Gout Symptoms, Causes, Diet, and Treatment
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What is Gout?
Gout is the most common form of inflammatory arthritis, caused by an accumulation of uric acid crystals in the joints. If gout is left untreated, it can lead to permanent bone, joint, and tissue damage. An attack of gout will cause pain and last longer if left untreated.
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Gout Signs and Symptoms
The signs and symptoms of gout almost always occur suddenly, and often at night.
Symptoms of Gout include:
Pain and swelling — Usually in one or two joints in the feet or legs, gout is most common in the big toe. During an acute gout attack, the intensity of the pain is usually described as excruciating (8 to 10 out of 10).
Limited joint function — After five or more years of recurrent flares, people with gout may develop tophi crystals as uric acid deposits under the skin and around joints. While generally not painful, tophi can be disfiguring and interfere with normal joint function. The presence of tophi close to bones can lead to bone and cartilage destruction creating further deformities in the affected joints.
Chronic persistent arthritis — During the early stages of gout, the inflamed arthritis is intermittent and during the periods between flares, joints may feel and function normally. Years to decades after the initial flare, flares may continue to be a recurrent problem but the intervals between flares become painful on a daily basis.
Untreated gout can lead to serious health conditions, not to mention severe pain.
Treat Gout Promptly to Avoid Joint Damage and Tophi
Today, more than 9.2 million Americans are living with gout—a number that is on the rise. Unfortunately, just 10 percent of people with gout are getting needed, ongoing treatment.
Health Conditions Associated with Gouty Arthritis
Gout rarely exists in isolation; there is a high prevalence of gout in patients who have cardiovascular and other metabolic diseases. Once gout and uric acid are controlled with medication, it’s easier to treat the comorbidities and vice versa.
If you don’t treat gout, it can lead to permanent joint damage and destruction of tissue. There are other disorders associated with untreated gout and excess uric acid, which is why gaining control of the disease early is important.
Kidney stones, which can also be extremely painful, are often composed of uric acid. They may block the urinary tract and, if left untreated, can result in infection and kidney damage. About one out of five gout sufferers will develop kidney stones. Hyperuricemia and gout can be associated with decreased kidney function.
Obesity is a condition that exists when someone carries excess body fat that is severely out of proportion for their height. An obese person is three times more likely to develop gout compared to someone with normal body weight.
Diabetes is a disease in which blood glucose (sugar) levels are above normal due to either a lack of insulin in the blood or resistance to insulin. Some research suggests that insulin resistance may even play a role in the development of gout and that hyperuricemia may worsen insulin resistance.
Heart problems, including high blood pressure, blocked arteries and heart failure, are associated with gout. Hyperuricemia, or high uric acid levels, is associated with a higher risk of death and complications from these conditions. Research from the University of Oxford has shown that having gout doubles a person’s risk for heart attack and stroke.
The Cause of Gout
Uric acid is naturally produced in everyone’s body. Too much uric acid can put people at risk for gout. As cells die, they release substances called purines, which are also found in some foods. Purines break down and are eliminated as uric acid. Uric acid passes mostly through the kidneys.
If the body makes too much uric acid, or if the kidneys are not efficient in getting rid of it, hyperuricemia develops and the risk of gout increases. Hyperuricemia is necessary to develop gout. Lowering uric acid levels to a healthy range – 6.0 mg/dL or below – is the most important step to successfully managing gout.
Gout Flare Triggers - Gout Attack
Gout triggers can differ from one person to another. Once a person identifies his or her specific triggers, gout can be easier to manage.
Can You Spot a Symptom of Gout?
Take this quick interactive quiz to put your gout knowledge to the test.
Gout Risk Factors
The following is a list of common risks that can lead to gout flares.
Hyperuricemia – High levels of uric acid, above 6.8 mg/dL, can lead to gout attacks. The best uric acid level for a person with gout is below 6.0 mg/dL—regardless of age or gender.
Family History/Genetics – One in four people with gout has a family history of gout, yet less than half of people with the disease know that it can be hereditary.
Age – Gout occurs most often in men during their 30s through 50s and in women in their 60s through 70s.
Gender – Gout is a common problem for men more often than women—although, once women are post-menopausal, their rates of gout increase almost (but not quite) to the same level as men.
Ethnicity – Some ethnic groups are more likely to get gout than others. This is genetic and varies by ethnicity and other health risks. For example, Hispanics and African Americans are more likely to suffer from obesity, which has been linked to gout.
Obesity – Only one in 10 Americans knows that obesity can contribute to an increased risk for gout. Someone with a Body Mass Index (BMI) of 30 or higher is considered obese.
Other Health Issues – Gout is associated with other health issues, including high blood pressure, heart disease, diabetes, and kidney disease. It is important to receive a prompt diagnosis and ongoing treatment to manage these conditions.
Joint Injury – People with previously damaged joints and joint pain are more likely to be the sites of gout flares.
Diet – Many foods can raise the level of uric acid in the blood. Chief among these are beer, beef, pork, shellfish, and foods or beverages sweetened with high-fructose corn syrup (which causes uric acid to go up). High-fructose corn syrup is also found in sweetened soft drinks and juices; certain cereals and pastries; ice cream and candy; and processed foods at fast-food restaurants. In some people with gout, eating these foods can trigger gouty flares.
Medications – Use of certain medications—especially diuretics or water pills and certain anti-rejection medications used in transplant patients—can produce excess blood uric acid in the blood.
Gout Prevention and Diet
Preventing acute gout requires the reduction of the urate burden on your body. By reducing the level of uric acid in your body, you can curb urate crystals from building up around the affected joint thus managing painful gout attacks.
Your body produces uric acid naturally, so while the best way to achieve this is through certain medications that provide uric acid-lowering therapy, dietary and lifestyle changes can help by lowing the risk of gout.
At best, a healthy diet can reduce your uric acid by 1.0 mg/dL; however, a healthy diet can help obesity – a risk factor that leaves someone three times more likely to develop gout. Dietary changes can also help you recognize foods that cause flares and avoid them. As such, setting and keeping up with good eating habits should be a goal alongside uric acid-lowering therapy.
No food and drinks “cause” gout, but overindulgence in certain foods rich in purines can bring on painful flares.
This includes foods such as:
- Red meat
- Organ meats
- Processed foods
It’s recommended that a diet consists of low-purine foods if you have gout. The DASH diet and Mediterranean diet are good models to follow when trying to eat healthier. Foods to consider as a part of your diet include:
Lean proteins like fish and chicken are fine in moderation (around 4 to 6 ounces per day).
Low-fat and nondairy products
Nuts, nut butter, and healthy grains
Vegetables: luckily there is a wide variety of vegetables to choose from for your healthy diet.
Blood Uric Acid Levels – Medication and Lifestyle Changes
It’s normal for everyone to have at least low to moderate levels of uric acid in their bodies.
As cells die, they release substances called purines, which are also found in some foods. Purines break down and are eliminated as uric acid. When uric acid crystals get lodged in your joints causing intense pain.
To help prevent gout attacks you will want lower uric acid. Elevated uric acid levels over a long period of time can lead to chronic gout.
Uric acid typically dissolves in the blood and then passes through the kidneys, where it is eventually eliminated through urine.
To avoid gout and other medical problems, uric acid levels should be at 6.0 mg/dL or below. A person with a level above 6.8 mg/dL is considered to have hyperuricemia. Most experts agree that lowering a person’s uric acid can prevent the painful consequences of hyperuricemia—particularly gout.
Medical professionals can measure your serum uric acid through a simple blood test. They will know when and to treat gout. Just as it’s important to monitor your cholesterol, it is important to know the level of your uric acid. People with gout should have their uric acid levels tested every six months to be sure it is below 6.0 mg/dL (or even lower if the doctor recommends).
Gout is SeriousWhen asking “what is gout?” it’s important to know that during a gout attack, a person experiences sudden and severe episodes of pain, warmth, and swelling in one or more joints. While gout symptoms often begins in the big toe, a gout attack can spread to the feet, ankle, wrists, hands, and elbows and cause permanent joint damage.
Frequently Asked Questions
We know you have questions about gout and its symptoms. Here are some popular questions about gout, its causes, symptoms, and treatments!
What is Gout?
Gout is the most common form of arthritis. Gout usually starts with an accumulation of uric acid crystals in the joints that can lead to painful flares. Gout often begins in the big toe but can affect any joint. Untreated, it can cause permanent joint damage, deformities, and more. Developing gout can be very painful for the affected joint.
What are the Symptoms and Causes of Gout?
Gout is caused by a condition known as hyperuricemia, where there is too much uric acid in the body. The body naturally makes uric acid when it breaks down purines, which are found in your body and the foods you eat.
High levels of uric acid can lead to the development of crystals and painful flares. Read more
What happens during a gout flare?
During a gout flare, a person experiences sudden and severe episodes of pain, warmth, and swelling in one or more joints.
While gout often begins in the big toe, attacks can spread to the feet, ankle, wrists, hands, and elbows and cause permanent bone, joint, and tissue damage. Gout flares come on quickly and can last for several days.
How can you stop gout pain?
Acting quickly to get this health situation diagnosed and under control is important.
1) Make a same-day appointment with your primary care physician (PCP) or visit an urgent care clinic or hospital emergency room.
2) Take medication to help ease the intense pain and inflammation, such as nonsteroidal anti-inflammatory drugs (NSAIDs such as Advil®, Aleve®, and Motrin®), glucocorticosteroids (Cortisone), and Colchicine.
3) When tolerable, use cool/ice compresses to help with pain and inflammation in addition to the medication. Read more
What is the Treatment for Gout?
Once diagnosed with gout, you will likely be given uric acid-lowering medications. Like many other medications for blood pressure or high cholesterol, these are meant to be taken daily for life. They should not be discontinued—even when a gout flare is over. It is also important to follow a healthy diet, exercise, and visit your doctor for checks every six months. Read more
How Will My Doctor Diagnose Gout?
Providing your doctor with a thorough health and family history is important. A CT scan, ultrasound, MRI, and/or synovial fluid aspiration can detect crystals that are proof-positive of a diagnosis of gout. A blood test will check for elevated uric acid levels. Read more
How is gout different from rheumatoid arthritis?
Gout is a form of inflammatory arthritis, but the symptoms of gout, causes, and treatments for gout and rheumatoid arthritis are different. RA is an autoimmune condition caused when your body’s immune system attacks the tissue that lines your affected joint.
Gout is caused by too much uric acid in your blood and the resulting crystals that can form in your joints. Read more
How is gout prevented?
If you have had one gout flare, you are susceptible to others. Taking daily uric acid-lowering medication, following a healthy lifestyle, and visiting your doctor every six months are good steps to reduce uric acid levels, prevent gout and keep future flares away. Read more
What foods cause gout?
High-fructose corn syrup and purine-rich foods (like beer, red meat, and shellfish) may trigger a gout attack if uric acid is not under control. While these foods are not the main cause for developing gout, they can increase uric acid levels, so limiting their intake can be beneficial in addition to taking other steps. Read more
Who can be diagnosed with gout?
Gout affects anyone at any age but is more common in men over the age of 40 and women who are post-menopause. Gout is also strongly linked with kidney disease, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides), and diabetes. Because of genetic factors, gout tends to run in families. Read more