Gout Causes, Symptoms & Prevention Insights

March 12, 2024

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Gout is a common form of inflammatory arthritis characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints. It most often affects the joint at the base of the big toe, but can occur in other joints as well. Gout occurs when urate crystals accumulate in the joints, leading to inflammation.

What is Gout?

Gout is a painful form of arthritis caused by excess uric acid in the bloodstream. 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, seafood, sugary drinks etc.

Most people efficiently remove uric acid from their blood via the kidneys. But in some, uric acid builds up and crystallizes around the joints, causing inflammation and intense pain. These crystal deposits are called tophi.

The most common symptom of gout is a sudden, severe attack of pain, swelling, warmth and redness in a joint, often the joint at the base of the big toe.

Gout attacks cause excruciating pain and come on suddenly, often at night. Symptoms reach peak intensity within just 12 hours of onset. Gout also has periods of remission where there are no symptoms.

What Causes Gout?

Gout occurs when excess uric acid builds up in blood and crystallizes. Several factors can lead to high uric acid levels:

  • Genetics – family history of gout increases your risk
  • Diet – foods high in purines and alcohol lead to more uric acid
  • Obesity
  • Medications – diuretics, aspirin, some anticancer drugs
  • Other health conditions – high blood pressure, diabetes, metabolic syndrome

Acute trauma, surgery, cold exposure can also trigger gout attacks in those with high uric acid levels.

Gout is more common in men, especially after age 40. Post-menopausal women also face higher risk as estrogen offers protection before menopause.

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Symptoms of a Gout Attack

The most distinctive symptom of gout is a sudden, severe attack of pain, swelling, warmth and redness in a joint, especially at the base of the big toe.

Other symptoms may include:

  • Excruciating pain that comes on rapidly, often reaching maximum intensity in less than 12 hours
  • Joint appears hot, shiny red or purplish
  • Decreased range of motion in the affected joint
  • Only one joint is affected at a time (usually the large joint of a big toe, but may occur in the knees, ankles, heels, wrists and fingers)

Untreated gout attacks usually resolve on their own within 3 to 14 days, even without treatment. Yet recurrence is likely. Over time, gout attacks last longer and the joints become more permanently damaged from erosion caused by the uric acid crystals.

Advanced Gout Symptoms

If gout goes untreated, urate crystals can build up in soft tissues and joints, forming wart-like growths called tophi. Tophi typically develop after having gout for 10 years and cause joint damage.

Tophi symptoms include:

  • Rigid, painful joints with decreased range of motion
  • Persistent discomfort even between attacks
  • Visible bumps or lumps on skin near joints
  • Joint erosion visible on imaging tests

Tophi most often occur around the toes, ankles, heels, knees, wrists, fingers, forearms and elbows. Tophi can also develop in the soft tissue inside the ear, under the skin or around the spine.

Gout Attack Stages

There are four stages of a gout attack:

  1. Asymptomatic hyperuricemia – Elevated uric acid levels without symptoms
  2. Acute gouty arthritis – Intense joint inflammation from crystal deposits
  3. Intercritical gout – Period between acute attacks
  4. Chronic gouty arthritis – Recurrent attacks lead to joint damage

The first asymptomatic stage can last for years without alarming symptoms. Those with a family history should get uric acid levels tested periodically, as early intervention helps enormously.

Many patients alternate between acute attacks and being in an intercritical phase where they experience no symptoms. Each acute attack can potentially cause cumulative joint damage.

If left untreated, the fourth stage of chronic gout occurs after many years of recurrent acute attacks and tophi formation. The joints become permanently damaged and deformities or disability can occur. Appropriate long-term uric acid lowering treatment helps prevent reaching this stage.

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Diagnosing Gout

Gout may be challenging to diagnose as symptoms can resemble other forms of arthritis and joint infection. Proper diagnosis involves assessing symptoms as well as testing uric acid and joint fluid.

Possible diagnostic tests include:

  • Blood tests checking serum uric acid levels
  • Joint fluid test to identify monosodium urate crystals
  • Ultrasound or CT scan showing tophi
  • X-rays to rule out fractures or other injuries

The gold standard for diagnosing gout involves inserting a needle in the affected joint to withdraw fluid, which is then analyzed for urate crystals. Other disorders also may be ruled out.

Gout may be confused with:

  • Joint infection
  • Rheumatoid arthritis
  • Pseudogout – calcium pyrophosphate crystals
  • Fractures or joint injury

Key features suggesting gout include:

  • Rapid onset of symptoms
  • History of similar acute attacks
  • Joint redness
  • Only one joint affected
  • Joint located at base of big toe
  • Presence of tophi lumps

Uric Acid Levels

A blood test can measure the level of uric acid in the bloodstream.

  • Most people have 2.4-6.0 milligrams/deciliter (mg/dL)
  • Those genetically prone to gout tend to produce too much uric acid
  • Levels above 6.8 mg/dL indicate hyperuricemia

Uric acid testing cannot definitively diagnose gout by itself, as not everyone with high levels develops gout. Levels can also be normal during an acute attack. But elevated serum uric acid along with telling symptoms strongly suggests gout.

Treating Gout

The treatment goals for gout are easing symptoms during acute attacks and preventing future attacks and joint damage. This requires lowering uric acid levels, avoiding triggers, and taking anti-inflammatory medications.

  1. Treating Acute Gout Attacks
    • Rest, elevate and avoid standing on the affected joint
    • Apply ice packs to ease pain and inflammation
    • Take prescription NSAIDs, steroids or colchicine
    • Stay well hydrated
    • Avoid alcohol and red meat
  2. Preventing Further Gout Attacks
    • Take xanthine oxidase inhibitors like allopurinol or febuxostat daily
    • Improve diet – avoid red meat, seafood and sugary drinks
    • Limit or avoid alcohol
    • Drink plenty of fluids daily
    • Maintain healthy body weight
    • Control related health problems

The most important thing is lowering uric acid levels using xanthine oxidase inhibitor medication to dissolve existing crystals and prevent formation of new ones. Xanthine oxidase inhibitor medications include:

  • Allopurinol – taken daily long term
  • Febuxostat (Uloric) – newer xanthine oxidase inhibitor

These medications block production of uric acid and allow the kidneys to better remove it from the body. When taken regularly, further gout attacks are largely preventable.

Alongside medication, lifestyle adjustments like diet and exercise improvements, hydration and avoiding triggers are also crucial for managing gout.

Anti-inflammatory Agents for Acute Gout

  • NSAID painkillers – naproxen, ibuprofen
  • Colchicine – disrupts white blood cell response
  • Steroids – fast acting to ease inflammation

These provide rapid relief during sudden acute attacks when lowering uric acid levels long term is not fast enough. They help ease the pain and inflammation allowing the person to rest.

Home Remedies to Soothe Gout

  • Rest and elevate the inflamed joint
  • Apply ice packs for 20 minutes several times a day
  • Avoid standing – use crutches if needed
  • Drink extra fluids like water
  • Avoid alcohol and sugary drinks
  • Consider over-the-counter cherry extract which some find helps

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Gout Diet

Diet plays an important role. Foods high in substances called purines increase uric acid production. These include:

High-purine foods:

  • Red meat and organ meats
  • Seafood, especially shellfish
  • Sugary drinks and foods
  • Alcohol, especially beer
  • Some vegetables – peas, lentils, spinach

Gout-friendly low-purine foods:

  • Whole grains – oats, brown rice
  • Fruits – especially citrus and cherries
  • Non-seafood protein sources
  • Low-fat dairy products
  • Most vegetables
  • Water and other unsweetened drinks

Weight loss helps lower uric acid levels. Obesity stresses joints and tends to go along with gout. Losing even a little excess weight makes a big difference.

Staying well hydrated is equally important, as dehydration elevates uric acid levels. Drink plenty of water and limit diuretics like caffeinated coffee.

Cherries in particular are popular home remedy due to compounds that help lower uric acid. Tart cherry juice or extracts are best studied, but whole cherries likely help too.

Avoid fasting and rapid weight loss, as this releases purines from tissue also increasing uric acid.

Complications of Gout

If left untreated, gout can lead to permanent joint damage, erosion and deformity over time. Tophaceous gout develops after 5-10 years of recurrent attacks.

Complications may include:

  • Tophi causing arthritis, joint destruction
  • Increased risk of kidney stones from urate crystals
  • Kidney disease (uric acid nephropathy)
  • Joint infection is possible if tophi become infected

Another complication is that untreated gout tends to lead to developing other health issues like high blood pressure, insulin resistance, obesity and coronary artery disease. It signals dysfunctional metabolism.

This relates to common risk factors like poor diet, obesity and inactivity rather than gout directly causing these problems. But managing gout goes a long way in preventing related disorders.

FAQs About Gout:

Below are answers to some frequently asked questions about gout.

What is the main cause of gout?

The main cause of gout is hyperuricemia – having too much uric acid buildup in the body that crystallizes into needle-sharp deposits around the joints. This causes sudden inflammation and extreme joint pain.

What does a gout attack feel like?

A gout attack causes sudden, intense pain, swelling, warmth and redness, most often in the large joint at the base of the big toe. The pain frequently starts at night and is described as crushing, excruciating or debilitating.

What are symptoms of gout in the foot?

Common symptoms of gout in the foot include intense pain, swelling, redness, and warmth suddenly occurring in the large joint at the base of the big toe. The joint is extremely tender to touch and foot range of motion decreases.

How do you prevent gout attacks?

Ways to help prevent gout attacks include taking daily uric acid lowering medications, eating a gout friendly diet low in purines, staying well hydrated, limiting alcohol, achieving a healthy weight and exercising regularly.

How do you get rid of gout permanently?

There is no permanent “cure” for gout but with proper treatment gout attacks can be prevented in most people. This includes taking xanthine oxidase inhibitors long term to lower uric acid levels along with making lifestyle changes like improving diet, exercise and hydration.

Conclusion: Key Takeaways About Gout

In summary, knowing key points helps understand gout:

  • Gout is common inflammatory arthritis causing extremely painful attacks
  • It occurs due to excess uric acid crystallizing in joints
  • Telltale symptoms are sudden severe pain in one joint, most often the big toe
  • Raising awareness of risk factors allows preventing gout
  • Diagnosis involves assessing symptoms and testing uric acid levels
  • Treatment centers on relieving attacks and preventing future ones
  • Most important is taking xanthine oxidase inhibitors to lower uric acid
  • Lifestyle changes like diet, exercise and hydration are also key

Recognizing gout symptoms, triggers and proper treatment helps minimize bothersome attacks and irreversible joint damage. Anyone with concerns should speak with their doctor and get prompt assessment if a gout attack is suspected.

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