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Patient education: Gout (The Basics)

Patient education: Gout (The Basics)

What is gout? — Gout is a form of arthritis. It can cause pain and swelling in the joints.

Gout happens in people who have too much uric acid in their blood. Uric acid is a chemical that is produced when the body breaks down certain foods. Uric acid can form sharp needle-like crystals that build up in the joints and cause pain. These crystals can also form inside the tubes that carry urine from the kidneys to the bladder. There, they can turn into kidney stones that can cause pain and problems with the flow of urine.

People with gout get sudden "flares" or attacks of severe pain. But there are medicines that can help prevent this.

What are the symptoms of gout? — Gout flares most often cause pain in the big toe, ankle, or knee. Often, the joint also turns red and swells. Usually, only 1 joint is affected, but some people have pain in more than 1 joint. Gout flares tend to happen more often during the night.

The pain from gout can be extreme. The pain and swelling are worst at the beginning of a flare. The symptoms then get better within a few days to weeks. It is not clear how the body "turns off" a gout flare.

Is there a test for gout? — Yes. To test for gout, your doctor or nurse can take a sample of fluid from your joint that is in pain. If they find typical gout crystals in the fluid, then you have gout.

Even without checking fluid from a joint, the doctor or nurse might still strongly suspect gout if:

You have had pain and swelling in 1 joint, especially the joint at the base of the big toe.

Your symptoms completely go away between flares, at least when you first start having them.

Your blood tests show high levels of uric acid.

How is gout treated? — There are a few medicines that can reduce the pain and swelling caused by gout. When you find one that works for you, have it close by all of the time. That way, you can take it as soon you feel a flare starting. Gout medicines work best if you take them as soon as symptoms start.

The medicines used to treat gout flares include:

NSAIDs – This is a large group of medicines that includes ibuprofen (sample brand names: Advil, Motrin) and indomethacin (brand name: Indocin). NSAIDs might not be safe for people with kidney or liver disease, or for people who have bleeding problems.

Colchicine – This medicine helps with gout but it can also cause diarrhea, nausea, vomiting, and stomach pain.

Steroids – Steroid medicines can reduce swelling and pain. Steroids can be taken as pills or as shots.

Are there medicines to prevent gout flares? — Yes, there are medicines that can reduce the chances of having future gout flares. Most people who have repeated or severe flares of gout need to take these medicines. In general, they all work by reducing the amount of uric acid in the blood.

Examples of these medicines include:

Allopurinol (brand names: Aloprim, Zyloprim)

Febuxostat (brand name: Uloric)

Probenecid

People with severe gout can also get a medicine called pegloticase (brand name: Krystexxa), which is given through a vein. This medicine can cause an allergic reaction in some people.

If you take a medicine to prevent gout, your doctor or nurse will want to make sure that you use it safely. They might also want to check that your uric acid level gets low enough to dissolve the gout crystals. Allopurinol, febuxostat, and probenecid can actually increase gout flares when you first start taking them. To prevent these flares, your doctor or nurse might suggest that you take low doses of colchicine when you start the medicines. This will give the gout crystals time to dissolve, and that will stop the flares over time. If you do have a gout flare, it's important to keep taking your daily medicines normally.

Your doctor will order blood tests to check your uric acid levels regularly. This is to make sure that the medicines are working and that you are taking the right dose. Keeping your uric acid level below a certain level can help prevent gout flares.

Can I do anything on my own to prevent gout flares? — Yes. There are some things that might help:

It's not clear that following a specific diet plan will help with gout symptoms. But eating a balanced diet can help improve your overall health. Try to eat plenty of fruits, vegetables, whole grains, and low-fat dairy products. It's also important to drink plenty of water, and try not to get dehydrated.

Limit sugary drinks and alcohol. These can make gout flares worse.

Some people feel better when they limit foods that are high in "purines." (Purines are natural substances found in many foods.) You can ask your doctor if avoiding high-purine foods might help you. But other things, like taking your medicines and avoiding alcohol, are more likely to help with gout symptoms.

If you have excess body weight, losing weight can help relieve gout.

Some people with gout also have other health problems, such as heart disease, high blood pressure, kidney disease, or obesity. If you have any of these issues, work with your doctor to manage them. This can help improve your overall health and might also help with your gout.

When you have a gout flare, you might feel better if you also rest or ice your joint.

If you are having trouble managing your gout, your doctor might refer you to a specialist called a "rheumatologist."

More on this topic

Patient education: Calcium pyrophosphate deposition disease (The Basics)
Patient education: Low-purine diet (The Basics)

Patient education: Gout (Beyond the Basics)
Patient education: Calcium pyrophosphate crystal deposition (CPPD) disease (Beyond the Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
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