Managing Gout: A Complete Guide to Causes and Treatment
Originally Published by Zocdoc | November 4, 2022
In this article is everything you should know about gout.
What is gout?
Gout is a type of arthritis. Small crystals form inside and around the joints, which can cause sudden, severe pain. There may also be some swelling.
Sometimes a gout attack may start suddenly, while at other times it can be caused by things such as:
A high temperature
Drinking too much alcohol
Eating a large meal with a lot of fat
Suffering an injury in a joint
Taking medicines for high blood pressure, or diuretics
A gout attack may last for days or weeks, but no matter how long it is, you should seek treatment as soon as you notice any of the symptoms listed below.
What are the symptoms of gout?
The symptoms of gout are:
Sudden, severe pain in a joint
Swollen red skin on and around the painful joint
Hot skin on or around the joint
Fingers, knees, ankles and toes are commonly affected, but any joint can experience symptoms of gout.
The length of time between gout attacks can be weeks, months or years. Most people with gout experience multiple flare-ups throughout the years. If someone gets lots of flare-ups, it’s known as chronic gout.
You may have an infection if:
The pain becomes even more severe
You have a high temperature, but you’re shivering
You feel sick
You can’t eat
Contact your primary care provider if you have any of these symptoms. Getting treatment quickly can minimize any damage caused by the infection.
Who is likely to get gout?
People are more likely to get gout if they:
Are male and over the age of 30
Drink excessive amounts of alcohol, particularly beer or spirits
Eat excessive amounts of red meat or seafood
Have one or more of the following health conditions:
High blood pressure
Problems with their kidneys
Have been through the menopause
Have family members who have gout (particularly close relatives)
Have had surgery
Have had a recent injury
Take diuretics or medication for high blood pressure
Data shows that gout affects around 9.2 million people in the United States, which is 3.9% of the adult population.
What causes gout?
Gout is caused by the build-up of uric acid, which is a byproduct of purines in the blood. Your body gets rid of uric acid when you go to the bathroom. Both these substances are normal, but uric acid can build up in your blood if your body makes too much of it, or if your kidneys don’t function well. Uric acid forms tiny crystals in and around your joints if too much of it builds up. This is what causes the pain and swelling.
Does gout cause any complications?
There are a few possible complications of gout, some physical and some mental.
Perhaps unsurprising, considering how gout affects the joints, frequent flare-ups can lead to joint damage, especially if the gout goes untreated. If the damage is severe, you may need surgery.
As well as leading to gout, high levels of uric acid can also cause kidney stones to form. Kidney stones are made of minerals and salts which have crystalized and stuck together to form hard deposits.
Kidney stones can make passing urine painful, and you may feel like you need to go to the bathroom more often. Other symptoms include severe pain in the side, back, lower abdomen and groin; blood in the urine; cloudy urine; nausea and vomiting.
Sometimes kidney stones can be passed naturally, which can be uncomfortable and even cause pain. At other times, surgery may be needed to remove them.
Tophi are small, white lumps. They form under the skin, and are a result of the build-up of the crystals that form around your joints when you have gout. You’re more likely to get them if you suffer from chronic gout.
Tophi normally form around:
Sometimes they can be painful, but not always. They may become inflamed and produce discharge, in which case they need to be treated. Inflamed or particularly large tophi may be surgically removed to prevent joint damage. Smaller tophi can be shrunk using a combination of medication and lifestyle changes, of which we’ll discuss more later.
Gout can cause bone erosion. When parts of the bone have been eroded, your joint will typically have issues functioning correctly. You may need surgery to correct the issue. One study found that 44% of patients with gout also had bone erosions. Bone erosions were more likely to be seen in those who were older, had had gout for longer and had tophi present.
Anxiety or depression
The symptoms of gout can make it difficult to go about your everyday life. This, in turn, can affect your mood, and in more serious cases may lead to a mental health condition, such as an anxiety disorder or depression.
Anxiety and anxiety disorders
Anxiety is a normal emotion for us, where we might feel tense and worried. An anxiety disorder, on the other hand, involves more than temporary worry. According to the American Psychological Association, an anxiety disorder is characterized by “recurring intrusive thoughts or concerns. They [people with anxiety disorders] may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness, or a rapid heartbeat.”
Speak to your doctor if you notice:
You feel constantly on edge
You’re finding it difficult to concentrate
You feel restless and irritable
You’re isolating yourself from family and friends
You’re avoiding situations which make you feel anxious
They’ll be able to offer you support, such as referring you for talk therapy, which is also known as psychotherapy. Talk therapy is a way for patients to identify and discuss emotional issues with a mental health professional, as well as create strategies to deal with them. Research shows that talk therapy is one of the most effective ways to treat an anxiety disorder, but it can also be useful for those who need a safe, confidential space to talk about their feelings and worries.
The American Psychological Association defines depression as “extreme sadness or despair that lasts more than days. It interferes with the activities of daily life and can cause physical symptoms such as pain, weight loss or gain, sleeping pattern disruptions or lack of energy. People with depression may also experience an inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide.”
Speak to your doctor if you notice:
You feel sad or have a low mood for more than a few days
You feel hopeless
You have low self-esteem
You feel tearful
You feel guilty
You feel irritable
You lose motivation
You lose interest in activities that you usually enjoy
You have thoughts of harming yourself
You have suicidal thoughts
Get help from a medical professional as soon as possible if you have suicidal thoughts. You can call or text 988 to reach the 998 Suicide & Crisis Lifeline and receive emotional support. They also offer a chat service called Lifeline, and a Spanish-language phone line. All these services are free, confidential, and available 24/7.
Your doctor will be able to support you by referring you for talk therapy, where you can discuss your experience with a mental health professional. They may also prescribe antidepressants, a type of medication which reduces the symptoms of depression. There are many types of antidepressants available, so your doctor will prescribe one depending on what other medical conditions you have and which medications you already take.
How to treat gout
Can gout be cured?
Gout is an incurable condition, but fortunately there are effective ways in which a doctor can treat the symptoms. While treatment is normally required throughout your life, it can sometimes be so effective that it prevents you from having any more gout attacks, as long as you continue to follow your program.
Seeing a doctor
It’s important to see your primary care provider if you have symptoms of gout. They’ll be able to refer you to someone who can diagnose it, or they may identify a condition which has similar symptoms (for example, infected joints). Either way, your doctor will be able to advise on the best treatment and management of your condition.
You can help your doctor by making note of the following before your appointment:
Your symptoms, when they started, and how often you experience them
Whether anything seems to trigger your symptoms
Any other medical conditions you have, and whether you’re taking an medications or supplements for them
Whether there’s history of gout in your family
Your typical diet and alcohol intake
Any recent changes in your life (for example, something that may cause extra stress)
Any questions you have for the doctor
This will help you remember everything you want to tell them.
You’ll likely be referred to a rheumatologist. Rheumatologists specialise in diagnosing and treating conditions (including gout) which affect the muscles, bones, joints, ligaments, and tendons. You can also find a rheumatologist using the American College of Rheumatology database.
The rheumatologist may:
Carry out a blood test to measure how much uric acid is in your blood.
Scan the affected joint(s). An ultrasound and dual-energy computerized tomography (DECT) can find urate crystals in joints, while X-rays are used to investigate other possible causes of joint inflammation.
Use a needle to take a sample of the fluid inside the joint so it can be tested for the amount of uric acid present.
Once you have a diagnosis, your primary care provider will be able to help you manage your gout.
If you’ve been diagnosed with gout
See your primary care provider if you have a gout flare-up and the medication you’ve been prescribed doesn’t start working within two days.
Gout can be treated and managed with medication. There are two types of medication: one reduces pain and inflammation, and one lowers the amount of uric acid in your blood.
Examples of gout medication which reduces pain inflammation:
Colchicine, such as Colcrys, Gloperba and Mitigare. It decreases swelling and the build-up of uric acid.
Corticosteroids, such as Prednisone. This type of medication reduces inflammation and can be given to you as pills or an injection.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Some of these are available over the counter (Ibuprofen, Naproxen Sodium), while others are stronger and therefore only available on prescription (Indomethacin, Celecoxib). They reduce inflammation.
Examples of gout medication which lowers the amount of uric acid in the blood:
Allopurinol and Febuxostat, which both limit the amount of uric acid the body makes.
Probenecid, which improves the removal of uric acid from the body.
During a gout flare-up, there are things you can do to stay as comfortable as possible, including:
Take your medication as you’ve been instructed to. Some people find it helpful to store it in a dosette box, in which you can organise your pills by day (and sometimes by times within that day). This makes it easier to see whether you’ve taken what you need to.
Don’t put any pressure on the affected joint. Raise it if possible – for example, if the gout attack is in your knee then sit with your foot up.
Apply something cold to the affected joint, such as an ice pack or bag of frozen food wrapped in a towel. Keep your cold pack on the joint for up to 20 minutes at a time (any longer and you risk damaging the skin).
Try to keep your duvet off the affected joint when you go to bed, as this can apply unwanted pressure.
By seeking medical treatment, you can deal with the symptoms to relieve the pain and pressure of gout.
How to manage gout
Gout can affect your daily activities. Luckily, self-management strategies can be used in conjunction with the medications previously mentioned to manage the condition, prevent flare-ups and improve your quality of life. For example, there are dietary and lifestyle changes you can make. Let’s look at some of these below.
Eat a healthy diet
A healthy, balanced diet, as recommended by the government’s Dietary Guidelines for Amercans, includes:
Vegetables, including dark greens, red and yellow vegetables, beans, peas and lentils
Fruits of all types
Grains, especially wholegrains
Dairy products, including low-fat milk, yogurt and cheese, or fortified dairy alternatives
Sources of protein, including lean meat, poultry, eggs, beans, peas, lentils, nuts and seeds
Oils, including vegetable oils
A healthy diet also limits the level of sugar, sodium and saturated fat consumed.
There are some foods it’s better for people with gout to avoid, as they may cause a flare-up. These include: