Patient education: Gout (The Basics)

What is gout? — 

This is a kind 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 the body produces when it 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 urine flow.

People with gout get sudden attacks, or "flares," 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 usually 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 the painful joint. 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 the time. That way, you can take it as soon as 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 bleeding problems.

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

●Steroids – These can reduce swelling and pain. They come as pills or 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 lowering the amount of uric acid in the blood, which causes the gout crystals to dissolve.

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 thin tube that goes into a vein, called an "IV." This medicine can cause an allergic reaction in some people.

If you take a medicine to prevent gout, your doctor or nurse will make sure you use it safely. They will order blood tests to check your uric acid levels regularly. This is to make sure the medicine is working and you are taking the right dose.

It can take weeks to months for the medicine to lower uric acid to the right level. Keeping your uric acid level below a certain level can help prevent future gout flares. But the risk of gout flares can actually increase when you first start treatment. There are things that help with this:

●Medicines that lower uric acid (such as allopurinol, febuxostat, and probenecid) increase the chance of having a flare at first. To prevent these flares, your doctor or nurse might suggest you take low doses of an antiinflammatory medicine (such as colchicine, NSAIDs, or steroids).

●Once your uric acid levels are low enough, your doctor might suggest stopping the antiinflammatory medicine. When you first stop taking it, you have a higher chance of having another flare for a short time. After a few months, the risk will decrease. If you do have a gout flare, it's important to keep taking your daily medicines normally.

What can I do on my own to prevent gout flares? — 

The following things might help prevent gout flares:

●It's not clear that following a specific diet helps 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." (These are natural substances found in many foods.) 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.

●Lose weight, if you have excess body weight. Your doctor or nurse can help you do this safely.

●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: Uric acid blood test (The Basics)
Patient education: Low-purine diet (The Basics)
Patient education: Calcium pyrophosphate deposition disease (The Basics)

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