David Ozeri, MD, is a board-certified rheumatologist from Tel Aviv, Israel specializing in arthritis, autoimmune diseases, and biologic therapies.
Gout is an extremely painful form of arthritis that affects more than three million Americans each year. Also known as gouty arthritis, the disease is caused by the formation of uric acid crystals in a joint (most often the big toe), triggering severe pain, redness, and swelling.
While certain factors like genetics or kidney disorders may predispose you to gout, your diet, alcohol, and obesity can also contribute.
Without proper treatment, gout attacks tend to get worse every time they strike. Treatment may include over-the-counter (OTC) and prescription drugs to alleviate pain and reduce uric acid levels. You can further minimize the frequency of attacks by losing weight, exercising regularly, and avoiding trigger foods.
Anything that impairs kidney function or causes chronic inflammation, both of which can increase uric acid levels, can increase your risk of gout. That includes:
In its early stages, gout causes infrequent arthritis attacks associated with extreme pain and swelling in a single joint.. As it progresses, the arthritis attacks become more frequent and involve more than one joint. In long-standing gout you may develop lumps under the skin due to deposits called tophi.
During a gout attack, the affected joint is extremely painful, stiff, and warm. Some people say it feels like being stabbed or breaking a bone. This may be accompanied by fatigue or mild fever. In the later stages, you may experience chronic arthritis symptoms. Common locations include the:
Gout attacks are known to come on quite suddenly, with the first 36 hours being the most painful. In some cases, the attack may go away quickly and on its own. However, most of them will last for a week or so, and possibly even several weeks or longer if you don’t get proper treatment.
Purines are chemical compounds in some foods, and they create the uric acid that leads to gout attacks. Avoiding purines can help you manage symptoms. Purine-containing foods include:
Not all cases of gout come from genetic conditions but genetics can play an important role in your risk of developing gout. Genetic conditions that can lead to gout include:
High uric acid levels can lead to both arterial hypertension (high blood pressure) and gout. In fact, about 25% of people with hypertension have elevated levels of uric acid. More than 30% of people with gout also have hypertension.
Arthritis means joint inflammation. Arthritis is an umbrella term for a host of conditions involving joint inflammation and pain, including gout, osteoarthritis, and rheumatoid arthritis. Gout is the most common form of arthritis and many consider it to be the most painful form, as well.
Pain is considered chronic when it lasts a long time. Medically, there’s no clear cut-off. Some doctors consider pain chronic when it’s lasted for three months, others say six months or a year, while some say it’s chronic if it lingers longer than is usual for what caused it. In a condition like gout, in which pain isn’t constant, it may be considered chronic if it recurs frequently.
Also sold under the brand name Colcrys, colchicine is a prescription drug that’s considered a first-line treatment for gout in people who have two or more attacks per year. A potent anti-inflammatory, it’s also used to treat many other conditions, including amyloidosis, Behçet’s disease, and pericarditis.
Also called synovial fluid analysis, arthrocentesis, or a joint tap, a joint fluid test is a diagnostic tool that can help identify gout, pseudogout, inflammatory arthritis, and infection. This is the gold standard test for diagnosing gout. A doctor uses a needle to draw fluid from an affected joint and the fluid goes to a laboratory for analysis.
Purine is a chemical compound used by your cells to create the building blocks of genetic material (DNA and RNA). Your body creates some and you also eat it in certain foods, including red meat. When your body breaks down purine, it becomes uric acid. Most uric acid is eliminated in urine, but in conditions like gout, it can build up in the body.
Tophi are clusters of urate crystals that grow in and around joints in cases of advanced gout. Tophi is plural, while tophus is singular. A tophus in a joint can cause inflammation and visible deformity, it can stretch the skin to the point that it tears, and it can erode bone and cartilage. This leads to extreme pain that can be debilitating.
Uric acid is a compound created naturally in your body when it breaks down purines, which are either produced by your body or derived from food. Uric acid then travels through the kidneys and is passed in your urine. However, in some conditions, including gout and hyperuricemia, it builds up in the body and causes numerous problems.
Urate crystals are spiky structures that form in your joints when uric acid levels become abnormally high. When your immune system detects urate crystals, it launches an attack and tries to destroy them. This leads to the inflammation seen in gout.
Explore interactive models that show how gout affects the human body—in this case, the foot—and how chronic inflammation can lead to the formation of hard, crystalline tophi over time.
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