Understanding Gout: Symptoms, Causes And Treatments

Gout is a common and painful form of arthritis that has affected humans for centuries. If you or someone you love suffers from gout, you likely have a lot of questions about what causes it, why it happens, and how to find relief.

In this comprehensive guide, we will cover the basics of gout, including the most common symptoms, what leads to gout occurring, as well as the latest scientific research on treatments and lifestyle changes that can help reduce gout attacks.

What is gout?

Gout is a common and painful form of inflammatory arthritis caused by too much uric acid in the bloodstream (hyperuricemia). Uric acid is a normal waste product that forms when the body breaks down purines, which are found in foods like red meat, organ meats, and seafood.

A painful form of inflammatory arthritis

In gout, excess uric acid forms needle-like crystals that lodge in the joints, tendons, and surrounding tissues. This causes sudden and severe pain, swelling, redness, and tenderness in the affected joint, often the big toe, ankle, or knee.

Gout attacks typically last a few days to a couple weeks if untreated. The pain usually maximizes within the first 12 hours, and patients cannot even drape a sheet over the affected joint due to intense pain and sensitivity.

If uric acid levels aren’t brought under control, attacks can become more frequent over time and more joints can be affected. Chronic gout that goes untreated can result in hardened deposits of uric acid crystals in the joints and soft tissues called tophi.

Tophi can lead to permanent joint damage, destruction, and deformity.

Caused by excess uric acid crystallizing in the joints

Gout occurs when excess uric acid in the bloodstream crystallizes and deposits in the joints, tendons, or surrounding tissues. This causes irritation, swelling, and intense pain in the affected area.

Several factors can contribute to hyperuricemia and gout attacks, including:

• Genetics – some people are genetically predisposed to produce too much uric acid
• Diet high in purines, which break down into uric acid
• Obesity
• Excess alcohol consumption
• Dehydration
• Certain medications and diseases that affect kidney function

For many gout sufferers, diet and lifestyle changes aren’t enough on their own to lower uric acid levels sufficiently. But medications can help get uric acid under control and prevent recurrent gout attacks. These may include:

• Xanthine oxidase inhibitors like allopurinol and febuxostat
• Uricosurics like probenecid and lesinurad
• Corticosteroids like prednisone to treat acute gout flares

By managing uric acid levels and avoiding triggers, many patients can lead symptom-free lives and avoid gout-related joint damage.

What causes gout?

Genetics

Gout often runs in families, so genes may play a role. Certain gene mutations affect how the body breaks down purines, which can cause uric acid buildup. According to research, genetics account for about 18% of gout risk.

Diet high in purines

Eating foods high in purines, a natural substance found in some foods, can raise uric acid levels. Foods particularly high in purines include organ meats like liver or kidneys, seafood like anchovies and sardines, and some other meats.

Dehydration

Not drinking enough fluids can make it harder for the body to remove uric acid. Aim for at least eight 8-ounce glasses of fluids daily to help dilute uric acid and remove it from the body.

Obesity

Being overweight increases the risk of developing gout. Excess weight may lead to higher uric acid levels and joint inflammation. Losing weight safely can help lower uric acid levels.

Medications and health conditions

Certain diuretic medications, commonly called water pills and used to treat high blood pressure, may increase uric acid levels. Other medications like aspirin and some cancer treatment drugs can also increase gout risk.

Some health conditions like poorly controlled diabetes and metabolic syndrome are associated with higher gout risk as well.

Common symptoms of gout

Gout is a form of inflammatory arthritis characterized by sudden, severe attacks of pain, swelling, redness and tenderness in joints, often the joint at the base of the big toe. An excruciating burning sensation, warmth, stiffness and swelling in the big toe or other joints are key gout symptoms.

The symptoms come on rapidly, often reaching maximum intensity within 12 to 24 hours.

Intense joint pain

Gout usually begins with intense pain in a single joint, most often the big toe, knee, ankle, foot or wrist. The pain frequently starts during the night and is often described as throbbing, crushing or excruciating. Even the weight of a sheet can be intolerable.

The affected joint may feel hot to the touch and appear red or purplish.

Most often in the big toe

Gout most often affects the joint at the base of your big toe. About half of gout attacks involve this joint. Other commonly affected joints include your ankles, knees, heels, wrists, fingers, and elbows.

Attacks are usually confined to one joint or area, though it’s possible to have more than one attack at a time. After an attack, most people have no symptoms until the next attack.

Redness and swelling

Intense joint inflammation with redness, swelling and warmth often accompanies gout symptoms in the affected joint. The swelling may be mild initially, but it can increase quickly within hours after it begins.

Swelling and fluid retention may spread beyond the joint to soft tissue, resulting in a bursa or a noticeable bulge over the joint.

Difficulty walking

The inflammation and pain of a gout attack can make walking or even standing unbearable. Visible swelling and redness can accompany the intense pain. Gout attacks most often occur in the big toe, so difficulty walking is extremely common.

Even light pressure from a sheet can be intolerable during an acute gout attack.

According to the Centers for Disease Control and Prevention (CDC), gout affected 9.2 million adults in the United States in 2016. Its prevalence is rising globally in tandem with obesity rates and aging populations (1).

Recognizing the symptoms early and seeking treatment is key to managing gout effectively.

To learn more, check out the CDC information on gout symptoms and prevalence at: https://www.cdc.gov/arthritis/basics/gout.htm

Diagnosing gout

Medical history

To diagnose gout, a doctor will start by taking a thorough medical history. They will ask about any recent symptoms, including the location and severity of pain. Doctors may also ask about previous gout attacks or family history of the condition.

Understanding a patient’s full health profile can help pinpoint what’s causing swelling and inflammation.

Physical exam

During a physical exam for potential gout, a doctor will look for signs of swelling, redness, and tenderness in the joints. They may apply pressure to the affected area to identify exactly where there is inflammation.

Doctors also look for nodules called tophi that can develop under the skin in chronic gout cases. Checking body temperature and blood pressure can reveal an underlying infection or other issues that could be triggering painful flare-ups.

Joint fluid test

One of the most definitive ways to diagnose gout is to test the synovial fluid from an affected joint. A doctor will use a needle to draw a small sample of this fluid and then examine it for uric acid crystals.

Finding these microscopic crystals strongly suggests gout as the cause of swelling and pain.

Imaging tests

Sometimes X-rays, ultrasound, or CT scans are used to evaluate joint damage and rule out other potential causes of symptoms. For example, imaging can detect signs of injury, arthritis, infection, or rare bone disorders that could be behind recurring pain and inflammation.

While not their primary purpose, some advanced imaging tests may also reveal deposits of uric acid crystals within joints.

Treatment options for gout

Medications

There are several types of medications used to manage gout attacks and prevent future occurrences. Common options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to relieve inflammation and pain.
• Colchicine to reduce swelling and lessen the production of uric acid.
• Corticosteroids like prednisone used for severe gout cases.
• Xanthine oxidase inhibitors such as allopurinol or febuxostat that lower uric acid production over the long term.

Doctors often start with NSAIDs to treat sudden gout flares. Preventive medications like allopurinol may be introduced later to prevent recurrent attacks. Finding the most effective medication or combination can take some trial and error under medical supervision.

Dietary Changes

Diet plays a major role, as foods high in purines and fructose can increase uric acid production. Helpful dietary tips include:

• Drink plenty of fluids like water to dilute uric acid.
• Limit intake of high-purine foods like red meat, organ meats, and certain types of seafood.
• Avoid sugary foods and beverages with high-fructose corn syrup.
• Eat more low-fat dairy products, nuts, legumes, whole grains, and green leafy vegetables.

Making dietary changes can lower blood uric acid levels significantly for some gout sufferers. It may allow stopping medications over time. Keeping a food diary can help identify personal triggers.

Home Remedies

There are also some home remedies that may provide relief during gout attacks:

• Applying ice packs to the affected joints for 20 minutes several times a day.
• Drinking tart cherry juice, which contains compounds that may limit uric acid production.
• Taking supplements like milk thistle, bromelain, or turmeric to reduce inflammation.
• Immersing sore joints in an Epsom salt bath to ease swelling and pain.

While home remedies may not treat gout directly, they can be used alongside medications and diet changes suggested by your physician for best results.

Surgery

For some severe, chronic gout cases, surgery may be considered to remove uric acid crystal deposits or repair joint damage. Procedures can include:

• Joint aspiration – draining fluid from the joint using a needle.
• Debridement – surgically removing uric acid crystal deposits.
• Joint fusion – fusing the joint to reduce pain if arthritis develops.
• Joint replacement such as a knee replacement operation.

These procedures all carry potential surgical risks and would only be utilized for severe gout cases not responsive to other treatments. Most patients can control gout attacks with medications, diet and lifestyle adjustments.

Preventing gout attacks

Stay hydrated

Drinking plenty of fluids, especially water, is key to preventing gout attacks. Water helps flush excess uric acid from the body. The CDC recommends men drink approximately 13 cups (3 liters) of fluids a day, and women consume about 9 cups (2.2 liters).

Some studies have found that for each additional cup of fluids consumed, the risk of a gout attack was reduced by 8%. So grab that water bottle and start sipping!

Lose weight if needed

Being overweight increases the risk of developing gout and triggering painful gout attacks. Losing even a few pounds can make a big difference. According to the CDC, every one-point increase in body mass index (BMI) is associated with a 5% higher risk of gout in women and a 7% higher risk in men.

Adopting healthy eating habits and incorporating exercise into your routine can help shed excess pounds and lower gout risk.

Limit alcohol

Alcohol, especially beer, has been strongly linked to gout attacks. That’s because drinking alcohol can raise uric acid levels. One study found that men who consumed two or more beers daily had a 49% higher risk of gout than those who drank less than one beer per month.

If you choose to drink alcohol, do so in moderation by limiting yourself to one drink per day for women and two drinks daily for men.

Avoid trigger foods

Certain foods high in purines can trigger painful gout attacks in some people. Purines are broken down into uric acid in the body. Foods particularly high in purines include organ meats like liver, sweetbreads, anchovies, sardines, and mackerel.

Other problem foods are game meats, yeast, spinach, asparagus, dried beans and peas, some mushrooms, and gravy. Keeping a food diary can help identify your personal gout attack triggers.

Conclusion

Living with gout can be exceptionally difficult and painful. While there is no definitive cure, understanding the common root causes and proven treatment options gives you the power to minimize gout attacks.

Staying hydrated, maintaining a healthy diet and weight, and taking medications as prescribed can make a big difference in managing gout pain over the long term. There are also effective home remedies and natural anti-inflammatories that may provide additional relief during flare ups for some individuals.

If you believe you may have symptoms of gout, get checked by your doctor for an accurate diagnosis. Catching and treating gout early, before permanent joint damage occurs, gives you the best chance of living pain-free.