Gout

Gout is a form of arthritis caused by too much uric acid build-up in your body. Gout often causes sudden pain and swelling in one joint, often the big toe or other joints in the feet. Uric acid is a natural substance that’s in your blood. Your kidneys filter uric acid, but if levels get too high or the kidneys can’t remove enough of it, urate crystals can form and settle into a joint, causing pain, swelling, and redness. Gout affects men more often than women. Foods rich in purines, high alcohol intake, and drugs like immunosuppressants and diuretics can raise your risk of gout.

What Are the Signs/Symptoms?

Gout’s main symptoms are sudden, intense pain and swelling in one or two joints. Severe attacks are typically followed by periods of no symptoms. Urate crystals can form tophi, or swollen growths, under the skin, often located over a joint or on the outer ear and can damage the joints over time. A rheumatologist can diagnose gout. Diagnosis is based on history and exam findings and laboratory tests. Blood tests can measure uric acid, although high levels don’t always mean you have gout. Some people with gout may have low uric acid levels at times, even during flares. Diagnosis may require a sample of joint fluid using a needle to withdraw fluid from the swollen joint to look for urate crystals under a microscope.

What Are Common Treatments?

Gout treatments include drugs to ease inflammation, lower uric acid in the blood, or help the kidneys remove excess uric acid. Colchicine (Colcrys) or Nonsteroidal anti-inflammatory drugs (NSAIDs) and Glucocorticoid (steroid) pills or shots into the joint can ease pain and swelling of an attack. Gout treatment aims for a uric acid level of 6 mg/dL or lower in the blood to dissolve or prevent crystals. Allopurinol (Zyloprim) and Febuxostat (Uloric) block uric acid production. Probenecid (Benemid) and Lesinurad (Zurampic) help the kidneys remove uric acid, and pegloticase (Krystexxa) infusions help break down uric acid. Each person with gout needs a unique treatment plan including dietary and lifestyle modifications and medication.

Living with Gout

Diet and lifestyle modification can help control gout and prevent attacks so it’s important to watch your diet and maintain a healthy weight. Gout is often associated with high blood pressure, heart and kidney disease, so your primary care provider or rheumatologist may test and/or watch for signs of these health problems.

• Avoid shellfish, gravies, red meat, soups, and organ meats such as liver.
• Limit alcohol, especially beer.
• Avoid drinks high in sugar or fructose like concentrated juices or sodas.
• Purine-rich vegetables like spinach or mushrooms are safe to eat.
• Low-fat dairy foods may lower uric acid levels and help prevent gout.

Updated February 2023 by Kristen Lee, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.