Gout is a common and painful form of inflammatory arthritis that can lead to joint damage and other complications if left untreated. Despite outdated misconceptions, gout is still very much a current health concern that affects millions of Americans.
What is gout?
Gout is a common type of inflammatory arthritis caused by a combination of genetic and environmental factors. It happens when uric acid builds up in the blood, a condition known as hyperuricemia. Uric acid forms when the body breaks down substances called purines, which are found naturally in your body and in foods like red meat, organ meats, and seafood such as sardines, scallops, and tuna. Alcohol, especially beer, and drinks with fruit sugar can also raise uric acid levels.
Under normal conditions, uric acid dissolves in the blood and passes out of the body in urine. But if your body makes too much uric acid or doesn’t remove enough of it, the excess can form sharp crystals in the joints. These crystals cause inflammation, which leads to gout symptoms.
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If you have hyperuricemia, the uric acid may form needle-like crystals. If those form or settle in your joints, they trigger an inflammatory response from your immune system that produces gout symptoms.
Risk factors
Men are three times more likely than women to develop gout. That’s largely because women tend to have lower uric acid levels than men until they pass menopause. As a result, while men usually develop gout between the ages of 30 and 50, women usually develop it after menopause.
You are more likely to develop gout if you:
• Have a biological parent or grandparent who has or had it
• Frequently consume foods and beverages that can increase your uric acid levels
• Are overweight
• Have certain conditions or diseases, including untreated high blood pressure, diabetes, metabolic syndrome, and heart or kidney disease
• Take certain medications, including aspirin, some drugs used to treat hypertension, and anti-rejection drugs prescribed to people after an organ transplant
• Recently had surgery or experienced a trauma
Symptoms and progression
Gout usually begins as an episode of inflammation in your big toe, although it may occur in other foot or ankle joints. This episode, called a flare, often happens suddenly at night. If you’re sleeping, it may cause pain intense enough to wake you. It also may cause the affected joint to swell and become red, warm, and hard to move.
Pain from a flare usually is strongest about four to 12 hours after an episode begins. Once the most severe pain subsides, you may experience discomfort in the joint for a few days or weeks. You also may feel ill and get chills or a fever. If you have a fever and the joint where the flare is occurring is inflamed and hot, it may be infected, and you should seek medical help.
While flares may initially be infrequent, untreated hyperuricemia can lead to more frequent episodes affecting your hands, wrists, elbows, feet, and ankles. Hyperuricemia may also lead you to develop kidney stones.
Long-term untreated gout can cause crystal deposits known as tophi, which form hard lumps around affected joints. Tophi can deform joints and cause lasting damage to bones and tissues.
Diagnosis and treatment
If you suspect you have gout, your health care provider will likely:
• Give you a physical
• Check your medical history and ask if any relatives have or have had gout
• Examine the joints where you’ve experienced flares
Your doctor may also order tests, including blood or urine tests to measure uric acid levels, joint fluid analysis, or imaging studies such as ultrasound or CT scans to confirm that gout crystals are present.
Management typically involves lifestyle adjustments aimed at lowering uric acid levels. These include achieving and maintaining a healthy weight as well as avoiding foods high in purine, alcohol, non-alcoholic beer, and drinks with high-fructose corn syrup. Medications may also be prescribed to reduce uric acid and prevent future flares.
During a gout flare, you can manage symptoms by:
• Drinking plenty of water
• Limiting the amount of stress you put on the affected joints
• Icing the affected joints
• Elevating the affected joints so they’re above your heart
A serious but manageable condition
Gout is one of the most manageable forms of arthritis. Early intervention with lifestyle changes and medical treatments can significantly reduce the frequency and intensity of gout attacks, or even eliminate the condition entirely.