What Is Gout?

Definition

Gout is a common and painful type of arthritis, or joint inflammation. The cause is a buildup of uric acid crystals in the joints. Gout attacks cause rapid onset of pain, swelling, and warmth in one or more joints at a time. Longstanding, advanced gout can cause permanent, disabling arthritis.

About 2% to 6% of adults in the U.S. have gout. And it has become more common over the past 20 years due to obesity and the “western diet” (a diet low in fruits and vegetables, and high in fat, sugar, and salt).

People used to refer to gout as the “disease of kings,” since we thought the cause was eating rich foods and drinking wine. But now we know that gout can affect all sorts of people, and risk factors include more than diet.

The good news? Gout is one of the most treatable types of arthritis.

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Causes

Gout happens when uric acid crystals collect in the joints, and the body sends inflammatory cells to clean them up. Uric acid is a natural waste product made when the body breaks down purines, which are found in foods and drinks. We get rid of it via the kidneys when we urinate. As we age, our ability to get rid of uric acid decreases, and uric acid blood levels increase.

Interestingly, it’s possible to have high uric acid levels (hyperuricemia) and never get gout. There are also other risk factors — some you can’t avoid, but others you can change.

Risk factors for gout that you can’t change include:

• Age: Gout happens more often in people over 65. But some people get gout at younger ages, too.

• Male sex: Men are three to four times more likely to get gout than females. Women have lower uric acid levels thanks to estrogen, but their risk goes up after menopause.

• Family history: Your risk increases if you have a first-degree relative (like a father or brother) with gout.

Risk factors for gout that you can change (or control) include:

• Certain medical conditions: Examples include chronic kidney disease, high blood pressure, and Type 2 diabetes.

• Certain medications: Common medications like hydrochlorothiazide and furosemide can increase uric acid levels.

• Diet: Purine-rich foods — like red meat, shellfish, and high-fructose corn syrup — can increase uric acid levels.

• Alcohol consumption: Alcohol — especially beer — can increase uric acid levels.

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Symptoms

Your first gout attack often comes out of nowhere. For example, you might wake up suddenly with a very painful, swollen joint. Gout most commonly affects the knee and big toe joints first (80% of initial gout attacks). But gout can affect any joint in the body. Women may be more likely to have gout in other joints, like the fingers.

Symptoms of gout include the following joint changes:

• Pain

• Swelling

• Redness

• Warmth 

• Tenderness 

• Difficulty bearing weight or using the affected joint

You may also experience fever with a gout attack. But if you have a painful, swollen joint and fever, you should contact your healthcare provider. These could also mean you have septic arthritis, which is a medical emergency.

Your first gout attacks will likely resolve on their own after 1 to 2 weeks. After that, you may not have symptoms for a long time. But if you continue to have gout attacks, you may never get a break from the symptoms. Uric acid crystals continue to build up in the body, which can lead to permanent joint damage and disability.

When gout isn’t treated, it can lead to more severe, advanced symptoms:

• Tophi: These are chalky, white deposits of uric acid. When they are large enough, you can see tophi underneath the skin.

• Joint erosions: Gout can attack the bones and cause permanent damage.

Diagnosis

To be 100% sure that the diagnosis is gout, your healthcare provider will perform a joint aspiration. For this procedure they insert a needle into the joint to remove fluid and then examine the fluid under the microscope for uric acid crystals.

But your provider can often make the diagnosis of gout without joint aspiration if there are enough clues. For example, you might not need this procedure if you have risk factors for gout, a suddenly swollen and painful big toe joint, and elevated uric acid levels. Tophi are also a very big clue that gout is the correct diagnosis. In these situations, it’s reasonable to go ahead and treat for gout. But if your symptoms don’t improve after treatment, your provider will likely recommend joint aspiration to rule out gout and check for other types of arthritis.

During your first gout attack, your provider might also order an X-ray to rule out other causes for your joint pain, like a fracture or osteoarthritis.

Your primary care provider can diagnose and treat gout. When gout is severe, a rheumatologist (arthritis specialist) might be involved, too.

Medications

First, the good news: Gout is one of the most treatable forms of arthritis. Let’s break it down into the treatment of acute gout attacks and long-term gout treatment.

Treatment of acute gout attacks

During a gout attack, the key is to start medication at the first sign of an attack — that means as soon as possible. Gout attacks get harder to treat the longer you wait.

Medications to treat gout attacks include:

• Colchicine

• Non-steroidal anti-inflammatory drugs (NSAIDs) like indomethacin or naproxen (Aleve)

• Steroids like prednisone 

• Injection of steroid into the affected joint (a healthcare provider does this)

Long-term treatment of gout

Recent guidelines recommend long-term gout medication if you have more than one gout attack per year, or if you already have tophi or joint erosions (severe gout).

Medications to treat long-term gout lower uric acid blood levels, so crystals can no longer form. These medications include:

• Allopurinol (Zyloprim)

• Febuxostat (Uloric)

Probenecid is another gout medication, but providers usually recommend the others first.

After starting allopurinol or febuxostat, your doctor will check your uric acid levels every 2 to 6 weeks. They’ll increase your dose until the uric acid level is less than 6.0 milligrams per deciliter. If your level is higher than 6.0, uric acid crystals can still form. You’ll also need to take a second medication (colchicine, NSAIDs, or steroids) to help prevent gout attacks until your uric acid level is less than 6.0.

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Living

Gout is an incredibly painful type of arthritis that can totally knock you out during attacks. Left untreated, it can lead to long-term joint pain, damage, and disability. But, again, it’s very treatable with proper medication management.

According to recent data in the American College of Rheumatology guidelines, diet changes are less important for preventing gout flares than researchers previously thought. But they still might help, so it’s worthwhile to know about them.

To help decrease the risk of gout flares, limit your intake of the following: 

• Alcohol (especially beer)

• Red meat

• Shellfish

• High-fructose corn syrup (often in sodas and fruit juices that aren’t freshly squeezed)

Maintaining a healthy weight may also help decrease the risk of gout flares.

If you have gout, it typically means that you’ll need to take medications for life. This can feel overwhelming. But when the alternative is crippling attacks of joint pain, the choice is simple. Gout medications are the best thing you can do to (literally) get back on your feet.

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