Gout: Causes, Symptoms, & Treatment

What Is Gout?

Gout is a condition that occurs when urate crystals build up in the joints, causing inflammation and intense pain. Urate crystals can form when you have high levels of uric acid in your blood, which can occur due to predisposing genetic factors and exacerbated by the consumption of certain food and alcohol. It most often affects the joint at the base of the big toe but can also occur in the hands, feet, wrists, ankles, knees, and elbows.

Uric acid is produced by your body during the process of breaking down purines, an amino acid found in plants and animals. In most instances, the uric acid dissolves in your blood, is cleared through your kidneys and then passes into your urine without issue. If you’re experiencing gout, your body either produces too much uric acid, or your kidneys excrete too little, causing a deposition of urate crystals in your joints.

Stages and types of gout

• Asymptomatic hyperuricemia: When your uric acid levels are elevated without any outward symptoms, you may have asymptomatic hyperuricemia. At this stage, it is important to take steps to prevent gout through dietary and lifestyle changes.

• Acute gout: Sudden attacks, also referred to as a “flare” or acute gout, normally subside within 3-10 days. Flares can be triggered by stressful events, certain foods, alcohol, and even cold weather.

• Interval or intercritical gout: The period in between acute gout attacks is often referred to as remission, and flares may not occur for months or years at a time.

• Chronic tophaceous gout: This is the most serious type of gout that can cause a person to suffer from chronic arthritis. It is rare to experience this type of gout if you are treating the condition properly.

• Pseudogout: Pseudogout is caused by a deposition of calcium pyrophosphate crystals rather than urate crystals in the joints. Pseudogout causes similar symptoms, but may need to be treated somewhat differently.

Symptoms Of Gout

Gout most commonly affects the large joint of the big toe, but can also affect any joints in your body, including in the feet, ankles, knees, elbows, wrists, and fingers. Gout symptoms usually appear suddenly and become severe quickly.

The main symptoms of gout include:

• Intense joint pain
• Prolonged discomfort
• Inflammation
• Redness
• Warmth
• Limited range of motion

Pain is the most common symptom of gout and can vary in severity—the onset pain can be very intense and then subside to a dull ache. A gout attack typically lasts for 3-10 days.

Signs your gout may be getting worse

Gout attacks and symptoms are usually controllable, but if the condition worsens, you may experience additional, associated symptoms.

• Flares that occur more frequently and last longer
• Flares in multiple joints
• Hard bumps that form under the skin, known as gouty “tophi”
• Kidney problems

What Causes Gout?

There is a famous quote about gout, “Gout is the foe that may be lying in ambush amid the sauces, the bottles, the sweets, and the flesh-pots” (Ellwanger, 1897). Gout flares occur when high levels of uric acid build up in your joints. This buildup is worsened by a variety of factors including the foods you eat, medications you take, and medical conditions you may suffer from.

Food that can cause gout

Certain foods contain higher levels of purines and therefore cause your body to produce large amounts of uric acid if you consume them. These include:

• Red meat
• Seafood
• Alcohol, beer in particular
• Sugary drinks like soda and fruit juice

Medicines that can cause gout

Some medications used to treat other conditions are known to cause gout, including:

• Salicylate containing medications, such as aspirin
• Certain diuretics (water pills)
• Some blood pressure-lowering medications

Medical conditions that can cause gout

Gout may be associated with other medical conditions or medications used to treat them, including:

• Diabetes
• High blood pressure
• Joint trauma
• Obesity
• Infection
• Congestive heart failure
• Kidney disease

Risk Factors and Complications

Gout is a direct result of elevated levels of uric acid in the body. There are certain factors that can increase your risk of developing gout, including:

• Family history: Gout is often inherited and associated with other hereditary conditions such as high blood pressure, diabetes, and obesity.

• Diet: Consuming a diet high in purines, such as red meat and seafood, as well as sweetened beverages, increases your risk of gout. Consuming alcohol, especially beer, also increases your risk.

• Medical conditions: Certain diseases and conditions such as high blood pressure, diabetes, heart disease, and kidney disease are often associated with gout.

• Sex: Gout more commonly affects men, due to naturally higher uric acid levels in the body.

• Age: Men typically start to develop gout between the ages of 30-50. It is more common for women to develop gout after menopause, when uric acid levels increase.

Diagnosing Gout

Your doctor will diagnose you with gout after assessing your symptoms, performing a physical exam, and potentially ordering x-rays and lab tests. The condition can only be definitively diagnosed during a flare, when fluid from the affected joint can be examined to look for uric acid crystals. If the diagnosis is unclear, you may need to make an appointment with a rheumatologist, a doctor who specializes in gout and other forms of arthritis, for further evaluation.

Gout Treatment and Prevention

There is no cure for gout, but there are ways to effectively prevent and treat the condition. It is important to treat gout as soon as you experience symptoms. If untreated for an extensive period of time, gout can lead to chronic arthritis.

Treatment plans vary depending on the causes and severity of your gout, but most include a combination of medication and lifestyle changes.

Medical treatment of gout

• Pain management: Treatment of gout flares consists of nonsteroidal anti-inflammatory drugs such as ibuprofen and Indomethacin. Steroids are sometimes used acutely if NSAIDs can’t be used, or in combination with them.

• Prevention: Changing or stopping medications associated with hyperuricemia (like diuretics) may help prevent future flares. Some medications, such as Colchicine, may be prescribed to aid in prevention.

Home remedies

There are several natural remedies for gout that you can find right in your pantry. The following foods and supplements may help lower uric acid levels and prevent gout flare ups:

• Apple cider vinegar
• Tart cherry juice
• Celery
• Ginger
• Magnesium
• Celery seeds
• Water with lemon
• Essential oils

Gout surgery

While gout rarely requires surgery, there are circumstances when it may be considered. Surgery is most often used to remove nodules, otherwise known as tophi, that form in a person's joints as a result of gout. These nodules can be uncomfortable and unsightly. In rare cases, the tophi can also lead to infections. Surgery may be limited to solely removing the tophi, or may require more extensive procedures to fuse or even replace joints.

When to See a Doctor

If you are experiencing symptoms of gout, it is important to see a doctor while the symptoms are present. Your doctor will review your symptoms and medical history, perform a physical exam, and perform any necessary tests in order to make a diagnosis. These tests include x-rays of your joint and a fluid sample to check for uric acid buildup.

You can speak with a primary care doctor for your initial treatment and diagnosis, but depending on the severity of your gout, you may be referred to a rheumatologist—a doctor who specializes in joints—for further treatment.

How K Health Can Help

If you think you are experiencing symptoms of gout, you may want to see a doctor. Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.