Find Gout Specialists near you

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FAQs:

What is Gout?

Gout is a type of inflammatory arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then resolve. Gout flares often begin in your big toe or a lower limb. Gout happens when high levels of serum urate build up in your body, which can then form needle-shaped crystals in and around the joint. This leads to inflammation and arthritis of the joint. When the body makes too much urate, or removes too little, urate levels build up in the body. However, many people with high levels of serum urate will not develop gout.

Who Gets Gout?

Many people develop gout. It is more common in men than in women. Gout usually develops in middle age. Women usually do not develop gout before menopause, which is why women tend to develop the disease at a later age than men. Rarely, younger people develop the disease; however, if they do, the disease tends to be more severe.

Is Gout Hereditary?

Gout is at least partly due to heredity. Researchers have found dozens of genes that increase people’s susceptibility to gout, including SLC2A9 and ABCG2. Genes associated with gout affect the amount of uric acid the body holds onto and releases. Because of genetic factors, gout runs in families. People with a parent, sibling, or other close relative who has gout are more likely to get this condition themselves. It’s likely that genes only set the stage for gout. Environmental factors, such as diet, actually trigger the disease.

What is the First Sign of Gout?

A gout attack usually happens suddenly and without much warning. You’ll probably notice a sudden, intense pain in your affected joints. Gout attacks often develop overnight, so you might notice symptoms when you wake up in the morning. It’s common to go from having no symptoms to experiencing severe symptoms all at once during a gout attack. If you haven’t been diagnosed with gout or gout symptoms before, visit a provider as soon as possible to make sure you don’t have an infection or another condition that’s causing your joint pain and swelling. If you’ve been diagnosed with gout and you notice a flare starting, take the medication that your healthcare provider prescribed to help you manage your symptoms right away.

Is Gout Painful?

Yes, gout can be painful. In fact, pain in the big toe is often one of the first symptoms people report. The pain is accompanied by more typical arthritis symptoms, such as swelling and warmth in the joints. Gout pain can vary in severity. Pain in the big toe can be very intense at first. After the acute attack, it may subside to a dull ache. The pain, as well as swelling and other symptoms, are the result of the body launching a defense (by the immune system) against uric acid crystals in the joints. This attack leads to the release of chemicals called cytokines, which promote painful inflammation.

How Long Does a Gout Attack Last?

Gout attacks usually last a week or two. You might have some flares that last longer than others, and some might cause more severe symptoms. Between attacks, you might not experience any gout symptoms.

Is Gout a Sign of Kidney Failure?

Uric acid moves through your blood to your kidneys. Your kidneys then add that uric acid to your urine, so it can leave the body. However, sometimes uric acid in the blood gets too high. This happens because: the body makes too much uric acid, and/or the kidneys can’t add enough uric acid to your urine, so it builds up in your blood (the more common reason). That’s why having gout and high uric acid may be signs of kidney disease, so if you have gout, get checked for kidney disease.

Is Hot Water Good for Gout?

Heat should not be used during a gout attack since applying heat can make symptoms worse. However, between attacks, taking a warm shower and using warm packs (such as hot water bottles or microwavable heating pads) are great ways to help reduce general pain and stiffness.

Is Cherry Juice Good for Gout?

In lowering serum urate, cherry consumption may be of benefit in gout prophylaxis because cherries contain a variety of polyphenolic compounds with anti-inflammatory properties. These compounds may ameliorate the inflammatory response induced by monosodium urate crystals. Indeed, cherry consumption has been shown to lower a recognised biomarker of inflammation C-reactive protein (CRP) in both healthy people and those with arthritis.

What Fruits are Good for Gout?

Grapefruit, oranges, pineapples, and strawberries are all great sources of vitamin C, which lowers your uric acid levels and helps prevent gout attacks. But if you take colchicine for your gout, skip the grapefruit.

Is Coffee Good for Gout?

For individuals with gout, diet and lifestyle behaviors can help prevent flare-ups. Coffee is safe to drink if you have gout and will not contribute to the build-up of uric acid. Some studies, although inconsistent, have found some association between coffee consumption and a lower risk of developing gout.

What to Expect If You Have Gout?

If you have gout, you should expect to have flares of symptoms that come and go. Flares can happen more frequently if you don’t get gout diagnosed and treated by a healthcare provider. Some people with gout experience more severe or more frequent attacks right after starting treatment as the uric acid in their body adjusts to new medications or changes in their diet.

Cause of Gout

Researchers continue to study how genes and environmental factors contribute to a buildup of urate in your blood. However, certain factors may increase your chances of developing gout, including:

1. Having high urate levels; however, not everyone who has high levels develops gout.

2. Having a family history of gout.

3. Increasing age.

4. Drinking alcohol.

5. Eating foods that are rich in purines (usually from animal sources), a substance that breaks down into urate.

6. Drinking beverages that have high-fructose corn syrup, such as soda.

Some health conditions may increase your risk of developing gout, such as:

1. Overweight or obesity.

2. Metabolic syndrome, a name for a group of conditions that include high blood pressure, high blood sugar, abnormal cholesterol levels, and excess body fat around the waist.

3. Chronic kidney disease, a condition that develops when your kidneys are damaged and cannot filter blood the way they should.

4. High blood pressure.

5. Conditions that cause your cells to turn over rapidly, such as psoriasis, hemolytic anemia, or some cancers.

6. Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome, two rare conditions in which your body either does not have the enzyme that regulates urate levels or does not have enough of that enzyme.

Some medications can increase your risk of developing gout, such as:

1. Diuretics, which help your body eliminate excess fluid.

2. Low-dose aspirin.

3. Niacin, a vitamin, when taken in large amounts.

4. Cyclosporine, which is an immunosuppressant for people who have organ transplants and treats some autoimmune diseases.

Signs and Symptoms of Gout

The signs and symptoms of gout almost always occur suddenly, and often at night. They include:

1. Intense joint pain. Gout usually affects the big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.

2. Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.

3. Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.

4. Limited range of motion. As gout progresses, you may not be able to move your joints normally.

Areas That Can Be Affected by Gout

Areas of the body that can be affected by gout include:

- Joints.

- Bursae, cushion-like sacs between bones and other soft tissues.

- Tendon sheaths, membranes that surround tendons.

- Kidneys, because the high uric acid levels can lead to stones and sometimes kidney damage.

Different Stages of Gout

Gout is a disease that can move through several stages:

1. Hyperuricemia, when you have elevated levels of urate in your blood and crystals are forming in the joint, but you do not have symptoms.

2. Gout flares, when you have an attack of intense pain and swelling in your joints.

3. Interval or intercritical gout, which is the time between gout attacks when you do not have any symptoms.

4. Tophi, a late stage of gout when crystals build up in the skin or other areas of the body. Depending on their location, tophi can permanently damage your joints and other internal organs such as the kidneys. Proper treatment can prevent the development of tophi.

With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis. Many people avoid gout flares and can decrease the severity of their symptoms, and can even become gout free.

Foods that Cause Gout

Eating or drinking foods high in purines are more likely to lead to high uric acid levels in your body that cause gout, including:

1. Sugary drinks and sweets: Standard table sugar is half fructose (fruit sugar), which breaks down into uric acid. Any food or drink with high sugar content can trigger gout.

2. High fructose corn syrup: This is a concentrated form of fructose. Packaged food products and processed snacks can contain lots of high fructose corn syrup.

3. Alcohol: Even though not all alcoholic drinks are high in purines, alcohol prevents your kidneys from eliminating uric acid, pulling it back into your body, where it continues to accumulate.

4. Organ meats: These include liver, tripe, sweetbreads, brains and kidneys.

5. Game meats: Specialties such as goose, veal and venison all contain high levels of purines.

6. Certain seafood: Herring, scallops, mussels, codfish, tuna, trout and haddock.

7. Red meat: Beef, lamb, pork and bacon.

8. Turkey: Especially processed deli turkey.

9. Gravy and meat sauces.

Best Foods for a Gout Diet

You’ll want to go for low-purine options like:

1. Low-fat and nondairy- fat products, such as yogurt and skim milk

2. Fresh fruits and vegetables

3. Nuts, peanut butter, and grains

4. Fat and oil

5. Potatoes, rice, bread, and pasta

6. Eggs (in moderation)

7. Meats like fish, chicken, and red meat are fine in moderation (around 4 to 6 ounces per day).

8. Vegetables: You may see veggies like spinach and asparagus on the high-purine list, but studies show they don’t raise your risk of gout or gout attacks.

8 Ideal Drink Options for People with Gout

Some ideal drink options for people with gout include:

1. Water: Drinking eight glasses of water a day is essential for people with gout since more water is needed to reduce swelling associated with the condition. Water lubricates the joints, preventing further symptoms, and flushes out uric acid from the body, preventing their crystal formation.

2. Clear fluids: Broth or herbal teas (chamomile, lavender, green, and hibiscus purchased from trusted sources) are another way to increase fluid consumption in your diet. Thus, increasing fluid consumption is essential to counterattack gout symptoms.

3. Coffee: Coffee may reduce uric acid in the body. Hence, people with gout should drink coffee with low-fat or skimmed milk and without sugar to prevent attacks. Drinking one to two cups of coffee should do the trick.

4. Lemon water: A study has reported that lemon water or drinks high in vitamin C helps neutralize uric acid in the body. Squeezing two fresh lemons into two liters of water can help reduce uric acid levels in the body. Even orange juice can do wonders, but always have them in moderation.

5. Fresh cherry juice: Fresh cherry juice has antioxidants called anthocyanins that are anti-inflammatory and reduce inflammation associated with gout. A study has reported that drinking cherry juice for two days results in a significant reduction in gout symptoms.

6. Low-fat milk or skimmed milk: Drinking a glass of skimmed milk may reduce the amount of uric acid in the body. Hence, including skimmed milk or low-fat yogurt can lower the risk of gout attacks.

7. Wine: In general, alcohol can exacerbate the symptoms of arthritis. Hence, a physician might ask you to moderate your alcohol consumption. However, if you still wish to drink alcohol, drinking wine seems to be the least offensive. Other types of alcohol are high in purines, thereby worsening gout symptoms.

8. Green tea: Studies report that green tea moderately lowers uric acid levels in the blood. Its antioxidant properties may help fight inflammation associated with gout. However, more evidence is required to prove these claims. Drinking a glass of green tea may be beneficial overall.

Risk Factors of Having Gout

You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

1. 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. Alcohol consumption, especially of beer, also increases the risk of gout.

2. Weight. If you're overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.

3. Medical conditions. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases.

4. Certain medications. Low-dose aspirin and some medications used to control hypertension — including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers — also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.

5. Family history of gout. If other members of your family have had gout, you're more likely to develop the disease.

6. Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women's uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.

7. Recent surgery or trauma. Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, receiving a vaccination can trigger a gout flare.

Complications of Gout

People with gout can develop more-severe conditions, such as:

1. Recurrent gout. Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.

2. Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas, such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren't painful, but they can become swollen and tender during gout attacks.

3. Kidney stones. Urate crystals may collect in the urinary tracts of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

How to Treat Gout

Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to 

1. Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or acetaminophen and the anti-inflammatory drug colchicine. Oral or injected corticosteroids may also be used.

2. Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, avoiding foods high in purines (like red meat or organ meat which can cause gout flares), may help prevent future attacks. Changing or stopping medications associated with hyperuricemia (like diuretics) may also help.

3. Prevent tophi and kidney stones. These stones occur because of chronically high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent flares or chronic gout, doctors may recommend taking certain drugs like allopurinol, febuxostat, and pegloticase. These drugs lower uric acid levels and can prevent future flares.

In addition to medical treatment, you can manage your gout with self-management strategies. Self-management strategies are things that you can do each day to manage your condition and stay healthy. The self-management strategies described below are proven to reduce pain and disability so that you can do the activities that are important to you.

How to Prepare for a Rheumatologist Appointment

Make an appointment with your doctor if you have symptoms that are common to gout. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What You Can Do

1. Write down your symptoms, including when they started and how often they occur.

2. Note important personal information, such as any recent changes or major stressors in your life.

3. Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking. Your doctor will also want to know if you have any family history of gout.

4. Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

5. Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Questions to ask the doctor at the initial appointment include:

1. What are the possible causes of my symptoms or condition?

2. What tests do you recommend?

3. Are there any treatments or lifestyle changes that might help my symptoms now?

4. Should I see a specialist?

Questions to ask if you're referred to a rheumatologist include:

1. What are the possible side effects of the drugs you're prescribing?

2. How soon after beginning treatment should my symptoms start to improve?

3. Do I need to take medications long term?

4. I have these other health conditions. How can I best manage them together?

5. Do you recommend any changes to my diet?

6. Is it safe for me to drink alcohol?

7. Are there any handouts or websites that you'd recommend for me to learn more about my condition?

If any additional questions occur to you during your medical appointments, don't hesitate to ask.

Sources:

NIH

Cleveland Clinic

Mayo Clinic

WebMD

CDC

Medicine Net

National Kidney Foundation

Healthline

Arthritis Society Canada

Very Well Health

 

The content herein is provided for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Medical information changes constantly, and therefore the content on this website should not be assumed to be current, complete or exhaustive. Always seek the advice of your doctor before starting or changing treatment. If you think you may have a medical emergency, please call your doctor or 9-1-1 (in the United States) immediately.