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Why is gout such a pain?

Gout may conjure visions of a hobbling and obese king from the Middle Ages wielding a massive turkey leg in one hand and a goblet of wine in the other. But the intensely painful condition once reserved for overindulgent royalty is the most common form of inflammatory arthritis today. 

According to the Journal of the American Medical Association (JAMA), 9.2 million Americans – or nearly 4 percent of the adult population – have gout.

What causes gout?

To understand what gout is, we need to start with a little something called uric acid. This natural waste substance in the blood forms when your body breaks down purines, a common chemical compound found in some foods and beverages.

Most uric acid leaves the body when you pee or poop. But when there’s too much of it, your kidneys can’t keep up. As uric acid levels rise, sharp crystals can form around joints, causing severe pain, redness, swelling and tenderness – also known as gout attack.

While there is no cure for gout, it is one of the most treatable forms of arthritis. Medication, lifestyle and dietary changes can help prevent the frequency of gout attacks.

 

Who is most likely to be affected by gout?

Gout can affect anyone, although age and sex play a role. Men between the ages of 30 and 50 generally have higher levels of uric acid and are three times more likely than women to get gout. After menopause, women’s uric acid levels also rise, making them more prone to gout flare-ups.

Additional risk factors may also increase uric acid levels and trigger a gout attack, including:

  • Weight. People who are overweight produce more uric acid.
  • Diet. Eating a diet heavy on red meat and shellfish and drinking beverages sweetened with fructose can increase uric acid levels.
  • Medical conditions, such as untreated high blood pressure, diabetes, obesity, metabolic syndrome, and heart and kidney disease.
  • Medications, including low-dose aspirin and some medications that are used to control hypertension.
  • Family history of gout. If someone in your family has gout, you’re more likely to develop the disease.
  • Recent trauma or surgery.

 

What are the symptoms of gout?

Gout attacks typically affect the joint at the base of the big toe, but gout can also be found in other joints, including the ankle, foot, knee, hand, wrist and elbow. Gout attacks often occur at night, with the worst pain occurring within the first 24 hours.

Flare-ups can start suddenly and can last days or weeks. Symptoms in the affected joint may include:

  • Intense pain, which is most severe within the first 4 to 12 hours after onset.
  • Inflammation. The affected joint may become swollen, tender (even to light touch), warm and red.
  • Lingering discomfort that can last up to a few weeks.
  • Limited range of motion in the affected joint.

Gout attacks can be followed by long periods of remission with no symptoms.

 

How is gout diagnosed?

Gout is diagnosed during a flare-up when the joint is inflamed and painful. A doctor will examine the affected joint and may conduct tests to determine if you have gout or something else going on.

Diagnostic tests may include:

  • Joint-fluid test. Fluid taken from the affected joint is studied under a microscope to check for crystals.
  • Blood test. High levels of uric acid in the blood may be an indicator of gout.
  • X-rays. Images of the joints will help rule out other problems.
  • Ultrasound. This test uses sound waves to detect uric acid crystals.

 

How can I prevent gout attacks?

If you are at risk for gout, you can take preventative steps to avoid a painful attack:

  • Avoid or limit alcohol. Drinking alcoholic beverages can inhibit the body’s ability to eliminate uric acid. Even one or two glasses of wine, beer or spirits can increase the likelihood of a gout attack.
  • Drink plenty of water. Increasing your intake of water can flush uric acid from the body and keep kidneys healthy. How much water you should be drinking is based on your age, weight, sex and other factors. As a general guideline, the National Academies of Sciences, Engineering, and Medicine recommends 13 a day for men and 9 cups for women.
  • Limit or avoid trigger foods. Red meat, organ meat, some types of seafood (anchovies, shellfish, sardines and tuna) and sugar-sweetened foods and beverages are high in purines and can cause uric acid levels to rise.
  • Maintain a healthy weight. You can reduce the risk of gout by losing excessive weight and maintaining a healthy weight by eating a balanced diet and exercising.
  • Re-evaluate your medications. If you have gout and are taking medications to manage other health conditions, talk with your health provider about other treatments that might work for you.

 

How is gout treated?

Acute pain and swelling that come with flare-ups can be treated with anti-inflammatory medications, such as:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve, Motrin and Advil,
  • Colchicine
  • Oral steroids

Icing and elevating the joint can also bring relief.

Prescription treatments are available that may lower uric acid levels and prevent the risk of future gout attacks. Talk with your primary care provider to find out what treatment is right for you.

If left untreated, gout will usually progress and can become chronic. Attacks can happen more frequently or may spread to new joints.

Gout can also lead to other serious medical complications, including:

  • Permanent damage to joints
  • Cardiovascular disease
  • Chronic kidney disease
  • Kidney stones
  • Diabetes
  • Depression
  • Sleep apnea

 

Don’t wait. Indigo Health can diagnose and treat your gout symptoms

If you think you may be having a gout attack, it’s important to see a doctor when you experience symptoms. Skip the wait for an appointment — and the waiting room. At Indigo Health, you can book a primary care appointment online and see a provider when and where’s it’s convenient for you.

During your video visit, a primary care provider will evaluate your symptoms, order tests, if needed, and work with you to create a treatment plan that’s best for you. That includes guidance and recommendations on steps you can take to prevent future attacks. And to make sure your symptoms improve and you stay on track, they’ll arrange for a follow-up appointment to see how you’re doing.

If you need specialist care, leave it to us. Your Indigo Health primary care provider will coordinate a referral to a rheumatologist.

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