What is gout/uric acid?
Gout is a type of arthritis. Arthritis is a common condition that causes swelling and pain in your joints. Gout is considered a chronic disease, meaning it does not have a cure and will usually last your whole life.
Gout comes in sudden, and sometimes severe attacks, also called flares, or flare-ups. During a gout attack you may have pain, swelling, and/or redness in your joints. Gout attacks often happen in the big toe, but can affect any of your body’s joints like your elbows, knees, hands, or ankles. Gout is extremely painful and sometimes hard to control. Gout can be either acute or chronic.
Kidney disease can lead to gout, and gout may lead to kidney disease. If you have either condition, talk to your doctor about preventing the other.
- What is the difference between acute and chronic gout?
- What causes gout?
- Who is at risk for gout?
- What are the symptoms of gout?
- How can I manage gout attacks?
- Why do gout attacks happen more at night?
- What are the complications of gout?
- What are the tests for gout?
- What are the treatments for gout?
- Is gout preventable?
- What is the best diet for gout?
- Gout and kidney disease
- Where can I get more information?
- Find a gout specialist
What is the difference between acute and chronic gout?
- Usually only 1-3 joints are affected.
- You will only feel symptoms during attacks.
- Attacks may last from a few days to a week.
- After attacks, you will not feel symptoms.
- You may start by having acute gout but worsen to chronic gout over time if attacks happen more often.
- Chronic gout is having 2 or more gout attacks per year.
- Often more than one joint is affected.
- Some people with severe chronic gout have only short breaks in between attacks and feel symptoms of gout most of the time.
- Chronic gout can lead to permanent joint stiffness, damage, and deformity.
What causes gout?
Gout is caused by having too much uric acid in your blood. Uric acid is made when your body breaks down chemicals called purines.
Who is at risk for gout?
Anyone can get gout, but it is more common in men than in women. Gout is more common in adults than in children.
What are the symptoms of gout?
Although many people have their first gout attack in one of their big toes, gout attacks can also happen in other joints.
How can I manage gout attacks?
Gout attacks, also called flares, or flare-ups, can come on suddenly and be extremely painful.
Why do gout attacks happen more at night?
Gout attacks happen more at night and in the early morning rather than during the day. You may have an attack start during your sleep. The reasons this happens are not entirely known, but some of the leading ideas are dehydration, lower body temperature, and changes in hormone levels during sleep.
Talk to your doctor about ways to prevent gout attacks during your sleep.
What are the complications of gout?
Gout does not only cause pain. Having gout, and especially chronic gout, can lead to serious health problems over time if left uncontrolled.
What are the tests for gout?
If you think you might have gout, it is important to get tested and diagnosed by a doctor, so that you can get the treatment you need.
What are the treatments for gout?
Taking too many medicines or taking certain medicines at the same time can be dangerous, so it is very important to talk to your doctor about how many medicines you can take.
Is gout preventable?
Gout is usually not preventable through lifestyle changes alone. Many people with gout need medicines to get their gout under control.
What is the best diet for gout?
Certain foods and drinks are better than others for controlling gout.
Gout and kidney disease
Most commonly, kidney disease can cause gout. However, gout may also lead to kidney disease. Since uric acid is filtered through the kidneys, the two diseases are related.
Where can I get more information?
Find a gout specialist
If you don’t have a gout specialist, use this “Find a Gout Specialist” tool to identify healthcare professionals who are experienced treating chronic gout.
The majority of gout cases are treated with medication. Medication can be used to treat the symptoms of gout attacks, prevent future flares, and reduce the risk of gout complications such as kidney stones and the development of tophi.
Commonly used medications include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids. These reduce inflammation and pain in the areas affected by gout and are usually taken orally. Various brands are available to purchase online.
Medications can also be used to either reduce the production of uric acid (xanthine oxidase inhibitors such as allopurinol) or improve the kidney’s ability to remove uric acid from the body (probenecid).
Without treatment, an acute gout attack will be at its worst between 12 and 24 hours after it began. A person can expect to recover within 1 to 2 weeks without treatment.
Tests and diagnosis
Gout can be tricky to diagnose, as its symptoms, when they do appear, are similar to those of other conditions. While hyperuricemia occurs in the majority of people that develop gout, it may not be present during a flare. On top of that, the majority of people with hyperuricemia do not develop gout.
One diagnostic test that doctors can carry out is the joint fluid test, where fluid is extracted from the affected joint with a needle. The fluid is then examined to see if any urate crystals are present.
As joint infections can also cause similar symptoms to gout, a doctor can look for bacteria when carrying out a joint fluid test in order to rule a bacterial cause.
Doctors can also do a blood test to measure the levels of uric acid in the blood, but, as mentioned, people with high uric acid levels do not always experience gout. Equally, some people can develop the symptoms of gout without having increased levels of uric acid in the blood.
Finally, doctors can search for urate crystals around joints or within a tophus using ultrasound or CT scans. X-rays cannot detect gout, but may be used to rule out other causes.
There are various stages through which gout progresses, and these are experienced as the different types of gout.
It is possible for a person to have elevated uric acid levels without any outward symptoms. At this stage, treatment is not required, though urate crystals are being deposited in tissue and causing slight damage.
People with asymptomatic hyperuricemia may be advised to take steps to address any possible factors contributing to uric acid build-up.
This stage occurs when the urate crystals that have been deposited suddenly cause acute inflammation and intense pain. This sudden attack is referred to as a “flare” and will normally subside within 3 to 10 days. Flares can sometimes be triggered by stressful events, alcohol and drugs, as well as cold weather.
Interval or intercritical gout
This stage is the period in between attacks of acute gout. Subsequent flares may not occur for months or years, though if not treated, over time, they can last longer and occur more frequently. During this interval, further urate crystals are being deposited in tissue.
Chronic tophaceous gout
Chronic tophaceous gout is the most debilitating type of gout. Permanent damage may have occurred in the joints and the kidneys. The patient can suffer from chronic arthritis and develop tophi, big lumps of urate crystals, in cooler areas of the body such as the joints of the fingers.
It takes a long time without treatment to reach the stage of chronic tophaceous gout – around 10 years. It is very unlikely that a patient receiving proper treatment would progress to this stage.
One condition that is easily confused with gout is pseudogout. The symptoms of pseudogout are very similar to those of gout.
The major difference between gout and pseudogout is that the joints are irritated by calcium phosphate crystals rather than urate crystals. Pseudogout requires different treatment to gout.
The following images show the appearance of gout when it develops.
Gout is caused initially by an excess of uric acid in the blood, or hyperuricemia. Uric acid is produced in the body during the breakdown of purines – chemical compounds that are found in high amounts in certain foods such as meat, poultry, and seafood.
Normally, uric acid is dissolved in the blood and is excreted from the body in urine via the kidneys. If too much uric acid is produced, or not enough is excreted, it can build up and form needle-like crystals that trigger inflammation and pain in the joints and surrounding tissue.
There are a number of factors that can increase the likelihood of hyperuricemia, and therefore gout:
Age and gender: Men produce more uric acid than women, though women’s levels of uric acid approach those of men after the menopause.
Genetics: A family history of gout increases the likelihood of the condition developing.
Lifestyle choices: Alcohol consumption interferes with the removal of uric acid from the body. Eating a high-purine diet also increases the amount of uric acid in the body.
Lead exposure: Chronic lead exposure has been linked to some cases of gout.
Medications: Certain medications can increase the levels of uric acid in the body; these include some diuretics and drugs containing salicylate.
Weight: Being overweight increases the risk of gout as there is more turnover of body tissue, which means more production of uric acid as a metabolic waste product. Higher levels of body fat also increase levels of systemic inflammation as fat cells produce pro-inflammatory cytokines.
Recent trauma or surgery: Increases risk.
Other health problems: Renal insufficiency and other kidney problems can reduce the body’s ability to efficiently remove waste products, leading to elevated uric acid levels. Other conditions associated with gout include high blood pressure, diabetes, and an underactive thyroid gland.
Gout usually becomes symptomatic suddenly without warning, often in the middle of the night.
The main symptoms are intense joint pain that subsides to discomfort, inflammation, and redness.
Gout frequently affects the large joint of the big toe, but can also affect the ankles, knees, elbows, wrists, and fingers.
The pain can be excruciating. A veteran visiting a Hospital in Birmingham, AL, said:
“I’ve been shot, beat up, stabbed, and thrown out of a helicopter, but none of that compared to the gout.”
In some cases, gout can develop into more serious conditions, such as:
- Kidney stones: If urate crystals collect in the urinary tract, they can become kidney stones.
- Recurrent gout: Some people only ever have one flare up; others may have regular recurrences, causing gradual damage to the joints and surrounding tissue.
There are many lifestyle and dietary guidelines that can be followed to protect against future flares or prevent gout from occurring in the first instance:
- maintain a high fluid intake of around 2 to 4 liters a day
- avoid alcohol
- maintain a healthy body weight
Individuals with gout can manage flare-ups by moderating their diet. A balanced diet can help reduce symptoms.
Individuals with gout should avoid low-carbohydrate diets. Low intake of carbohydrate means that the body is unable to properly burn fat stores, leading to the release of substances called ketones into the bloodstream.
This rise in ketones can result in a condition called ketosis that can increase the level of uric acid in the blood.
It is most important to avoid many foods that are high in purines, to ensure that the levels of uric acid in the blood do not get too high. Here is a list of high-purine foods to be wary of:
- beef kidneys
- dried beans and peas
- game meats
While it is important to avoid these foods, it has been found that certain purine-rich foods will not increase the risk of gout, or aggrevate symptoms.
Asparagus, beans, some other plant-based foods, and mushrooms are also sources of purines, but research suggests that these do not trigger gout attacks and do not impact uric acid levels.
Various epidemiological studies have shown that purine-rich vegetables, whole grains, nuts and legumes, and less sugary fruits, coffee, and vitamin C supplements decrease the risk of gout, whereas red meat, fructose-containing beverages, and alcohol increase the risk.
Vitamin C supplements are available to purchase online. Speak with a doctor before taking any new supplements.
The role of uric acid in gout has been clearly defined and understood. As a result of this and the wide availability of relevant medications, gout is a very controllable form of arthritis.