What is gout?
Gout is a form of inflammatory arthritis that occurs when uric acid, a waste product in your blood, forms crystals that deposit in the joints. This typically results in sudden, severe attacks of pain, redness, and swelling in your joints, often your big toe. However, gout can occur in other joints as well, including your ankles, knees, elbows, wrists, and fingers. Periods of intense symptoms are known as gout flares, and times without symptoms are called remission.
High levels of uric acid (hyperuricemia) may be due to increased production or decreased removal by the kidneys. Contributing factors include a diet rich in purines (found in red meat, shellfish, and alcoholic beverages, especially beer), certain medications, obesity, and other health conditions.
Acute gout attacks are treated with medications that reduce inflammation and pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs), alongside lifestyle changes like a low purine diet and weight loss. Long-term management may include medications that lower uric acid levels to prevent future attacks.
What causes gout?
Gout is primarily caused by a buildup of uric acid in the body, leading to the formation of sharp, needle-like urate crystals in joints and surrounding tissue. This triggers inflammation and sudden, intense pain (gout flare). Chronic, untreated hyperuricemia can lead to permanent joint damage.
Risk factors include:
- High uric acid levels due to overproduction or reduced kidney excretion
- Diet high in purines (red meat, organ meats, seafood) and intake of alcohol or fructose-sweetened beverages
- Genetic predisposition (family history of gout)
- Medical conditions such as untreated high blood pressure, diabetes, high cholesterol, metabolic syndrome, heart or kidney disease
- Medications that raise uric acid (diuretics, low-dose aspirin, immunosuppressants)
- Obesity, which increases uric acid production and reduces excretion
- Age and sex—more common in men; post-menopausal women’s risk approaches men’s levels
What are the symptoms of gout?
- Intense joint pain, often in the big toe but can affect ankles, knees, elbows, wrists, and fingers
- Joint discomfort lasting days to weeks after the worst pain subsides
- Inflammation and redness of the affected joint
- Joint stiffness and limited range of motion
- Tophi—lumps of urate crystals under the skin in chronic gout
- Increased risk of kidney stones
Gout symptoms typically begin suddenly, often at night, and peak within 12–24 hours of onset.
How is gout diagnosed?
- Medical history and physical exam focusing on diet, family history, and joint examination
- Joint fluid test: synovial fluid analysis for urate crystals is the definitive diagnostic test
- Blood test to measure uric acid levels, though levels may be normal during an attack
- Ultrasound to detect urate crystals or tophi in joints
- X-ray imaging to rule out other joint disorders
- CT scan for detection of urate crystals in joints, used selectively
Early diagnosis allows effective management and prevents joint damage. Gout may be differentiated from pseudogout by the type of crystals found (urate vs. calcium pyrophosphate).
How is gout treated?
Treatment of acute gout attacks
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or indomethacin
- Colchicine, most effective if taken within 24 hours of attack onset; may cause nausea, vomiting, or diarrhea
- Corticosteroids, given orally, by injection into muscle, or directly into the joint for those who cannot take NSAIDs or colchicine
Prevention of future attacks
- Medications to lower uric acid levels, including allopurinol, febuxostat, and probenecid
- Lifestyle and dietary changes: limit purine-rich foods, reduce alcohol (especially beer), avoid fructose-sweetened drinks
- Maintain a healthy weight and stay well-hydrated
- Engage in low-impact exercise such as walking, cycling, or swimming
- Regular monitoring of uric acid levels to keep them within target range
Sources
- Gout. American College of Rheumatology. Accessed Apr. 24, 2024.
- Gout. Arthritis Foundation. Accessed Apr. 24, 2024.
- Gout. U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Accessed Apr. 24, 2024.
- Gout. U.S. National Library of Medicine. Accessed Apr. 24, 2024.