Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in the joints. It usually affects the joint at the base of the big toe, known as the metatarsophalangeal joint. Its main cause is the presence of too much uric acid in the body.
Gout affects more than 3 million Americans and is the most common form of inflammatory arthritis in males. And although it is less likely to affect them overall, females have a higher rate of developing gout after menopause.
Gout attacks can come on quickly and may keep recurring over time. This ongoing resurgence can slowly harm tissue in the inflammation area and can be extremely painful. Hypertension, cardiovascular conditions, and obesity are risk factors for gout.
Hyperuricemia, where there is too much uric acid in the body, is the main cause of gout.
People will typically treat the condition with prescription medication. These drugs can help treat the symptoms of gout attacks, prevent future flares, and reduce the risk of complications such as kidney stones and tophi. Tophi refers to when acid crystals form masses of white growths that develop around the affected areas.
Common medications include nonsteroidal anti-inflammatory drugs and corticosteroids, another anti-inflammatory. These reduce swelling and pain in the areas affected by gout.
Excessive uric acid levels are
Without treatment, an acute gout attack will be at its worst between
Tests and diagnosis
Gout can often be challenging to diagnose, as its symptoms are similar to those of other conditions. While hyperuricemia occurs in most people who develop gout, it may not be present during a flare-up. As a result, a person does not need to have hyperuricemia for a diagnosis.
High levels of uric acid in an individual’s blood or urate crystals in their joint fluid are the main diagnostic criteria for gout.
To assess this, a rheumatologist will carry out a blood test and may also extract fluid from an affected joint for analysis.
In addition, they can search for urate crystals around joints or within growths using an ultrasound scan. X-rays cannot detect gout, but healthcare professionals may use them to rule out other causes.
As joint infections can also cause similar symptoms to gout, doctors can look for bacteria when carrying out a joint fluid test to rule out a bacterial cause.
There are various stages through which gout progresses.
A person can have elevated uric acid levels without any outward symptoms. While individuals do not need treatment at this stage, high uric acid levels in the blood
As a result, a doctor may advise a person with high uric acid levels to address factors possibly contributing to its buildup.
This stage occurs when urate crystals in a joint suddenly cause acute inflammation and intense pain. This sudden attack is a “flare” and may last between
Interval or intercritical gout
This stage is the period in between attacks of acute gout. As a person’s gout progresses, these intervals become shorter. Between these periods, urate crystals may continue to build up in tissue.
Chronic tophaceous gout
Chronic tophaceous gout is the most debilitating type of gout and may result in permanent damage to the joints and the kidneys. At this stage, people can have chronic arthritis and develop tophi in cooler areas of the body, such as the joints of the fingers.
Chronic tophaceous gout typically occurs after
One condition that experts easily confuse with gout is calcium pyrophosphate deposition, known as pseudogout. The symptoms of pseudogout are very similar to those of gout, although the flare-ups are usually less severe.
The major difference between gout and pseudogout is that the joints are irritated by calcium pyrophosphate crystals rather than urate crystals. Pseudogout requires different treatments than gout.
Hyperuricemia, an excess of uric acid in the blood, is the leading cause of gout.
The body produces uric acid during the breakdown of purines. These are chemical compounds found in high amounts in certain foods such as meat, poultry, and seafood.
Typically, uric acid is dissolved in the blood and excreted from the body in urine via the kidneys. If a person produces too much uric acid or does not excrete enough, it can build up and form needle-like crystals. These trigger inflammation and pain in the joints and surrounding tissue.
Several factors can increase the likelihood of hyperuricemia and gout, including the below.
- Age: Gout is
more commonin older adults and rarely affects children.
- Sex: In people under the age of 65 years, gout is
four timesas prevalent among males than females. This ratio slightly decreases in people over the age of 65 years to be three times as likely.
- Genetics: A family history of gout can increase the likelihood of a person developing the condition.
- Lifestyle choices: Alcohol consumption interferes with the removal of uric acid from the body. Eating a high-purine diet also increases the amount of uric acid in the body. Both of these can lead to gout.
- Lead exposure: Studies have suggested a link between chronic lead exposure and an increased risk of gout.
- Medications: Certain medications can increase the levels of uric acid in the body. These include some diuretics and drugs containing salicylate.
- Weight: Being overweight or obese and having high levels of visceral body fat have associations with an
increased riskof gout. However, being overweight or obese cannot directly cause the condition.
- Other health conditions: Renal insufficiency and other kidney conditions can reduce the body’s ability to remove waste, leading to elevated uric acid levels. Other conditions associated with gout include high blood pressure and diabetes.
The main symptom of gout is intense joint pain that subsides to discomfort, inflammation, and redness.
The condition frequently affects the base of the big toe but can also occur in the forefoot, ankles, knees, elbows, wrists, and fingers.
In some cases, gout can develop into more severe conditions, including kidney stones or recurrent gout.
There are many lifestyle and dietary guidelines a person can try to protect against flares or prevent gout from occurring in the first instance:
- maintaining a high fluid intake of around 2–4 liters a day
- avoiding alcohol
- maintaining a moderate weight
Individuals with gout can manage flare-ups by moderating what they eat and drink — a balanced diet can help reduce symptoms.
Decreasing foods and drinks high in purines to ensure that uric acid levels in the blood do not get too high is an important first step.
Foods high in purines include:
- red meats
- game meats
- glandular meats, such as kidneys, livers, and sweetbreads
- foods and drinks sweetened with high fructose corn syrup
A person can reduce their risk of developing gout by limiting their intake of purine-rich foods. However, avoiding purine consumption altogether is not necessary. Moderate consumption of purine-rich items can help manage uric acid levels and gout symptoms and benefit overall dietary health.
Gout is a type of inflammatory arthritis. As a result, a person experiencing symptoms of gout
Gout is a common form of arthritis that affects the joints. It can lead to intense pain, swelling, and stiffness. The condition affects more than 3 million Americans and is more prevalent in males than females.
Hyperuricemia — when too much uric acid is present in a person’s blood — is the leading cause of gout.
Individuals may experience hyperuricemia if their body overproduces uric acid or if their kidneys do not excrete the substance adequately.
A doctor will typically recommend prescription medications to treat gout. This may include treatments to reduce inflammation in the affected joints and drugs to help regulate uric acid levels.
People can help reduce their risk of developing gout by avoiding foods high in purines that the body converts into uric acid, keeping adequately hydrated, and avoiding alcohol.