Gout

Overview

Definition

Gout is inflammation in and around joints due to uric acid crystals.

Causes

Uric acid comes from the break down of purine from food or human cells. Sometimes the body makes too much uric acid. It may also have problems passing uric acid out of the body through the kidneys. Uric acid crystals form when uric acid levels get too high. This leads to gout.

Risk Factors

Gout is more common in men and older adults. But it can happen in men and women at any age.

Other risk factors are:

  • Certain medications, such as:
    • Low-dose aspirin
    • Diuretics
    • Cyclosporin, an antirejection drug
    • Chemotherapy drugs used to treat cancer
  • Kidney disease
  • Obesity, sudden weight gain, or rapid weight loss
  • High blood pressure
  • High cholesterol
  • Congestive heart failure
  • Obstructive sleep apnea
  • Anemia
  • Psoriasis
  • Sickle cell anemia
  • Certain types of cancer
  • Exposure to lead

Certain foods and drinks may also raise your chances of gout.

  • Foods high in purines, such as red meat and seafood
  • High-fructose drinks, such as sugar-sweetened sodas and orange juice
  • Excess alcohol

SymptomsandDiagnosis

Symptoms

Acute Gout

Here are some symptoms:

  • Sudden pain in a joint, usually starting in the big toe
  • Joints that are red, hot, swollen, and tender
Gout of the Big Toe
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Recurrent Gout

Most people with gout have more than one attack. This attack may be on many joints. Chalky deposits of uric acid called tophi can form. They often form in the elbows and earlobes, but may form in any part of the body.

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. Fluid from the affected joint will be taken. This fluid will be tested for uric acid crystals.

Your blood and urine may be tested.

Pictures may be taken of your body. This can be done with:

  • X-ray
  • Ultrasound
  • CT scan

Treatments

Treatment

Treatment depends on whether the gout is acute or recurrent.

Acute Gout

In general, the sooner you get medical help for an acute attack, the better. Treatment depends on:

  • The number of joints with gout
  • Previous responses to treatment
  • Your health

General Measures

Putting an ice pack on the joint may ease the pain. Keeping the weight of clothes or bed covers off the joint can also help.

Medications

Medications may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroids—may be given by mouth or as an injection into the joint
  • Colchicine

Recurrent Gout

General Measures

If you get gout more than once, you may be advised to treat it with:

  • A low purine diet
  • Alcohol avoidance
  • Gradual weight loss in those who are overweight
  • Stopping or changing medicines that may be causing it
  • Drinking more fluids

Medications

If you have recurrent gout, or you have kidney stones, tophi, or reduced kidney function, you may be given medicine to:

  • Lower the uric acid your body makes
  • Raise the amount of uric acid expelled by the kidneys
  • Convert uric acid into a byproduct

Prevention

To lower your chance of getting gout:

  • Eat a low-purine diet.
  • Lose weight slowly over time.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Gouty Arthritis)

RESOURCES

American Arthritis Society http://www.americanarthritis.org 

Arthritis Foundation https://www.arthritis.org 

CANADIAN RESOURCES

Arthritis Society https://www.arthritis.ca 

Health Canada https://www.canada.ca 

References

Gout. American College of Rheumatology website. Available at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout. Updated March 2017. Accessed June 5, 2018.

Gout. Arthritis Foundation website. Available at: http://www.arthritis.org/about-arthritis/types/gout/. Accessed June 5, 2018.

Gout. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T115215/Gout . Updated March 22, 2018. Accessed June 5, 2018.

Gout. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Gout/default.asp. Updated April 30, 2016. Accessed June 5, 2018.

Gout overview. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/gout.html. Updated June 14, 2017. Accessed June 5, 2018.

Gout management - prevention of recurrent attacks. EBSCO DynaMedPlus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T115215/Gout . Updated April 24, 2018. Accessed June 5, 2018.

1/4/2011 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T115215/Gout : Man CY, Cheung IT, Cameron PA, Rainer TH. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute gout-like arthritis: a double-blind, randomized, controlled trial. Ann Emerg Med. 2007;49:670-677. Epub 2007 Feb 5.

1/4/2011 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T115215/Gout : Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304(20):2270-2278.

4/24/2014 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T115215/Gout : Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed June 29, 2015.