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JAMA Patient Page
November 28, 2012

Gout

JAMA. 2012;308(20):2161. doi:10.1001/jama.2012.4095

Gout is an excruciatingly painful inflammatory disease of the joints. It is caused by an increased blood level of uric acid, which, when crystallized, can produce inflammation in the joints and surrounding tissues. People with gout tend to have conditions or take medications that increase blood uric acid. For example, kidney disease and diuretic medications (“water pills”) may increase the risk of gout. Genetic factors and diet also play a role. Foods associated with an increased risk of gout include organ meats, red meat, fish, fructose (a common sweetener), and alcoholic beverages, especially beer. Gout is common among men who are at least 30 years old and women who are postmenopausal; incidence rises with advancing age. In the last several decades, the frequency of gout has almost doubled. The reasons include longer life span; dietary choices; and rising rates of chronic kidney disease, obesity, and use of certain medications. The November 28, 2012, issue of JAMA contains an article about diagnosing and treating gout. This Patient Page is based on one published in the November 24, 2010, issue of JAMA.

SYMPTOMS

Typical gout attacks may cause

  • Sudden onset of joint pain and swelling in 1 or more joints, especially involving the first toe

  • Inability to use the joint

  • Fever

Over a number of years, these attacks may occur more frequently and lead to chronic gouty arthritis with

  • Tophi (lumps of uric acid in the soft tissues and joints)

  • Joint deformity and limited motion

  • Chronic pain

DIAGNOSIS, PREVENTION, AND TREATMENT

The diagnosis of gout is aided by review of medical history, symptoms, physical examination, and measurement of uric acid level in the blood. The diagnosis can be confirmed by the detection of uric acid crystals in the joint fluid.

Steps for prevention of gout attacks include

  • Limiting certain foods (eg, red meat, organ meats, and seafood)

  • Limiting alcoholic and fructose-rich beverages

  • Losing weight

  • Taking medications to lower uric acid (typically recommended for those with severe gout or complications)

Gout flares tend to resolve within 5 to 7 days even without treatment but often recur. The pain and the length of gout attacks can be significantly reduced by nonsteroidal anti-inflammatory drugs (eg, ibuprofen, indomethacin) or colchicine, and taking these medications within 24 hours of attacks is usually the first line of defense. In some cases, corticosteroid medications or a combination of medications (eg, colchicine and ibuprofen) is necessary.

If you have gout, see your doctor regularly. With proper treatment, gout attacks can usually be treated or prevented with great success.

FOR MORE INFORMATION

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA 's website at www.jama.com. Many are available in English and Spanish.

Sources: National Library of Medicine at the National Institutes of Health, Centers for Disease Control and Prevention

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Topic: INFLAMMATORY DISEASES

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