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Gout

What is gout?

Gout is a common form of arthritis that usually affects one joint at a time (often the big toe joint) and is very painful. Men and obese adults are more likely to have gout. There are times when symptoms get worse, known as flares, and times when there are no symptoms, known as remission. Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis. There is no cure for gout, but you can effectively treat and manage the condition with medication and self-management strategies.

 

What are the signs and symptoms of gout?

Gout flares start suddenly and can last days or weeks, followed by long periods of time—weeks, months, or years—without symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.

Symptoms in the affected joint(s) may include:

  • Pain, usually intense.
  • Swelling.
  • Redness.
  • Heat.

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What causes gout?

Gout is caused by a condition known as hyperuricemia, which is where there is too much uric acid in the body. The body makes uric acid when it breaks down purines, which are found in your body and the foods you eat. When there is too much uric acid in the body, uric acid crystals (monosodium urate) can build up in joints, fluids, and tissues within the body. Hyperuricemia does not always cause gout, and hyperuricemia without gout symptoms does not need to be treated.

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What increases your chances for gout?

The following make it more likely that you will develop hyperuricemia, which causes gout:

  • Being obese.
  • Having certain health conditions—congestive heart failure, hypertension (high blood pressure), insulin resistance, metabolic syndrome, diabetes, and poor kidney function.
  • Using certain medications, such as diuretics (water pills).
  • Drinking alcohol. The risk of gout is greater as alcohol intake goes up.
  • Eating or drinking food and drinks high in fructose (a type of sugar).
  • Having a diet high in purines, an organic compound found in some foods, which the body breaks down into uric acid. Purine-rich foods include red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna.

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How is gout diagnosed?

A medical doctor diagnoses gout by assessing your symptoms and the results of your physical examination, X-rays, and lab tests. Gout can only be diagnosed during a flare when a joint is hot, swollen, and painful and when a lab test finds uric acid crystals in the affected joint.

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Who should diagnose and treat gout?

The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and look like signs and symptoms of other diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologists on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.

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How is gout treated?

Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to

  • Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
  • Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food (like red meat or organ meat), may help prevent future attacks. Changing or stopping medications associated with hyperuricemia (like diuretics) may also help.
  • Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with recurrent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood with drugs like allopurinol, febuxostat, and pegloticase.

In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.

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How can I manage my gout and improve my quality of life?

Gout affects many aspects of daily living, including work and leisure activities.  Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.

  • Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines (like a diet rich in red meat, organ meat, and seafood), and limit alcohol intake (particularly beer and hard liquour).
  • Get physically active. Experts recommend that adults be moderately physically active for 150 minutes per week. Walk, swim, or bike 30 minutes a day for 5 days a week. These 30 minutes can be broken into three separate ten-minute sessions during the day.  Regular physical activity can also reduce your risk of developing other chronic diseases, such as heart disease and diabetes. Learn more about physical activity for arthritis.
  • Go to effective physical activity programs. Participation in CDC-recommended physical activity programs can help reduce pain and disability related to arthritis and improve mood and the ability to move. Classes take place at local parks, YMCAs, and other community centers. These classes can help you feel better.
  • Join a self-management education class, which can help you learn confidence and skills to manage your gout. People who have lived with arthritis teach the CDC-recommended self-management education programs.

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