What is Gout? Symptoms, Treatment, and How to Prevent Gout Attacks

Gout is a common form of inflammatory arthritis that can cause sudden, severe joint pain, swelling, redness, and tenderness. It most often affects the big toe but can also develop in the ankle, knee, foot, elbow, wrist, or fingers. Gout occurs when high levels of uric acid in the blood form sharp urate crystals in and around the joints, triggering painful inflammation.

Stuart Weisman, MD, is a board-certified rheumatologist at Boulder Medical Center and has cared for patients with gout, arthritis, autoimmune diseases, and other rheumatic conditions at BMC since 2002. He also serves as Boulder Medical Center’s Medical Research Director

In this article, Dr. Weisman explains what causes gout, how to recognize the symptoms of a gout attack, treatment options for relieving pain, and steps that may help prevent future gout flares and long-term joint damage.

What Causes Gout?

Gout is a type of arthritis that occurs when you have high levels of uric acid in your blood. Over time, uric acid can form needle-shaped crystals that collect around the joints and soft tissues. Eventually, these crystals can trigger a gout attack.

Uric acid is produced when the body breaks down substances called purines, which occur naturally in the body and are also found in certain foods and beverages. Normally, uric acid dissolves in the blood and passes through the kidneys into the urine.

When uric acid levels remain too high, however, urate crystals can form and collect around the joints and soft tissues, causing inflammation and pain.

What Are the Symptoms of Gout?

A gout attack often comes on suddenly and can be extremely painful. Common symptoms of gout include:

• Sudden, intense joint pain, typically affecting the big toe or ankle and sometimes the knee, hand, wrist, or other joints
• Extreme tenderness that can make even a light touch uncomfortable
• Swelling and inflammation
• A joint that feels very warm or hot
• Red or purple skin around the affected joint
• Fever in more severe cases

Because other conditions, including joint infections, can cause similar symptoms, a healthcare professional should evaluate sudden, severe joint pain, especially when accompanied by fever.

Fortunately, gout attacks will clear with time, and there is a lot that can be done to treat an acute attack and help prevent future episodes.

How Is a Gout Attack Treated?

Gout attacks can be quite severe, so treating inflammation early can help relieve pain and shorten the flare. Depending on your health history and symptoms, treatment options may include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). NSAIDs such as naproxen or ibuprofen may help reduce inflammation and pain during a gout attack. The appropriate medication and dose depend on your individual health history and other medications you may be taking.
• Corticosteroids. Your doctor may prescribe a short course of corticosteroids to reduce inflammation during a gout attack.
• Colchicine. Prescription colchicine can help decrease pain and inflammation and is generally most effective when taken early in a gout attack.

These treatment options can have side effects and may not be appropriate for everyone. Check with your doctor before taking medication for gout.

It is also important to let your healthcare providers know if you have gout when medications are being prescribed or changed. Certain medications can affect uric acid levels and may need to be considered as part of your overall gout management plan.

What Foods Can Trigger Gout?

If you are prone to gout, diet and lifestyle choices can play a role in managing the condition.

Foods high in purines can increase uric acid production. Other foods and beverages may also raise uric acid levels or increase the risk of gout attacks.

Foods and beverages that may be associated with gout include:

• Sugary foods and beverages
• Foods and drinks containing high-fructose corn syrup
• Organ meats, such as liver
• Red meat, including beef, lamb, and pork
• Certain types of seafood
• Alcohol, particularly beer and spirits. Alcohol can contribute to gout by increasing uric acid production and decreasing the body’s ability to eliminate uric acid. Beer additionally contains purines.
• Some seafood, including anchovies, herring, sardines, trout, tuna, and shellfish, is relatively high in purines.

You do not necessarily need to eliminate every food associated with gout. Talk with your doctor about dietary changes that make sense based on your uric acid levels, overall health, and how often you have gout attacks.

Can Lifestyle Changes Help Prevent Gout Attacks?

The good news about gout is that lifestyle changes may help prevent attacks or lessen their severity.

Several healthy habits can be part of an overall gout management plan:

• Stay hydrated. Drinking adequate water helps the body eliminate uric acid.
• Maintain a healthy weight. For people who are overweight, gradual weight loss may help lower uric acid levels and reduce the risk of gout attacks.
• Include low-fat or nonfat dairy foods in your diet.
• Eat plenty of vegetables as part of a balanced diet.
• Exercise regularly. If you are not currently exercising, ask your doctor about an exercise plan that is appropriate for you.

Some research has also explored whether foods and beverages such as cherries and coffee may be associated with a lower risk of gout attacks. These should not replace proven gout treatments, but your doctor can help determine whether dietary changes may be useful as part of your overall plan.

What Happens if Gout Is Left Untreated?

Don’t ignore gout between attacks.

Repeated or poorly controlled gout can eventually cause permanent joint damage. People with persistently high uric acid levels may also develop tophi, which are deposits of urate crystals that collect in and around joints, tendons, and other soft tissues.

Tophi generally develop after years of uncontrolled gout and can become large enough to cause joint damage, deformity, or movement problems.

For people who have recurrent gout attacks, tophi, joint damage, or certain other risk factors, a doctor may recommend long-term urate-lowering medication to reduce uric acid levels and help prevent future complications.

If you are experiencing repeated gout attacks, don’t simply wait for each episode to pass. Long-term gout management can reduce the risk of future flares and help protect your joints.

When Should You See a Rheumatologist for Gout?

Gout can often be managed with appropriate treatment, but recurring or difficult-to-control gout may benefit from evaluation by a rheumatologist.

Consider talking with your doctor or a rheumatologist if:

• You have sudden, severe joint pain and are unsure whether gout is the cause
• You have recurring gout attacks
• Your gout attacks are becoming more frequent or severe
• You have persistently elevated uric acid levels
• You have developed lumps or nodules that could be tophi
• Your current gout treatment is not controlling your symptoms
• You have questions about long-term uric acid-lowering treatment

A rheumatologist can help confirm the diagnosis, evaluate factors that may be contributing to gout, and develop a treatment plan to control attacks and reduce the risk of long-term joint damage.

Let’s Talk

Gout can be extremely painful, but it is also treatable. If you are experiencing gout attacks or need help managing recurrent gout, Boulder Medical Center’s Rheumatology team can evaluate your symptoms and discuss treatment strategies for both short-term relief and long-term prevention.

Learn more and schedule an appointment with BMC-Rheumatology in Boulder or Louisville, Colo.