Gout
Gout is an inflammatory type of arthritis that can come and go.
Gout is the most common type of inflammatory arthritis. It causes sudden and intense attacks of joint pain, often in the big toe and at night. It can also strike joints in other toes or the ankle or knee. People with osteoarthritis in their fingers may experience their first gout attack in their finger joints.
Men are three times more likely than women to develop gout. It tends to affect men after age 40 and women after menopause, when they lose the protective effects of estrogen. Gout symptoms can be confused with another type of arthritis called calcium pyrophosphate deposition (CPPD), formerly called pseudogout. However, the crystals that irritate the joint in CPPD are calcium phosphate crystals, not the uric acid crystals that cause gout.
More About Gout
Causes & Triggers
When uric acid builds up, either naturally or from a high-purine diet, it can form needle-like crystals that can lodge in joints – often the big toe – causing sudden, severe pain and swelling.
These attacks may last a week or two, and another may not occur for months or even years.
Gout results from genes; other health conditions, like high blood pressure, diabetes, obesity or psoriasis; some medications; being a man or a post-menopausal woman; or a high-purine diet. Surgery, an infection or severe illness can also trigger a flare.
Starting medicine to lower uric acid may trigger a flare, so you may need another medication to prevent it.
Diagnosis & Treatment Options
To diagnose gout, your doctor will take your medical history, physical exam and lab tests. She may take fluid from your joint to detect urate crystals or order an X-ray, ultrasound or MRI.
Tell your doctor how severe the pain is, when it started and which joints hurt.
You may be prescribed a medication to lower your uric acid level.
If you have a gout attack, ice and elevate the joint and drink plenty of non-alcoholic and non-sugary fluids. A prescription drug called colchicine helps relieve pain and swelling and should be taken at the first signs of a flare.
If you don’t have a prescription, take an anti-inflammatory drug, like ibuprofen. Flares usually get better within a week or two.
Work with your doctor and stick with your treatment plan, which may involve medication and lifestyle changes, including a healthy diet, regular physical activity and losing weight, if needed.
Living Well
One of the most important steps to living well with gout is closely following your medication plan.
Eating a healthy diet combined with regular exercise and weight loss, if needed, helps reduce gout attacks.
Although diet alone cannot control gout, choosing healthy foods and avoiding those high in purines, including red and organ meats and certain seafoods, may minimize flares.
Drink plenty of water and avoid beverages sweetened with high-fructose corn syrup and alcoholic beverages, especially beer.
Dropping excess weight helps reduce uric acid and lowers the risks of developing conditions that occur with gout, like diabetes and cardiovascular disease.
Stay physically active to manage weight and help joint and heart health.
Newly Diagnosed
- Learn about your disease, including what triggers your gout flares, what your medications are for and their potential side effects.
- Stick with your treatment plan. Know what to do when you have a gout attack and when to contact your doctor. Get lab work done as ordered by your doctor.
- Work closely with your doctor. Keep a record of your symptoms, activities, foods and other potential triggers to help pinpoint what makes your symptoms better or worse.
- Practice a healthy lifestyle. Take care of yourself by eating a healthy, low-purine diet, staying physically active, losing excess weight, managing stress and getting restful sleep.
- Learn self-management skills, including being prepared for a flare and taking measures to reduce and control uric acid levels.
Emotional Health
The stigma of gout and fear of another painful flare can increase anxiety and stress, which contribute to more inflammation in the body.
Reduce stress by prioritizing self-care and healthy habits.
Try to get at least seven hours of sleep each night.
Get moving every day to improve your sleep, mood and physical health.
Try meditation or listen to music that’s soothing or upbeat.
Avoid negative self-talk, and get support from family, friends, a counselor or support group, like the Live Yes! Arthritis Connect Groups.
Seek help if you have symptoms of anxiety or depression.
The better your mood and outlook, the more able you’ll be to manage gout.
What Causes Gout?
Gout develops in some people who have high levels of uric acid from the breakdown of purines — natural chemicals found in every cell of your body and in many foods, especially red meat, organ meats, certain seafoods, sugary sodas and beer.
When uric acid builds up, either because the kidneys don’t excrete it the way they should or from consuming too many from a high-purine diet, it can form needle-like crystals that lodge in joints, causing sudden, severe pain and swelling.
Gout attacks usually peak after 12 to 24 hours, then slowly go away on their own, whether they’re treated or not. You may have only one gout attack in your lifetime or one every few years. Recurrent gout attacks that aren’t treated may involve more joints, last longer, and become increasingly severe over time. Some people eventually develop tophi, large masses of uric acid crystals that form in soft tissues or bones around joints and may appear as hard lumps.
Risk Factors
You’re more likely to develop gout if you:
- Eat lots of purine-rich foods, including red meat and some kinds of fish, especially scallops, sardines and tuna, though the health benefits of eating fish likely outweigh any gout risk.
- Consume food and drinks sweetened with high-fructose corn syrup or drink excessive amounts of alcohol, especially beer.
- Are overweight, leading your body to produce more uric acid and to have a harder time eliminating it.
- Have a family history of gout.
- Have certain chronic conditions, including diabetes, obesity and heart or kidney disease.
- Take high blood pressure drugs, such as diuretics and beta blockers.
- Have an imbalance in your microbiome, the trillions of bacteria, viruses and fungi that live in your gut and regulate the immune system. The microbiome is implicated in most inflammatory diseases, including arthritis.
Diagnosing Gout
Your medical history, a physical exam and tests can help diagnose gout. Your doctor will also want to rule out other reasons for your joint pain and inflammation such as an infection, injury or other type of arthritis. Tests you might have include:
- Joint fluid analysis. This is best way to diagnose gout. Your doctor withdraws fluid from the painful joint(s) and examines it under a microscope for uric acid crystals.
- Blood test to check uric acid levels. However, many people who have high blood uric acid never develop gout, and some people with gout have normal uric acid levels.
- Imaging tests, such as X-rays, ultrasound, magnetic resonance imaging and dual-energy computerized tomography, which helps visualize uric acid crystals in joints.
Treatments
The treatment plan you and your doctor choose for your gout depends on the frequency and severity of your symptoms and your personal preference.
- Lifestyle changes. For some people, weight loss, if needed, and a Mediterranean diet or DASH diet may help prevent gout attacks. For decades, doctors told gout patients to limit red meat (beef, pork, lamb and organ meats) and alcohol, but it’s now known that an overall healthy eating plan is far more effective and has added benefits for the heart — a common concern in people with gout. One study of nearly 45,000 men found that those who ate a typical American diet — red meat, French fries, sweets and alcohol — had a 42% greater chance of developing gout than those eating a DASH diet. Eating the low-sodium DASH diet, with an emphasis on fruits, veggies, nuts, whole grains and other whole, unprocessed foods, reduced uric acid levels and gout risk significantly.
- Anti-inflammatories. When you’re in the midst of an attack, you want to stop it as fast as possible. Doctors are likely to recommend a brief course of:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen (Aleve), which are available over the counter or in stronger prescription versions. NSAIDs are generally prescribed for people under 65 who don’t take blood thinners or have a history of bleeding, because NSAIDs can cause ulcers and intestinal bleeding.
- Colchicine, a prescription anti-inflammatory relieves gout pain but may have unpleasant side effects like nausea, diarrhea or vomiting. Lower doses are as effective as higher doses and produce fewer side effects.
- Corticosteroids — also effective at bringing down inflammation quickly but with potentially serious side effects.
- Uric acid-lowering drugs. If you have several gout attacks a year, tophi or signs of joint damage on X-rays, your doctor may suggest taking drugs to lower uric acid and prevent further complications. According to the American College of Rheumatology’s (ACR) 2020 gout guidelines, allopurinol is the first choice for all patients. Febuxostat (Uloric) may be considered for some patients who cannot take allopurinol, but it carries a higher risk of heart-related death. The ACR also recommends trying a treat-to-target approach for gout, in which you and your doctor decide on a goal — usually less than 6 mg/dL blood level of uric acid — and adjust your medication and other treatments until you reach it.
Stigma and Mental Health
Gout has for centuries been associated with excess and is the butt of innumerable jokes. That stigma, along with fear of another painful flare, can increase stress and contribute to more inflammation in your body. Like other forms of arthritis, inflammation in gout is associated with a slightly increased chance of depression, especially in people who have frequent flares.
If you feel down or discouraged, don’t be embarrassed to talk about gout to your friends and family. And keep in mind that regular exercise, restorative sleep and healthy food can go a long way toward improving your mood. The better your mood and outlook, the more able you’ll be to manage gout.
Diagnosed With Gout?
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