Gout is inflammatory arthritis characterized by flare-ups of painful swelling in the joints that lasts days or even weeks. The incidence of this painful disease has been increasing over the years,1 and a number of factors may explain why. There is no cure for gout, only treatments to reduce its symptoms and strategies to reduce its occurrence.2
What Causes Gout?
Gout occurs due to abnormally high levels of uric acid in the body. Uric acid is a product that forms when the body breaks down purines, a chemical compound that is naturally found in the body and is also consumed in food, especially red meats and seafood.3 With hyperuricemia (too much uric acid in the body), uric acid crystals can settle in joints and tissues and cause inflammation. It is important to mention that hyperuricemia alone may not always cause gout.4
Who Gets Gout?
Men are more likely to develop gout than women. Those with a family history of gout are more likely to have it. People who are taking diuretics are at increased risk of developing gout. Eating or drinking lots of foods high in sugar, including alcohol, dispose of one for gout. Also, eating lots of foods that are high in purines, like red meat and shellfish, can increase the risk for gout.
Being obese and having health conditions such as congestive heart failure, high blood pressure, diabetes, and poor kidney function also make individuals at-risk for gout.
The increase in aging populations (and thus, the increase in age-associated chronic diseases) and increase in obesity (with increased consumption of foods, including those high in sugar like high fructose corn syrup) may be linked to overall increases in the incidence of gout.5
What Are the Symptoms of Gout?
Symptoms of gout include intense pain, redness, swelling, and warmth in a single joint, most commonly the big toe. When symptoms occur in the big toe, this is known as “podagra.”6 Other areas can be affected such as the feet, ankles, and knees. After an individual’s first gout attack, several months or years can go by without any symptoms.
How is Gout Diagnosed?
Uric Acid levels in the blood can be tested and high levels can suggest gout. Fluid surrounding the joint can also be obtained and sent to a lab for analysis. Crystals from the joint fluid are normally visualized under a microscope which can serve as a definitive diagnosis of gout.
How is Gout Treated?
Treatment includes medications that reduce inflammation such as NSAIDs (like naproxen) or steroids. Colchicine is another medication that can also be helpful when symptoms from a gout attack have been present for less than 36 hours.7
There are three main goals of gout treatment. They include:
- Managing pain during an attack
- Preventing future attacks
- Prevention of kidney stones and tophi, which are solid uric acid deposits under the skin
Can Gout be Prevented?
Prevention of gout attacks includes the following strategies:
- Treatment of health conditions such as high blood pressure and diabetes
- Weight loss
- Avoidance of purine-rich foods and foods high in sugar
- Protection of joints by participating in low impact activities such as swimming, bicycling, and walking
- Research has shown that cherries and Vitamin C may provide some benefit to decreasing future gout flares8
Always follow up with your healthcare provider for regularly scheduled visits to promote general health and for treatment of health conditions that could potentially increase your risk of developing gout. Those who suffer from gout are often referred to the care of a specialist, called a rheumatologist, for management of symptoms and prevention of gout flare-ups.
1 Bruce M Rothschild, “Gout and Pseudogout,” Medscape, updated July 26, 2019, https://emedicine.medscape.com/article/329958-overview#a5
2 Centers for Disease Control and Prevention, “Gout,” https://www.cdc.gov/arthritis/basics/gout.html
3 Judith Frank, “What Are Purines?,” Arthritis-Health, updated February 26, 2014, https://www.arthritis-health.com/types/gout/what-are-purines
4 Michael A Becker and Angelo L Gaffo, “Clinical manifestations and diagnosis of gout,” UptoDate, updated March 6, 2019.
6 David B. Hellmann and John B. Imboden Jr., “Rheumatologic, Immunologic, and Allergic Disorders: Gouty Arthritis,” in Current Medical Diagnosis and Treatment 2018, (McGraw-Hill Education, 2018): 837-842.
8 Michael A Becker and Tuhina Neogi, “Lifestyle modification and other strategies to reduce the risk of gout flares and progression of gout,” UptoDate, updated January 18, 2019.