Gout is a form of arthritis caused by the buildup of uric acid crystals in the body.
Gout can cause acute inflammation of 1 or more joints (gout flare) and in severe cases can lead to permanent joint damage (chronic gouty arthritis). Uric acid crystals can also form hard lumpy deposits in the skin called tophi.
Gout affects approximately 9.2 million people in the US (about 3.9% of the adult population). It is more common in men and older people.
People with gout have high blood levels of uric acid, a substance produced during digestion of certain foods and drinks (such as red meat, seafood, alcohol, and sugary drinks). However, most people with high uric acid levels do not develop gout. Other risk factors for gout include metabolic and genetic factors, obesity, high blood pressure, chronic kidney disease, and certain medications (diuretics).
Signs and Symptoms of a Gout Flare
A gout flare typically occurs over the span of a few hours with pain, redness, warmth, and swelling in a joint developing because of the presence of uric acid crystals. Often a gout flare involves a single joint (most commonly the big toe) but sometimes can affect multiple joints, including those in the feet, ankles, knees, and wrists. A gout flare tends to last several days; for most patients, it subsides over 2 weeks without treatment. Over time, repeated attacks can damage the joint, resulting in chronic gouty arthritis.
Gout is usually diagnosed by a medical professional through an evaluation of a patient’s medical history and a physical examination. Blood may be tested for uric acid levels and x-ray scans may be performed to assess for arthritis in the joint. Sometimes fluid may be removed from a swollen joint to look for uric acid crystals under a microscope.
There is no cure for gout. However, gout flares can be treated with anti-inflammatory medications (such as colchicine, nonsteroidal anti-inflammatory drugs [NSAIDs] like ibuprofen, or oral steroids). These drugs can reduce acute pain and swelling and are typically given for several days to weeks until a flare has subsided. To decrease the risk of future gout flares, medications (such as allopurinol, febuxostat, and probenecid) may be used to lower uric acid levels in the body. These drugs are taken on a long-term basis.
Management of Risk Factors for Gout
Dietary modifications should be made to reduce intake of alcohol, sugary drinks, and foods that increase uric acid (red meat or seafood). Weight loss in overweight or obese people with gout results in lower uric acid levels and decreased gout symptoms. In addition, management of high blood pressure, careful use of diuretics, and staying well hydrated may be helpful to prevent gout flares.
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Conflict of Interest Disclosures: None reported.
Source: FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. doi:10.1002/acr.24180