What Is Gout?

Gout is a form of inflammatory arthritis. It occurs when uric acid crystals accumulate in one (or rarely several) of the body’s joints. This painful condition often comes on without warning and most commonly affects the base of the big toe.

Gout can cause severe pain, inflammation, and difficulty walking if left untreated.

This article will detail the causes, diagnosis, and treatment strategies for this arthritic condition.

What Are Symptoms of Gout?

Several hallmark symptoms typically appear during a gout attack. These include:

• Sudden, intense pain that often comes on in the middle of the night
• Localized swelling in the affected joint
• Redness
• Heat or warmth
• Hypersensitivity around the affected area

Though gout can affect any joint in the body, it impacts several areas more commonly. These areas include the:

• Big toe (the most common)
• Ankles
• Smaller toes
• Knees
• Fingers

Gout is also a somewhat unpredictable condition. Its symptoms typically come on without warning and may persist for one to two weeks (or more). In addition, when a gout attack subsides, it may take many months (or even years) for another one to occur.

What Causes Gout?

Gout occurs when too much uric acid builds up in the body (hyperuricemia). Uric acid is a byproduct that forms when you metabolize substances called purines. Purines occur naturally in the body’s cells and in many foods you may consume.

High levels of uric acid can lead to the formation of microscopic, needle-like crystals (called monosodium urate). These crystals travel in the bloodstream and accumulate in the body’s joints, fluids, and tissues. When a crystal buildup occurs, it can irritate the affected area and lead to gout symptoms.

What Puts You at an Increased Risk of Gout?

Though anyone can get gout, several groups are at a higher risk of developing the condition. They include:  

• People who consume a diet high in purine-rich foods
• Individuals with hypertension, diabetes, congestive heart failure, psoriasis, or obesity
• Men (particularly those more than 40 years old)
• Individuals who consume excessive alcohol or fructose-containing foods
• People taking diuretic medication (water pills)
• Those with a family history of gout
  

How Is Gout Diagnosed?

Gout diagnosis is possible only during an acute flare-up of the condition. When this occurs, the diagnosis process typically starts with a physical exam.

A healthcare provider will evaluate your symptoms and obtain your personal history. They will also typically aspirate fluid from the affected joint to look for the presence of uric acid crystals under a microscope.

Anti-Inflammatory Gout Diet

In the past, many people with gout were advised to curb their consumption of alcohol and to eat a diet low in purine-containing foods. However, recent research has called the effectiveness and sustainability of this approach into question.

A recent review suggested that adopting either the Mediterranean or the DASH diet may be more beneficial in lowering systemic uric acid levels. In addition, these diets effectively address things like diabetes, hypertension, and obesity, all of which are risk factors for developing gout.

Here are more details about these diets:

• The Mediterranean diet focuses on eating plant proteins, fish, whole grains, and foods high in monounsaturated fats (like olive oil).
• The DASH diet emphasizes whole grains, fruits, vegetables, plant proteins, and low-fat dairy foods.

Importantly, though these dietary modifications may help prevent gout, neither has proved as beneficial as uric-acid-lowering medication treatment.

How Is Gout Treated?

Depending on the severity and frequency of your gout flare-ups, several different types of interventions can treat this condition. Among the most common are:

Medications

Medications for treating gout include:

• Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) medications: Advil (ibuprofen)—may be recommended during an acute flare-up. These drugs can help reduce gout-related pain, though they may also cause secondary gastrointestinal side effects in some people.
• Colcrys (colchicine): Another anti-inflammatory drug that may also be prescribed. This pain-relieving medication is helpful when taken immediately after the onset of a gout attack. However, it may cause side effects like nausea, diarrhea, or vomiting. 
• Oral or injected corticosteroid medications: These are also sometimes utilized to provide immediate anti-inflammatory effects.

To prevent the recurrence of gout flare-ups, a healthcare provider may prescribe Zyloprim (allopurinol) or Uloric (febuxostat). These medications help keep the body's uric acid levels low. They are typically recommended if you have more than one gout attack yearly.

Home Remedies and Self-Care

Though icing the affected area and avoiding pain-causing activities may provide temporary relief during a gout attack, the best long-term remedy is avoiding a flare-up in the first place. The best ways to do this are by:

• Modifying your diet
• Staying active
• Maintaining a healthy body weight

In addition, the Centers for Disease Control and Prevention (CDC) offers several free self-care programs to help people live well despite chronic conditions like gout.

Complications of Untreated Gout

Chronic or prolonged gout flare-ups can also lead to the development of gouty arthritis. This occurs when the smooth, slippery cartilage that lines the bones in a joint begins to break down or deteriorate.

If your healthcare provider suspects this is the issue, they may also order an X-ray to definitively diagnose this potential long-term gout complication.

Surgery

Surgery is rarely indicated because of a gout flare-up. If repeated gout attacks cause gouty arthritis to develop in a joint, an operation may be necessary. Surgical options for gouty arthritis vary depending on the affected area but may include the following:

• A joint replacement (arthroplasty)
• A joint fusion (arthrodesis)

In addition, hardened deposits of monosodium urate crystals (tophi) can develop near joints, bones, or cartilage. In some instances, a tophi removal procedure may also be necessary to alleviate pain and reduce the risk of infection.

Managing Gout Flare-Ups

To effectively manage your gout attacks, it is important to avoid foods that may trigger a flare-up. These include:

• Red meat
• Organ meat
• Seafood
• Sweetbreads
• Beer, wine, or hard liquor
• High-fructose food or drinks

High levels of stress can also aggravate gout. Practicing mindfulness, staying active, and performing other relaxation techniques may help lower your tension and aid in managing this condition.

What to Do During a Sudden Gout Flare

If you are experiencing a sudden gout attack, there are several steps to try at home:

• Take over-the-counter NSAID medication to alleviate the pain if you are able
• Apply ice to the affected area for 20–30 minutes, several times daily
• Avoid alcohol and stay hydrated to help flush some of the uric acid out of your body
• Take the pressure off the affected area with a cane or crutches to walk
• Avoid pain-causing activities
• Contact a healthcare provider about your symptoms
  

Is Gout Curable?

Though gout is not curable, it is possible to achieve disease remission.

Depending on the severity of the disease and the anti-inflammatory and urate-lowering medications prescribed, many find themselves able to eliminate flare-ups, resolve their pain, and normalize systemic uric acid levels.

Working closely with a healthcare provider skilled in treating gout is the best way to achieve disease remission.

Living Well With Gout

It is possible to improve your well-being in spite of having gout. Eating a healthy diet and abstaining from alcohol can help you maintain a healthy body weight and reduce the likelihood of developing gout-related risk factors like hypertension and diabetes. Performing at least 150 minutes of moderate-intensity aerobic exercises each week can also help achieve this goal.

In addition, regularly meeting with a healthcare provider and following their treatment plan is a cornerstone to living well with this condition. Doing so helps keep you healthy and reduces the likelihood of a painful flare-up.

Outlook for Gout

Though a gout flare-up is often extremely painful in the moment, most attacks subside within one to two weeks of onset. The long-term outlook for gout depends on effective symptom management.

As previously mentioned, remission from this condition is possible with regular monitoring of your uric acid levels and the use of uric-acid-lowering medication. Contact your healthcare provider if you are experiencing any of the symptoms detailed above.