Fast Facts: What You Need to Know About Gout

What is gout?

Gout is a type of inflammatory arthritis that causes painful flare-ups. Although the main symptom associated with gout is pain in the joints, and most commonly the big toe, gout is a serious disease that can have negative impacts almost anywhere in the body. Gout can also flare up in your elbows, wrists, fingers, knees and ankles — and even your spine. It happens when there’s a buildup of uric acid in the blood that causes needle-like crystals to form in the bones, joints, kidneys, heart and eyes, which can cause damage over time.

High levels of uric acid don’t always mean you’ll get gout. Around 2 in 3 people who have higher levels of uric acid don’t have gout flares.

Gout affects men more often but women can get gout — 5 in 100 people with gout are women. This is because women naturally have lower uric acid levels compared to men, and the female hormone estrogen helps the body push uric acid out through urine. Levels of uric acid tend to rise after menopause when estrogen levels drop, which increases the chances of gout.

In the past, gout was called a “disease of lords” or a “disease of kings,” as it was associated with wealthy males. That has led to a lot of misconceptions and stigma surrounding the condition and many people suffering in silence or feeling blamed for living with the disease.

Gout can be misdiagnosed as another form of inflammatory arthritis such as pseudogout, where there’s joint pain and swelling, but it’s due to calcium build-up, not uric acid.

How do you get gout?

Uric acid is produced in your body when purines break down. Purines are found naturally in the body, but also are in certain foods. Your kidneys normally flush out extra uric acid, but if they don’t, uric acid can build up throughout your body. That’s why people with chronic kidney disease or reduced kidney function have a higher risk for gout.

Risk factors for gout include:

• Genetics (a family history)
• Certain health conditions like kidney disease, obesity, metabolic syndrome or high blood pressure
• Taking certain medications, such as immunosuppressants or diuretics (water pills)
• A diet rich in foods that are high in purines like red meat, liver, certain seafoods, alcohol and sugary drinks

Despite what people think, diet is not the main cause of gout, and many people who eat healthy and do not drink alcohol still develop gout. Genetics, family history and reduced kidney function are the main factors leading to the development of gout.

Certain communities of color are also at higher risk of the disease. Gout is most common among Black Americans; Asian Americans and Asian Pacific Islanders also have a higher risk of the disease.

What are the symptoms of gout?

Symptoms of gout include:

• Sudden and severe pain, often in the big toe, but also in the small joints of the feet and hands, knees, ankles, wrists and elbows
• Swelling
• Redness
• Warmth

These symptoms are worse in the first 4 to 12 hours after they begin. If gout is not controlled, flare-ups can start happening more often and last longer.

It’s important to treat gout because uncontrolled gout can cause other health problems. These include:

• Joint and bone damage, including erosion of the joints and bones
• Joint nodules or gouty lumps, known as tophi, on the fingers, hands, feet, elbows or back of the ankle. Tophi come from uric acid build-up that can get swollen and tender during flare-ups.
• Kidney stones and development or worsening of chronic kidney disease from uric acid build-up in the urinary tract

The build-up of uric acid can lead to permanent damage in the bones and joints, as well as a higher risk of cardiovascular disease.

How long does gout last?

People with gout can experience flares that last for 1 to 2 weeks. These often follow a period of time with no symptoms, known as remission. But, even when you’re not having a painful flare, the uric acid can still be building up in the body.

A gout flare may only happen once in your life, or it can become chronic and gradually get worse over time. This can cause permanent damage throughout the body after several years of no treatment.

How is gout treated?

Gout treatment involves managing flares and preventing future flares and long-term complications such as joint damage. It’s a good idea to go to a gout specialist if you’re having symptoms because gout symptoms can look like other inflammatory conditions that cause joint swelling, like rheumatoid arthritis. Rheumatologists are doctors who specialize in treating gout. Many nephrologists (kidney specialists) also treat the disease because of its impact on the kidneys.

Different medications can be used to treat gout and prevent long-term damage to your joints. Anti-inflammatory medications such as ibuprofen (Advil), steroids (as pills or intra-articular injection, injected directly into the joint space) or colchicine (a prescription anti-inflammatory) can help reduce pain and swelling during a flare-up. To address the root cause of gout — excess uric acid — you can take medicine to lower the uric acid levels in your blood, which can help reduce the risk of complications.

There are also things you can do on your own to help prevent flare-ups, including:

• Diet changes: Limiting high-purine foods and eating an overall healthy diet of fruits and vegetables, whole grains, nuts and unprocessed food.
• Limiting alcohol intake, especially beer
• Reducing the amount of beverages that contain high levels of sugar, as research shows it can contribute to uric acid production
• Maintaining a healthy weight by getting regular exercise 30 minutes a day, five days a week that is easy on the joints. This can include walking, biking and swimming.

Some people may have gout that persists even after taking oral medications. If that’s the case for you, it’s a good idea to ask your healthcare provider about your other options.

How to talk about gout with your healthcare provider

Keep in contact with your HCP about your symptoms and advocate for what you need. It’s a good idea to keep a log of your flares that includes:

• Pain intensity
• Location of the pain
• When it started
• Stressors you’re currently experiencing
• The impact of flares on your work, relationships and daily life

Write down a list of questions you can discuss with your HCP. These might include:

• Is my uric acid level normal and, if not, what can I do to lower it?
• What might be causing my gout?
• Should I see a rheumatologist?
• What are the side effects of the medications you want me to take?
• When should I see an improvement in my symptoms?
• How long do I need to be on medication?
• How can I manage my other health conditions with gout?
• Are there resources you can provide to help manage the condition?

There’s no cure for gout, but working with an HCP to treat the condition, taking medications as directed and practicing self-management strategies can all help manage your condition.