Gout is a kind of arthritis. It can cause an attack of sudden burning pain, stiffness, and swelling in a joint, usually a big toe. These attacks can happen over and over unless gout is treated. Over time, they can harm your joints, tendons, and other tissues. Gout is most common in men.
Gout is caused by too much uric acid in the blood. Most of the time, having too much uric acid isn't harmful. Many people with high levels in their blood never get gout. But when uric acid levels in your blood are too high, the uric acid may form hard crystals in your joints.
Your chances of getting gout are higher if you are overweight, drink too much alcohol, or eat too much meat and fish that are high in chemicals called purines. Some medicines, such as water pills (diuretics), can also bring on gout.
The most common sign of gout is a nighttime attack of swelling, tenderness, redness, and sharp pain in your big toe. You can also get gout attacks in your foot, ankle, or knees, or other joints. The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years.
See your doctor even if your pain from gout is gone. The buildup of uric acid that led to your gout attack can still harm your joints.
Your doctor will ask questions about your symptoms and do a physical exam. Your doctor may also take a sample of fluid from your joint to look for uric acid crystals. This is the best way to test for gout. Your doctor may also do a blood test to measure the amount of uric acid in your blood. Your doctor may also do imaging tests, such as ultrasound.
To stop a gout attack, your doctor can give you a shot of corticosteroids or prescribe a large daily dose of one or more medicines. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away.
To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. But don't take aspirin. It can make gout worse by raising the uric acid level in the blood.
To prevent future attacks, your doctor can prescribe a medicine to reduce uric acid buildup in your blood.
Paying attention to what you eat may help you manage your gout. Eat moderate amounts of a healthy mix of foods to control your weight and get the nutrients you need. Limit daily intake of meat, seafood, and alcohol (especially beer). Drink plenty of water and other fluids.
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Uric acid may form crystals that build up in the joints. This causes the pain and other symptoms.
Gout can seem to flare up without specific cause. Or it can be brought on by:
Symptoms of gout include:
How, where, and when the symptoms of gout appear vary.
There are many other conditions with symptoms similar to gout.
Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissues. A gout attack usually starts during the night with moderate pain that grows worse. A gout attack typically causes pain, swelling, redness, and warmth (inflammation) in a single joint, most often the big toe. Then symptoms gradually go away.
There are three stages of gout. Many people never experience the third stage.
Certain things can either cause gout or make you more likely to get it.
Certain other conditions and diseases appear more often in people who have gout than in people who don't, though studies have not shown a clear relationship. Gout may share risk factors (such as obesity, hypertension, and high levels of triglycerides) with certain diseases, including:
Call or see your doctor right away if you have:
It's important to see your doctor even if the pain from gout has stopped. The uric acid buildup that caused your gout attack may still be irritating your joints and could eventually cause serious damage. Your doctor can prescribe medicines that can prevent and even reverse the uric acid buildup.
The following health professionals can diagnose and prescribe treatment for gout:
Exams and tests that may help with diagnosis and treatment of gout include:
While X-rays of extremities (hands and feet) are sometimes useful in the late stages of the disease, X-rays aren't usually helpful in the early diagnosis. Pain often causes people to seek medical attention before any long-term changes can be seen on an X-ray. But X-rays may help to rule out other causes of arthritis.
Your doctor may evaluate you for lead poisoning if you have been exposed to lead in your job or through hobbies.
The goals of treatment for gout are fast pain relief and prevention of future gout attacks and long-term complications, such as joint destruction and kidney damage. Treatment includes medicines and steps you can take at home to prevent future attacks.
Specific treatment depends on whether you are having an acute attack or are trying to manage long-term gout and prevent future attacks.
If gout symptoms have occurred off and on without treatment for several years, they may become ongoing (chronic) and may affect more than one joint.
If the blood uric acid is high but a person has never had an attack of gout, treatment is rarely needed. But people with extremely elevated levels may need regular testing for signs of kidney damage. And they may need long-term treatment to lower their uric acid levels. Your blood uric acid level may be watched by your doctor until it is lowered to normal levels.
Long-term medicine treatment depends on how high your uric acid levels are and how likely it is that you will have other gout attacks in the future.
After an acute attack of gout, talk with your doctor about the causes of the elevated uric acid levels in your blood. A review of your overall health may reveal diseases, medicines, and habits that could be raising your uric acid levels.
Most doctors will wait several days to weeks after a gout attack is over to begin medicine to lower the high uric acid levels. These medicines can cause uric acid stored elsewhere in the body to begin moving through the bloodstream and could make symptoms worse if treatment begins during a gout attack.
If there is swelling that causes pressure in a large joint such as a knee or ankle, your doctor may relieve the pain and pressure by aspiration. A needle is inserted into the joint and fluid is drawn out (aspirated) with a syringe connected to the needle.
Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissue. You probably won't know that you have an elevated uric acid level in your blood until you have had your first gout attack.
But you can help prevent or reduce the severity of future gout attacks. To learn more, see Home Treatment.
If you have been diagnosed with gout, you can do a lot on your own to treat your condition.
In the past, gout was thought to be caused by drinking too much alcohol and eating too many rich foods. Although eating certain foods and drinking alcohol may trigger a rise in the level of uric acid in the body, these habits may not by themselves cause gout. Gout is most often caused by an overproduction of uric acid (due to metabolism problems) or decreased elimination of uric acid by the kidneys.
You use medicine to treat an attack of gout and to reduce the uric acid in the blood. Reducing uric acid helps reduce how often you have attacks.
Medicine treatment for gout usually involves some combination of short- and long-term medicines.
Short-term medicine relieves pain and reduces inflammation during an acute attack or prevents a recurrence of an acute attack. These medicines may include:
If treatment is started right away, relief from symptoms often occurs within 24 hours.
During a gout attack, your doctor will prescribe a maximum daily dose of one or more medicines used for short-term treatment to stop the attack. Doses are then reduced as the symptoms go away.
Long-term treatment uses medicines to lower uric acid levels in the blood. This can reduce how often you have gout attacks and how severe they are. These medicines may include:
If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people will continue to take this medicine every day. It is also important to know how to take it.
Long-term medicine treatment depends on how high your uric acid levels are and how likely other gout attacks are. In general, the higher your uric acid levels and the more often you have attacks, the more likely it is that long-term medicine treatment will help.
Some people with gout have continuing problems because they don't take their prescribed medicine. Most people will need treatment every day to keep the uric acid levels in their blood normal. But they may feel perfectly healthy most of the time and wonder why they should keep taking their medicine. If you stop taking your prescribed medicine, nothing may happen at first. But after a while, another gout attack is likely to occur. Without treatment, future attacks are likely to be more severe and occur more often.
If gout symptoms have occurred off and on without treatment for more than 10 years, uric acid crystals may have built up in the joints to form gritty, chalky nodules called tophi. If tophi are causing infection, pain, pressure, and deformed joints, your doctor may be able to treat them with medicine. If this doesn't work, your doctor may recommend surgery to remove them.
Complementary therapies may be used by some people to relieve symptoms caused by gout.footnote 1
Be sure to talk with your doctor if you are considering taking vitamins, minerals, or other remedies to help reduce future gout attacks.
- Murray MT, Pizzorno JE Jr (2006). Gout. In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 2, pp. 1703–1709. St. Louis: Churchill Livingstone Elsevier.
Other Works Consulted
- Bhole V, et al. (2010). Epidemiology of gout in women. Arthritis and Rheumatism, 62(4): 1069–1076.
- Burns CM, Wortmann RI (2013). Clinical features and treatment of gout. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1554–1575. Philadelphia: Saunders.
- Comeau D, et al. (2011). Rheumatology and musculoskeletal problems. In RE Rakel, DP Rakel, eds., Textbook of Family Medicine, 8th ed., pp. 648–689. Philadelphia: Saunders.
- Keenan RT, et al. (2013). Etiology and pathogenesis of hyperuricemia and gout. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1533–1553. Philadelphia: Saunders.
- Khanna D, et al. (2012). 2012 American College of Rheumatology guidelines for the management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care and Research, 64(10): 1431–1446. DOI: 10.1002/acr.21772. Accessed March 11, 2016.
- Khanna D, et al. (2012). 2012 American College of Rheumatology guidelines for the management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care and Research, 64(10): 1447–1461. DOI: 10.1002/acr.21773. Accessed March 11, 2016.
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