Includes information on gout, a type of arthritis caused by too much uric acid in the body. Info on symptoms, including swelling and pain that is often in the big toe. Covers how a diet high in purines can raise uric acid levels. Discusses diagnosis and treatment.
What is gout?
Gout is a kind of
arthritis. It can cause an attack of sudden burning
pain, stiffness, and swelling in a joint, usually a big toe. These attacks can
happen over and over unless gout is treated. Over time, they can harm your
joints, tendons, and other tissues. Gout is most common in men.
What causes gout?
Gout is caused by
uric acid in the blood. Most of the time, having too
much uric acid isn't harmful. Many people with high levels in their blood
never get gout. But when uric acid levels in your blood are too high, the uric
acid may form hard crystals in your joints.
Your chances of
getting gout are higher if you are overweight, drink too much alcohol, or eat
too much meat and fish that are high in chemicals called purines. Some
medicines, such as water pills (diuretics), can also bring on gout.
What are the symptoms?
common sign of gout is a nighttime attack of swelling, tenderness, redness, and
sharp pain in your
big toe. You can also get gout attacks in your foot, ankle, or knees, or other joints. The
attacks can last a few days or many weeks before the pain goes away. Another
attack may not happen for months or years.
See your doctor even if
your pain from gout is gone. The buildup of uric acid that led to your gout
attack can still harm your joints.
How is gout diagnosed?
Your doctor will ask questions about your
symptoms and do a physical exam. Your doctor may also take a sample of fluid
from your joint to look for uric acid crystals. This is the best way to test
for gout. Your doctor may also do a blood test to measure the amount of uric
acid in your blood.
How is it treated?
To stop a gout attack, your doctor can give you a
shot of corticosteroids or prescribe a large daily dose of one or more
medicines. The doses will get smaller as your symptoms go away. Relief from a
gout attack often begins within 24 hours if you start treatment right
To ease the pain during a gout attack, rest the joint that
hurts. Taking ibuprofen or another
anti-inflammatory medicine can also help you feel
better. But don't take aspirin. It can make gout worse by raising the uric acid
level in the blood.
To prevent future attacks, your doctor can
prescribe a medicine to reduce uric acid buildup in your blood.
Paying attention to what you eat may help you manage your
gout. Eat moderate amounts of a healthy mix of foods to control your weight and
get the nutrients you need. Limit daily intake of meat, seafood, and
alcohol (especially beer). Drink plenty of water and other fluids.
Gout is caused
by too much
uric acid in the blood (hyperuricemia). The exact cause of hyperuricemia sometimes isn't
known, although inherited factors (genes) seem to
play a role.
Uric acid may
form crystals that build up in the joints. This causes the pain and other symptoms.
Gout can seem to flare up without
specific cause. Or it can be brought on by:
Certain conditions related to diet and body
weight, such as being overweight, eating a diet rich in
meat and seafood (high-purine foods), and drinking too much alcohol.
Medicines that may increase uric acid
concentration, such as regular use of aspirin or
niacin or using medicines that reduce the amount of salt and water in the
Major illness or certain medical conditions, such
as rapid weight loss or high blood pressure.
Having been born with a rare condition that
causes high blood uric acid levels. People with Kelley-Seegmiller syndrome or
Lesch-Nyhan syndrome have a partial or complete deficiency in an
enzyme that helps to control uric acid levels.
Symptoms of gout include:
Warmth, pain, swelling, and extreme tenderness
in a joint, usually a
big toe joint. This symptom is called podagra. The pain often starts during the night.
It may get worse quickly, last for hours, and be so intense that even light pressure from a sheet is intolerable.
Very red or purplish skin around the affected
joint. The joint may appear to be infected.
Limited movement in the affected
Peeling and itching of the skin around the affected joint as the gout gets better.
How symptoms vary
How, where, and when the symptoms of gout appear vary.
Some people may not experience gout as many painful
attacks. Instead they have gout nearly all the time (chronic gout). Chronic gout in older adults may be
less painful and can be confused with other forms of
Gout may lead to inflammation of the fluid sacs (bursae) that cushion tissues, particularly
in the elbow (olecranon
bursitis) and knee (prepatellar bursitis).
Gout can also affect the joints of the feet, ankles, knees, wrists, fingers,
Symptoms may occur after an illness or
Gout may first appear as
nodules (tophi) on the hands, elbows, or ears. You may not have any of the classic symptoms of a gout attack.
develops after a number of years of buildup of
uric acid crystals in the joints and surrounding
tissues. A gout attack usually starts during the night with moderate pain that
grows worse. A gout attack typically causes pain, swelling, redness, and warmth
(inflammation) in a single joint, most often the big
toe. Then symptoms gradually go away.
Most gout attacks stop after about a week.
Mild attacks may stop after several hours or
last for 1 to 2 days. These attacks are often misdiagnosed as tendinitis or a sprain.
Severe attacks may last up
to several weeks, with soreness lasting for up to 1 month.
people have a second attack of gout within 6 months to 2 years after their
first attack. But there may be intervals of many years between attacks. If
gout is untreated, the frequency of attacks usually increases with time.
There are three stages of gout.1 Many people never experience the third stage.
In the first stage, you have high uric acid levels in your blood, but no symptoms. The uric acid levels may stay the same, and you may never have symptoms. Some people may have kidney stones before having their first attack
In the second stage, uric acid crystals begin to form, usually in the big toe. You begin to have gout attacks. After an attack, the affected joint feels normal. The time between attacks may grow shorter. Your later attacks may be more severe, last longer, and involve more than one
In the third stage, symptoms may never go away. They may affect more than one joint. Gritty nodules called tophi may form under your skin.
Without treatment, the tophi may form in the
cartilage of the external ear or the tissues around
the joint (bursae,
tendons). This can cause pain, swelling, redness, and
warmth (inflammation). Progressive crippling and destruction of cartilage and
bone is possible.
This stage of gout is uncommon because of
advances in the early treatment of gout.
What Increases Your Risk
Certain things can either cause gout or make you more likely to get it.
Things you can't change
Having a family history of
Having been born with a rare condition that causes high blood uric acid levels, such as Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome
Medicines that may increase uric acid
Regular use of aspirin (more than 1 or 2 aspirin a day) or niacin
Certain other conditions and diseases appear more often in people who
have gout than in people who don't, though studies have not shown a clear
relationship. Gout may share risk factors
(such as obesity, hypertension, and high levels of triglycerides) with certain diseases, including:
Rapid weight loss, as might happen in hospitalized patients who have changes in diet or medicines.
When To Call a Doctor
Call or see your doctor right away if you have:
Severe pain in a single joint that comes on
Swollen, tender joints with warm, red
skin over them.
It's important to see your
doctor even if the pain from gout has stopped. The uric acid buildup that
caused your gout attack may still be irritating your joints and could
eventually cause serious damage. Your doctor can prescribe medicines that can
prevent and even reverse the uric acid buildup.
Who to see
The following health professionals can diagnose and
prescribe treatment for
X-rays of extremities (hands and feet) are sometimes
useful in the late stages of the disease, X-rays aren't usually helpful in the
early diagnosis. Pain often causes people to seek medical attention before any long-term
changes can be seen on an X-ray. But X-rays may help to rule out other causes
Your doctor may evaluate you for lead poisoning if you
have been exposed to lead in your job or through hobbies.
The goals of treatment for
gout are fast pain relief and prevention of future
gout attacks and long-term complications, such as joint destruction and kidney
damage. Treatment includes medicines and steps you can take at home to prevent
Specific treatment depends on whether you are having an acute attack or are trying to manage long-term gout and prevent future attacks.
Pegloticase (Krystexxa). This medicine is for gout that has lasted a long time and has not responded to other treatment.
Treat tophi. These are chalky nodules that form from uric acid crystals. Treatment includes:
Drugs called xanthine oxidase inhibitors, which may shrink the
tophi until they disappear.
In rare cases, surgery to remove large
tophi that are causing deformity.
What to think about
If the blood uric acid is
high but a person has never had an attack of gout, treatment is rarely needed.
But people with extremely elevated levels may need regular testing for signs of
kidney damage. And they may need long-term treatment to lower their uric acid
levels. Your blood uric acid level may be watched by your doctor until it is
lowered to normal levels.
Long-term medicine treatment depends on how high your uric acid levels are and how likely it is that you will have other gout attacks in the future.
After an acute attack of gout,
talk with your doctor about the causes of the elevated uric acid levels in your
blood. A review of your overall health may reveal diseases, medicines, and
habits that could be raising your uric acid levels.
Most doctors will wait several days to weeks after a gout attack is over to begin medicine to lower the high uric acid
levels. These medicines can cause uric acid stored elsewhere in the body to begin moving through the bloodstream
and could make symptoms worse if treatment begins during a gout attack.
If there is swelling that causes pressure in a large joint such as a knee
or ankle, your doctor may relieve the pain and pressure by aspiration. A needle is inserted into the joint and fluid is drawn out (aspirated) with a
syringe connected to the needle.
develops after a number of years of buildup of
uric acid crystals in the joints and surrounding
tissue. You probably won't know that you have an elevated uric acid level in
your blood until you have had your first gout attack.
But you can help prevent
or reduce the severity of future gout attacks. To learn more, see Home Treatment.
If you have been diagnosed with gout, you can do a lot on your own to treat your condition.
Decrease the pain of an acute attack
Rest the affected joint until the attack
eases and for 24 hours after the attack.
Control your weight. Being overweight increases your risk for gout. If you are overweight, a diet that is low in fat may help
you lose weight. But avoid fasting or very low-calorie diets. Very low-calorie
diets increase the amount of uric acid produced by the body and may bring on a
gout attack. To learn more, see the topic Weight Management.
Follow a moderate exercise program.
especially beer. Alcohol can reduce the release of uric acid by the kidneys
into your urine, causing an increase of uric acid in your body. Beer, which is
purines, appears to be worse than some other beverages
that contain alcohol.
Limit meat and
seafood. Diets high in meat and seafood (high-purine foods) can raise uric acid
Talk to your doctor about all the medicines you take.
Some medicines may raise the uric acid level.
Continue to take the medicines prescribed to you
for gout. But if you weren't taking medicines that lower uric acid (such
as allopurinol or
probenecid) before the attack, don't start taking
them when the attack begins. These medicines won't help relieve acute pain. They
may actually make it worse.
In the past, gout was thought to be caused by drinking too
much alcohol and eating too many rich foods. Although eating certain foods and
drinking alcohol may trigger a rise in the level of uric acid in the body,
these habits may not by themselves cause gout. Gout is most often caused by an
overproduction of uric acid (due to
metabolism problems) or decreased elimination of uric
acid by the kidneys.
You use medicine to treat an attack of gout and to reduce the uric acid in the blood. Reducing uric acid helps reduce how often you have attacks.
Medicine treatment for gout usually involves some
combination of short- and long-term medicines.
Short-term medicine relieves pain and reduces inflammation during an acute attack or prevents a
recurrence of an acute attack. These medicines may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, indomethacin, or naproxen. Do not take aspirin, which should never be used to relieve pain
during a gout attack. Aspirin may change uric acid levels in the blood and may
make the attack worse.
Colchicine, to prevent flare-ups during the first
months that you are taking medicines that lower uric acid.
Pegloticase (Krystexxa). This medicine is for gout that has lasted a long time and hasn't responded to other treatment.
If your doctor prescribes medicine to lower your uric
acid levels, be sure to take it as directed. Most people will continue to take this
medicine every day. It is also important to know how to take it.
If you're taking one of these medicines, continue to take the medicine during the attack.
If you have one of these medicines but have not been taking it, do not start taking the medicine during an
Starting these medicines while you are having a gout attack can make your
attack much worse.
What to think about
Long-term medicine treatment depends on how high your uric acid levels
are and how likely other gout attacks are. In general, the higher your uric acid
levels and the more often you have attacks, the more likely it is that long-term
medicine treatment will help.
Some people with gout have continuing problems because
they don't take their prescribed medicine. Most people will need treatment every day to keep the uric acid levels in their blood normal. But they may feel perfectly healthy most of the time and wonder why
they should keep taking their medicine. If you stop taking your prescribed
medicine, nothing may happen at first. But after a while, another gout attack is
likely to occur. Without treatment, future attacks are likely to be more severe
and occur more often.
If gout symptoms have occurred off and on without
treatment for more than 10 years, uric acid crystals may have built up in the
joints to form gritty, chalky nodules called
tophi. If tophi are causing infection, pain, pressure,
and deformed joints, your doctor may be able to treat them with medicine. If this doesn't work, your doctor may recommend surgery to remove them.
Complementary therapies may be used by some people to
relieve symptoms caused by
Cherries and an herb called devil's claw have been used as anti-inflammatories. Research is needed to evaluate the usefulness of these and other
complementary medicines to treat gout.
Eicosapentaenoic acid (EPA)
is known to reduce chronic inflammation. It has not yet been studied to see
whether it can help reduce inflammation from gout.
Although it's still
just a theory, some studies show that folic acid may be helpful in
inhibiting the enzyme needed to produce uric acid.
Be sure to talk with your doctor if you are considering
taking vitamins, minerals, or other remedies to help reduce future gout
Other Places To Get Help
American College of Rheumatology
2200 Lake Boulevard NE
Atlanta, GA 30319
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
Arthritis Foundation (U.S.)
P.O. Box 7669
Atlanta, GA 30357
The Arthritis Foundation provides grants to help find a
cure, prevention methods, and better treatment options for arthritis. It also
provides a large number of community-based services nationwide to make living
with arthritis easier, including self-help courses; water- and land-based
exercise classes; support groups; home study groups; instructional videotapes;
public forums; free educational brochures and booklets; the national, bimonthly
consumer magazine Arthritis Today; and continuing
education courses and publications for health professionals.
National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
1-877-22-NIAMS (1-877-226-4267) toll-free
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
How this information was developed to help you make better health decisions.