Gout

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Overview

Gout is a metabolic disorder which causes inflammation of the joints. During acute episodes, certain joints swell up within just a few hours and become very sensitive to pain. The inflammation is triggered by tiny needle-shaped crystals of uric acid that mainly build up in the joints. These crystals may form if there is too much uric acid in the body. The inflammation normally goes away on its own within one to two weeks. The pain can be relieved with medication.

Most people with gout experience acute attacks every now and then. Months or even years can pass between attacks, but they may be more frequent too. There are a number of options to prevent them. Some people already notice an improvement if they avoid certain foods and other possible triggers. Others may take medication to lower their uric acid levels over the long term. The medication is mostly considered for people who have frequent gout attacks or complications such as kidney stones or lumps called tophi.

Many people have high levels of uric acid without it causing any noticeable problems. It's not clear whether this affects their health. It doesn't need to be treated.

Symptoms

Gout attacks often begin at night or in the early morning with sudden, very painful joint swelling. The inflamed joint is sensitive to pressure, and becomes overheated and red. The swelling and other symptoms are usually at their worst after six to twelve hours. The joint often becomes so sensitive that even the weight of a thick blanket can be unbearable. When the swelling goes down after a few days, the skin around the joint may begin to peel.


An initial gout attack often only affects one joint, usually the base of the big toe. The midfoot and ankle joints, knees, elbows, wrists and knuckles may also become inflamed. Attacks of gout are very rare in the shoulders or hips. If the gout is chronic, the joints will remain slightly inflamed all the time. They may become disfigured over the long term, making it harder to move them.

Intense joint pain. Gout usually affects the big toe, but it can occur in any joint. ...

Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. ...

Inflammation and redness. ...

Limited range of motion.

the joint feeling hot and very tender, to the point of being unable to bear anything touching it.

swelling in and around the affected joint.

red, shiny skin over the affected joint.

peeling, itchy and flaky skin as the swelling goes down.

Causes

Gout may arise from too much uric acid in the bloodstream. It's estimated that only about one in three people with high uric acid levels develop gout, though.


Uric acid is a waste product of substances called purines, which are components of nucleic acid, an important building block in our body.


Our kidneys normally get rid of a certain amount of uric acid by releasing it into our urine. But in some people, the kidneys don’t get rid of enough uric acid. That causes uric acid levels in the body to increase. If they are too high, the uric acid may start to form crystals that build up in body tissue. The crystals usually build up in the joints, where they can trigger attacks of gout.


Certain medical conditions may also contribute to the build-up of too much uric acid, including some blood disorders or specific cancers such as leukemia. In rare cases, gout occurs because the body is producing too much uric acid. This could happen due to a hereditary disease that affects the functioning of particular proteins (enzymes) involved in uric acid metabolism.


Besides increased uric acid levels, other factors may also be involved, such as the balance of fluid in the joints. Too little joint fluid can increase the risk of uric acid crystals forming there. The acidity (pH) level of the joint fluid and the temperature of the joint also have an influence.

Risk factors

Diet. Eating a diet rich in red meat and shellfish and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. ...

Weight. ...

Medical conditions. ...

Certain medications. ...

Family history of gout. ...

Age and sex. ...

Recent surgery or trauma

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Complications

Tophi. Tophi are clumps of urate crystals that harden under your skin. ...

Joint damage and deformity. When you have chronic gout, you have swelling in your joints regularly. ...

Kidney stones. ...

Kidney disease and kidney failure. ...

Psychological and emotional problems.

Prevention

A combination of one or more of these strategies can help prevent uric acid build-up that leads to a gout attack. Doctors and patients are encouraged to talk about which prevention strategies may be the most effective and achievable.


Avoid or limit alcohol

Consuming alcohol inhibits the body’s ability to excrete uric acid, increasing the risk of hyperuricemia and a gout attack. Just one or two glasses of beer, wine, or hard liquor can increase the likelihood of a gout attack, and the risk increases with the number of drinks consumed.1


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Drink plenty of water

Increasing water intake will help keep the kidneys healthy and help them flush out uric acid from the body. The recommended daily intake of fluids varies depending on an individual’s age, weight, sex, and other factors.2


Lose excess weight or maintain a healthy weight

Obtaining and maintaining a healthy weight through diet and exercise helps reduce the risk of gout.3


Research evidence4 suggests that sudden, dramatic weight loss, such as after bariatric surgery, may increase the likelihood of a gout attack in the short term. In the long term, excess weight loss—sudden or gradual—is an effective way to reduce risk.


Treat sleep apnea

While more research is needed, some evidence suggests that treating sleep apnea may significantly affect the frequency of gout episodes.5-7 Treatment typically includes using a C-Pap machine or another treatment device designed to increase oxygen intake while sleeping. Increased oxygen intake may lower uric acid production and reduce the risk of a gout attack.