Orthopaedics
What Is Gout? Know the Signs and Risk Factors
Reviewed by UPMC Orthopaedic Care
February 4, 2020
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Gout is a form of inflammatory arthritis that causes pain, redness, stiffness, and swelling in your joints. More than 8 million people in the United States have gout.
The condition usually affects one joint at a time. About half of gout attacks begin in the big toe, but it also can be found in the ankles, heels, knees, wrists, fingers, and elbows.
Although gout can cause pain, it can be managed with proper treatment.
What Causes Gout?
Gout is caused by a buildup of uric acid, a waste product that comes from natural body processes and can also be found in some foods.
Normally kidneys dispose of uric acid through urine. Sometimes a buildup can occur if too much uric acid is produced or the kidneys can’t properly dispose of it.
If your uric acid levels get too high, hard, needle-like crystals can form in your joints, fluids, or tissues. These can cause pain.
Who Is at Risk of Gout?
Gout is sometimes called the “disease of kings” because of a false link to overindulgence in food and alcohol. Anyone can get the condition, but certain factors can increase your risk:
- Gender: Males are more likely than females.
- Age: Middle-aged and older men and women after menopause are more at risk for gout.
- Obesity
- Family history
- Diet: A diet high in purines, which get broken down into uric acid, can lead to gout. Foods high in purine content include meat like bacon, turkey, veal, venison, and liver, and seafood like anchovies, sardines, mussels, codfish, scallops, trout, and haddock. High-fructose food and drinks, such as soda pop, also can increase your risk.
- Alcohol use
- Diabetes
- High blood pressure
- High cholesterol
- Congestive heart failure
- Poor kidney function
- Chemotherapy
- Stress
- Lead exposure
- Certain medications, such as diuretics, niacin, and aspirin
- Previous gastric bypass surgery
Stages of Gout
Gout occurs in several stages.
What Are the Symptoms of Gout?
The symptoms of gout usually begin at night. Typically, attacks occur in the big toe, but they can happen in other joints as well.
Symptoms in the affected joint include:
- Sharp, intense pain
- Redness
- Swelling
- Heat
Symptoms from a gout attack can last days or weeks before the pain lessens.
How Do Doctors Diagnose Gout?
To diagnose gout, doctors usually will evaluate your symptoms and ask about your medical and family history. They also will examine the affected joint and may take a fluid sample from the joint to look for uric acid crystals.
Other potential diagnostic tests for gout include blood tests for uric acid levels and screenings such as ultrasounds or x-rays.
How Is Gout Treated?
Although gout can’t be cured, it can be treated through a mix of medicine and lifestyle changes. You can both treat an acute gout attack and attempt to lessen your chances of another gout attack in the future.
- Elevate the joint and apply ice
- Drink fluids: But avoid sugary drinks and alcohol.
- Change your diet: Restricting high-purine foods, high-fructose drinks, and alcohol can help prevent future gout attacks.
- Medication: Certain medicines can be used during an
attack to relieve symptoms. Others can be used after an attack to lower
uric acid levels.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Drugs like ibuprofen, like Motrin or Advil, and naproxen, like Aleve, can relieve the pain during a gout attack. Aspirin should not be taken because it can raise uric acid levels.
- Corticosteroids: These can be taken by mouth or can be injected into your joints during a gout attack.
- Colchicine: This drug can relieve the pain and inflammation of gout, but it also carries significant side effects.
- Drugs to lower uric acid levels: Medications like allopurinol, febuxostat, probenecid, and pegloticase can help your body lower or eliminate excess uric acid. These should be taken after the symptoms of a gout attack have gone away.
Complications of Gout
Most symptoms of gout can go away within three to 10 days with proper treatment. However, gout is not curable. And without treatment or a change in lifestyle, other health conditions can occur.
- Chronic gout: If your uric acid levels remain high, you run the risk of chronic gout. This may mean two or more gout attacks per year, affecting more than one joint. You may have shorter periods between attacks and feel symptoms more often.
- Tophi: Hard crystals of uric acid that form under the skin. They can form on most joints and cartilage and can damage joints, bones, and cartilage.
- Joint damage: Chronic gout and tophi both can cause permanent joint damage and deformity.
- Kidney stones: If urate crystals build up in your urinary tract, they can cause kidney stones. These can cause severe pain, especially during urination, and are one of the most common gout complications.
- Kidney disease: The buildup of urate crystals in your kidney can cause damage, potentially leading to future kidney disease and failure.
- Heart failure: Some of the risk factors for gout also are risk factors for heart disease. Also, inflammation from gout can increase your risk of heart problems.
- Diabetes: Obesity and excess alcohol are risk factors for both gout and diabetes.
- Sleep problems: Gout attacks occur most frequently at night. The resulting pain and other symptoms may cause sleep problems. Chronic gout may cause persistent symptoms, leading to long-term sleep problems.
- Mental health issues: Stress, anxiety, and depression can occur with continued physical pain from gout. For some, gout also carries a stigma because of its reputation as “the disease of kings.”
- Bone problems: Inflammation from gout can cause thinning bones, which can make it easier for breaks to occur.
Can I Prevent Gout?
Although gout can’t be cured, it can be managed effectively with medicine and lifestyle changes.
If your uric acid levels remain high after a gout attack, doctors may prescribe medication that can lower your levels. This can lessen your risk of long-term problems.
Self-care also is important if you have gout. A diet that avoids high-purine foods, high-fructose drinks, and alcohol can lessen your long-term risks. Losing weight also can lower your chances of gout. If you use medications like diuretics, stopping that use can help prevent gout as well.
If you do have gout, or suspect you might, schedule an appointment with your doctor for a consultation or treatment.
Sources
What Is Gout? . Alliance for Gout Awareness. Gout . American College of Foot and Ankle Surgeons. Gout . American College of Rheumatology. Complications of Gout . American Kidney Fund. What Is the Difference Between Acute and Chronic Gout? . American Kidney Fund. Gout . Arthritis Foundation. Safe Foods for Gout. Arthritis Foundation. Gout . Centers for Disease Control and Prevention. 8 Gout Complications You Need to Know About . CreakyJoints. Gout . U.S. National Library of Medicine.
About UPMC Orthopaedic Care
As a national leader in advanced orthopaedic care, UPMC treats a full range of musculoskeletal disorders, from basic to complex. We offer treatments for both acute and chronic conditions. Whether you have bone, muscle, or joint pain, we provide access to UPMC’s vast network of services for both surgical and nonsurgical treatments. UPMC Presbyterian Shadyside appears on U.S. News & World Report’s rankings of the top hospitals in the country for orthopaedics. We strive to use the most advanced treatments. We are leaders in research and clinical trials, seeking even more cutting-edge tools and techniques.