Gout

Overview

Gout happens when uric acid builds up in the body and forms needle-shaped crystals in a joint. The crystals cause sudden swelling and intense pain, called a flare.

Many people have their first flare in a big toe, often starting at night. Between flares, there may be no symptoms. Without treatment, flares can happen more often, last longer, and damage joints.

Symptoms

Flares usually start suddenly, often at night.

• Big toe pain that comes on suddenly
• Red, hot, swollen joint
• Pain so bad that even a bedsheet hurts
• Pain in the foot, ankle, or knee

Less common

• Pain in the wrist, fingers, or elbow
• Fever
• Peeling skin over the joint as it heals
• Hard lumps under the skin (tophi)
• Kidney stones

How it usually goes

• First 12 to 24 hours: Pain is usually at its worst.
• 1 to 2 weeks: The flare gets better.
• Between flares: Often no symptoms; new flares may come months or years later.

When to get medical care

Causes

Gout happens when the body makes too much uric acid or doesn't get rid of enough. Uric acid comes from purines, found in the body and in foods like red meat and seafood.

Flares can be triggered by alcohol, certain foods, some medicines, injury, illness, or surgery.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.

Who is more likely to get it

• Being male (women's risk rises after menopause)
• Obesity
• Drinking alcohol
• High blood pressure, kidney disease, or diabetes
• Water pills and some other medicines

Possible complications

• Kidney stones: Uric acid can form stones
• Chronic kidney disease: Linked with high uric acid
• Joint infection: Can look like gout; needs urgent care

Diagnosis

A healthcare professional asks about your symptoms and checks the joint.

Questions you may be asked

• Which joint hurts and when it started
• Whether it started suddenly, often at night
• Alcohol, diet, and medicines like water pills
• Past flares
• Fever or feeling sick

The exam

They'll look at the joint for redness, swelling, and warmth.

Tests

Tests may include:

• Joint fluid test: A needle takes fluid from the joint to look for uric acid crystals. This is the best test, and it also checks for infection.
• Uric acid blood test: Shows the level of uric acid. It can be normal during a flare.
• X-ray or ultrasound: To look for crystals or joint damage.

Treatment

Start treatment as soon as a flare begins. Long-term medicine can prevent future flares.

Self-care

• Rest and raise the joint
• Put ice on it, wrapped in a cloth, for 15 to 20 minutes at a time
• Drink plenty of water
• Limit alcohol, especially beer and liquor
• Eat less red meat, organ meat, and seafood, and fewer sugary drinks
• Keep a healthy weight

Medicines

Some medicines treat flares; others prevent them.

Some medicines, like water pills (diuretics) and high doses of niacin, can raise uric acid. Ask before changing any medicine.

If you have frequent flares, lumps under the skin (tophi), or kidney stones, your healthcare professional may prescribe medicine to lower uric acid every day. It can take months to work.

How it compares

Prevention

You can lower the chance of flares:

• Take uric acid–lowering medicine if prescribed, every day
• Limit alcohol, sugary drinks, red meat, and seafood
• Drink plenty of water
• Keep a healthy weight

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a rheumatologist (joint and immune system doctor).
• A physical therapist can help with exercises to rebuild strength and motion.

Living with it

• Stay active with walking, swimming, or biking.
• Keep a healthy weight to ease joint strain.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Support groups and helplines

• Arthritis Foundation: Helpline, exercise programs, and online community.

Back to school, work, or sports

• Most people can keep working or going to school.
• Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.

Children, pregnancy, and older adults

• Women: Gout is less common before menopause but becomes more common after.
• Older adults: NSAIDs can harm the kidneys and stomach. Ask which flare medicine is safest.
• Kidney disease: Some gout medicines need lower doses.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Go to visits when you can and take notes.
• Keep a list of medicines, allergies, and doctors in one place.
• Learn the warning signs that need fast care.
• Take breaks and ask for help. Caregivers need care too.

Outlook

With treatment and lowering uric acid, most people with gout can prevent flares and joint damage and live normally.

Myths and facts

Getting ready for your visit

Try to be seen during a flare.

What to bring

• Which joints hurt and when
• All medicines, including water pills and vitamins
• How much alcohol you drink

Questions to ask

• Do I need medicine to lower my uric acid?
• What should I take when a flare starts?
• What foods and drinks should I limit?
• Are my kidneys okay?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Gout