Gout: Symptoms, Causes, Treatment and When to Be Seen

What it involves

MedlinePlus says gout is a common type of inflammatory arthritis that causes pain, swelling, and redness in one or more joints, usually as a flare that lasts a week or two and then gets better. It happens when too much uric acid builds up in the body over a long time and forms needle-like crystals in the joints. NIAMS notes that many people with high urate levels never develop gout.

Who this is for

• Adults with sudden, intense pain, swelling, and redness in a toe, ankle, knee, or another joint
• Patients who have had a flare before and want a plan to prevent the next one
• Patients with high blood pressure, kidney disease, diabetes, or extra weight who are noticing joint pain
• Patients who take a water pill or low-dose aspirin and wonder whether it affects their joints

What to expect

• Questions about which joint hurts, how fast it started, and whether you have had flares before
• An exam of the affected joint and a review of your medicines, diet, and other health conditions
• A plain explanation of whether your symptoms fit gout and which tests, if any, make sense
• A plan for the flare and for preventing future ones, with a referral for imaging or to a rheumatologist if needed

What a gout flare feels like

MedlinePlus says gout usually affects one joint at a time. It is often the big toe, but it can also affect other toes, the ankle, and the knee. Flares often start suddenly at night, and the affected joint typically shows:

• Intense pain, which may be bad enough to wake you up
• Swelling
• Redness
• Warmth

Why flares come and go

MedlinePlus says flares typically get better within a week or two, and you usually have no symptoms in between. Both MedlinePlus and NIAMS say that gout left untreated for a long time can bring flares more often and for longer, and can lead to tophi, hard lumps of uric acid crystals under the skin that can damage joints. That is the reason a first flare is worth a visit.

What raises the risk

NIAMS lists these risk factors, and says some medicines also raise the risk:

• Being male, being older, or, for women, having gone through menopause
• Overweight or obesity, and a diet rich in purines from animal sources
• Drinking alcohol or sugar-sweetened drinks such as soda
• High blood pressure, chronic kidney disease, or metabolic syndrome
• A family history of gout, and medicines such as diuretics (water pills) and low-dose aspirin

Gout and the rest of your health

NIAMS says people with gout are more likely to have or develop other conditions, especially of the heart and kidneys: high blood pressure, chronic kidney disease, obesity, diabetes, and kidney stones. The blood pressure management page explains what ongoing care looks like. The kidney function tests guide covers the blood tests that show how well the kidneys filter, and the obesity and BMI guide explains how weight is measured. Never stop a prescribed water pill or aspirin on your own.

How gout is diagnosed

NIAMS says a few conditions can mimic gout. Your provider takes your history, examines the joint, and may order a blood test for urate levels. MedlinePlus adds that fluid from a painful joint can be checked for uric acid crystals and that an ultrasound or special CT scan may be used. Fluid testing and imaging would be arranged through a referral. If the knee is the sore joint, the knee pain evaluation covers other causes and the signs that need prompt attention.

Treating a flare

NIAMS lists anti-inflammatory medicines, colchicine, which works best when taken as symptoms first appear, and corticosteroids, which may be given by mouth or injected directly into the joint. MedlinePlus also names NSAIDs such as ibuprofen and acetaminophen. NIAMS suggests ice, raising the limb, and resting the joint during a flare. Your provider chooses the medicine based on your other conditions. Serenity offers joint injections at the Loxahatchee and West Palm Beach offices, and whether one fits depends on the diagnosis.

Preventing the next flare

MedlinePlus lists losing weight, limiting alcohol, and avoiding foods high in purines, and says your provider may suggest changing medicines that raise uric acid. NIAMS adds avoiding sugary drinks, red and organ meats, and some seafood. When flares are frequent or tophi develop, NIAMS says lifestyle changes alone are not enough and medicines that lower urate are the mainstay. Always talk with your doctor before changing your diet or medicines.

Who treats gout

NIAMS says rheumatologists, primary care providers such as internists, dietitians, and pharmacists may all help, and that most people with gout are managed by their primary care providers. A primary care visit is therefore a reasonable first step, and your provider can refer you to a rheumatologist when that is the better fit.

Sources

• MedlinePlus — Gout
• NIAMS — Overview of Gout
• NIAMS — Gout Diagnosis, Treatment, and Steps to Take
• MedlinePlus — Knee pain