Gout is a form of arthritis caused by too much uric acid build-up in your body. Gout often causes sudden pain and swelling in one joint, often the big toe or other joints in the feet. Uric acid is a natural substance that’s in your blood. Your kidneys filter uric acid, but if levels get too high or the kidneys can’t remove enough of it, urate crystals can form and settle into a joint. This clump of crystals causes pain, swelling, and redness. Gout affects men more often than women.
Foods rich in purines, high alcohol intake, and drugs like immunosuppressants and diuretics can raise your risk of gout.
• Shellfish, gravies, red meat, soups and organ meats, such as liver, are high in purines.
• Sugary drinks and alcoholic beverages are also linked to gout.
• Diet, weight loss, and regular exercise help manage gout and reduce flare risk.
• Gout usually strikes the toes or feet, but can occur in other joints
Gout’s main signs are sudden, intense pain and swelling in one or two joints. At first, gout attacks may start at night. Severe attacks are typically followed by periods of no symptoms. In addition to being located in the joints, crystals can form tophi, or swollen growths, under the skin, often located over a joint or on the outer ear. Urate crystals and tophi can damage the joints over time. A rheumatologist can diagnose gout and make sure symptoms are not due to some other type of arthritis or an injury.
Diagnosis is based on symptoms, medical history and lifestyle, and laboratory tests.
• Blood tests can measure uric acid, although high levels don’t always mean gout.
• Some people with gout may have low uric acid levels at times, even during flares.
• A needle can be used to withdraw fluid from the swollen joint. The fluid obtained can be examined by the physician or sent for laboratory analysis.
• Patients with long-standing gout may need x-rays or other scans to show joint damage.
Gout treatments include drugs to ease inflammation, lower or break down uric acid in the blood, or help the kidneys flush excess uric acid. Colchicine can ease a gout flare or help prevent attacks, but has some side effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) can ease pain and swelling. Glucocorticoid pills or shots can ease a gout flare. Allopurinol (Lopurin, Zyloprim) lowers uric acid levels in the blood and also blocks its production. Febuxostat (Uloric), a newer drug, also blocks uric acid. Probenecid (Benemid) and Lesinurad (Zurampic) help the kidneys remove uric acid, and pegloticase (Krystexxa) infusions help break down uric acid.
Each person with gout needs a unique treatment plan. A rheumatologist can prescribe the right treatment for gout and manage it over time.
• Gout treatment aims for a uric acid level of 6 mg/dL or lower to dissolve or prevent crystals.
• Kidney function and uric acid levels may affect choice of treatment.
• People with severe gout may benefit from a short treatment course of anakinra (Kineret), a biologic drug, though this medication is not FDA-approved for the treatment of gout.
• Low-dose colchicine and NSAIDs may prevent gout flares.
Diet and lifestyle can help manage gout and prevent flares. It’s important to watch your diet and maintain a healthy weight. Gout is often associated with high blood pressure, heart and kidney disease, so your primary care provider or rheumatologist may test for or watch for signs of these health problems.
• Excess alcohol, especially beer, can trigger gout. Cut back on alcohol drinking.
• People with gout should be safe to eat purine-rich vegetables like spinach or mushrooms.
• Low-fat dairy foods may lower uric acid levels and help manage gout.
• Avoid drinks high in sugar or fructose, like concentrated juices or sodas.