Medically reviewed by Paula Tanasa, MD
If you’ve ever woken up at night with a gout attack or flare-up, you know how painful it can be. Gout causes pain in the joints, often first in the big toe – and this pain can come and go throughout life. For some, managing these flare-ups can be difficult.
Here’s what you need to know about gout: what it is, how it’s managed, and how to take steps to prevent long-term complications.
What is gout?
Gout is a type of inflammatory arthritis this causes painful flare-ups. Although the main symptom associated with gout is pain in the joints, most commonly in the big toe, gout is a serious condition that can have negative effects almost anywhere on the body. Gout can also break out in the elbows, wrists, fingers, knees and ankles – and even in the spine. This occurs when there is a buildup of uric acid in the blood that causes needle-like crystals to form in the bones, joints, kidneys, heart and eyes, which can caused damage over time.
High levels of uric acid don’t always mean you’ll have gout. Around 2 out of 3 people those with higher uric acid levels do not have gout flare-ups.
Gout affects men more often, but women can suffer from it. 5 people out of 100 women get gout. This is because women naturally have lower uric acid levels than men, and the female hormone estrogen helps the body expel uric acid through urine. Uric acid levels tend to increase after menopause when estrogen levels drop, increasing the risk of gout.
In the past, gout was called “lords disease» or a “disease of kings”, because it was associated with rich men. This has given rise to many misconceptions and stigma surrounding this condition, and many people suffer in silence or feel blamed for living with the condition.
Gout can be misdiagnosed as another form of inflammatory arthritis such as pseudogoutwhere there is pain and swelling in the joints, but this is due to a build-up of calcium and not uric acid.
How do you get gout?
Uric acid is produced in your body when purines break down. Purines are found naturally in the body, but also in certain foods. Your kidneys normally rinse extra uric acid, but if it doesn’t, uric acid can build up throughout your body. This is why people with chronic kidney disease or reduced kidney function are at higher risk of gout.
Gout Risk Factors include:
- Genetics (a family history)
- Certain health problems such as kidney disease, obesity, metabolic syndrome or high blood pressure
- Taking certain medications, such as immunosuppressants or diuretics (water pills)
- A diet rich in purine-rich foods such as red meat, liver, certain seafood, alcohol and sugary drinks
Despite what people think, diet is not the main cause of gout, and many people who eat healthily and don’t drink alcohol still develop gout. Genetics, family history, and reduced kidney function are the main factors leading to the development of gout.
Certain communities of color are also at greater risk of contracting the disease. Gout is more common among Black Americans; Asian Americans and Asian Pacific Islanders are also at higher risk of contracting the disease.
What are the symptoms of gout?
Symptoms of gout include:
- Sudden, intense pain, often in the big toe, but also in the small joints of the feet and hands, knees, ankles, wrists and elbows.
- Swelling
- Redness
- Heat
These symptoms are worse at first 4 to 12 hours after they started. If gout is left uncontrolled, flare-ups may occur more often and last longer.
It is important to treat gout because uncontrolled gout can lead to other health problems. These include:
- Joint and bone damage, including joint and bone erosion
- Joint nodules or gouty bumps, called tophi, on the fingers, hands, feet, elbows, or back of the ankle. Tophi comes from the buildup of uric acid which can become swollen and tender during outbreaks.
- Kidney stones and development or worsening of chronic kidney disease due to a buildup of uric acid in the urinary tract
The buildup of uric acid can lead to permanent damage to bones and joints, as well as a higher risk of cardiovascular disease.
How long does gout last?
People with gout may have flare-ups that last 1 to 2 weeks. These often follow a period without symptoms, called remission. But even if you don’t have a painful attack, uric acid can still build up in the body.
A gout flare may only happen once in your lifetime, or it may become chronic and gradually get worse over time. This can cause permanent damage throughout the body after several years without treatment.
How is gout treated?
Gout treatment involves managing flare-ups and preventing future flare-ups and long-term complications such as joint damage. It’s a good idea to see a gout specialist if you have symptoms, because gout symptoms can resemble other inflammatory conditions that cause joint swelling, like rheumatoid arthritis. Rheumatologists are doctors who specialize in the treatment of gout. Many nephrologists (kidney specialists) also treat the disease because of its impact on the kidneys.
Different medications can be used to treat gout and prevent long-term damage to your joints. Anti-inflammatory medications such as ibuprofen (Advil), steroids (in pill form or intra-articular injection, injected directly into the joint space), or colchicine (a prescription anti-inflammatory) may help to reduce pain and swelling during a flare-up. To combat the root cause of gout – excess uric acid – you can take medications to lower the levels of uric acid in your blood, which can help reduce the risk of complications.
There are also steps you can take yourself to prevent flare-ups, including:
- Diet changes: limit foods high in purines and eat a overall healthy diet fruits and vegetables, whole grains, nuts and unprocessed foods.
- Limit alcohol consumption, especially beer
- Reduce the amount of drinks containing high levels of sugar, such as research shows that it can contribute to the production of uric acid
- Maintain a healthy weight by getting regular exercise 30 minutes a day, five days a week, which is gentle on the joints. This may include walking, cycling and swimming.
Some people may have gout that persists even after taking oral medications. If this is you, it’s a good idea to ask your doctor about your other options.
How to talk to your healthcare professional about gout
Stay in touch with your healthcare provider about your symptoms and advocate for what you need. It’s a good idea to keep a journal of your flares that includes:
- Pain intensity
- Location of pain
- When it started
- Stressors you are currently experiencing
- The impact of flare-ups on your work, relationships and daily life
Write a list of questions that you can discuss with your healthcare professional. These could include:
- Is my uric acid level normal, and if not, what can I do to lower it?
- What could be causing my gout?
- Should I see a rheumatologist?
- What are the side effects of the medications you want me to take?
- When should I see improvement in my symptoms?
- How long should I take medication?
- How can I manage my other gout-related health problems?
- Are there resources you can provide to help manage the condition?
There is no cure for gout, but working with a healthcare professional to treat the condition, taking medications as directed, and practicing self-management strategies can all help you manage your condition.
This resource was created with support from Horizon Therapeutics.
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