  • Home remedies: You can help ease the pain of a flare-up by elevating the affected joint, applying ice packs, and drinking plenty of water.

To prevent future flare-ups:

  • Lifestyle changes:

    • Diet: Limit foods and drinks that are high in purines, such as red meat, shellfish, and sugary sodas.

    • Alcohol: Reduce or avoid alcoholic beverages, particularly beer.

    • Hydration: Drink plenty of water to help your kidneys flush uric acid out of your body.

    • Weight management: If you are overweight, losing weight can help reduce uric acid levels.

  • Medication: For people with recurring attacks, a doctor may prescribe daily medication to lower uric acid levels. Common options include allopurinol and febuxostat. These medications prevent crystals from forming and can even dissolve existing ones.

 

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