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Gout is a common type of inflammatory arthritis, with sudden flares of joint swelling, pain, warmth, and redness, often in the big toe. Some patients may go months or even years between flares. Many gout sufferers assume that the gout is gone between flares and they don’t need medication to treat it.
These prolonged gaps between flares, when the patient feels fine, fuel the misconception that gout is no big deal—but that couldn’t be further from the truth.
Left untreated, gout can cause permanent joint damage, even between flares. As a rheumatologist, I see some of the worst outcomes from untreated gout: destroyed joints that cause significant, irreversible pain and disability.
Over 9 million people in the U.S. have gout. Yet only one-third to half of them receive treatment—and less than half of those who seek treatment stick to their care plan.
Patients consistently tell me, “I wish I had taken my gout more seriously.” It’s incredibly disheartening because most of the negative outcomes are preventable with early recognition and consistent treatment.
You can avoid permanent damage from chronic gout by learning its risk factors and symptoms—and seeking treatment at the first sign of the condition.
Know your risk factors.
Gout flares, also known as “attacks,” are triggered by a buildup of uric acid. This chemical develops in the bloodstream when your body breaks down purines, natural substances in certain foods. Normal amounts of uric acid simply dissolve and move through your kidneys and into your urine. But when there’s too much of it, uric acid crystals can form and accumulate in joints.
The exact cause of excess uric acid that leads to gout is an active area of research. It’s believed to be a perfect storm of genetics, environmental exposures, and other health conditions, such as:
- Chronic disease, including heart failure, high blood pressure, kidney disease, metabolic syndrome, and diabetes
- Certain high blood pressure medications, such as diuretics (“water pills”)
- Obesity
- A diet heavy in high-purine foods and beverages, such as alcohol, red meat, certain types of seafood and shellfish, and food and drinks sweetened with fructose
Estrogen appears to have a protective effect, so we rarely see gout flares in premenopausal women and most often see gout in middle-age and elderly men.
Gout isn’t fully preventable, but you can reduce flares by modifying risk factors you can control, such as your diet and weight. Your doctor can help you make healthier lifestyle or medication changes to reduce your risk of gout.
How to recognize symptoms of gout.
Symptoms of a gout flare can include:
- Redness
- Swelling
- Warmth
- Extreme tenderness
- Reduced range of motion in the affected joint
- Severe pain that lasts up to a few days and decreases to moderate discomfort for days or weeks
- Fevers
A key differentiator between gout and other types of arthritis is that gout attacks occur abruptly, often within a day, without warning. For example, you might feel fine when you go to bed and wake up unable to walk because of a gout flare in your foot.
While 50% of all first gout attacks occur in the big toe, gout can occur in many other joints, including the hands, wrists, elbows, shoulders, knees, and ankles. You may not have another flare for months, so you might forget about it or decide that treatment is unnecessary.
If you experience a gout attack, see a doctor right away. Gout usually can be diagnosed based on physical symptoms alone. The gold standard for diagnosing gout is needle aspiration of joint fluid and visualization of uric acid crystals under polarized microscopy. Gout can be visualized by ultrasound and advanced imaging like CT or MRI.
Seek short- and long-term treatment for gout.
Gout should be treated aggressively and consistently to improve a patient's long-term quality of life. With treatment, we can put gout into complete remission.
Treating gout is a two-pronged approach: minimizing the short-term pain and swelling that occur during a flare, and decreasing uric acid levels over time to prevent future attacks.
During a flare, our goal is to decrease painful inflammation as quickly as possible with oral medications such as:
- Colchicine
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Prednisone
If only one joint is inflamed, a rheumatologist can provide a steroid injection instead to quickly reduce the swelling.
While the flare is resolving, we recommend starting a long-term oral medication to help control uric acid levels, such as:
- Allopurinol
- Febuxostat
- Pegloticase
Gout treatment requires a lot of self-management. You’ll need to consistently take your medication and make sustainable lifestyle changes.
Related reading: Manage Metabolic Syndrome for Better All-Around Health
It's important to treat gout as soon as possible.
Over time, patients with untreated gout can develop a condition called tophi — hard and bulky uric acid deposits in the affected joint. Tophi are usually painless, but they can erode the bone and even pop open the overlying skin and start draining.
Untreated gout also can cause erosions, which are basically bites taken out of the bone. Erosions may or may not be painful but can reduce joint stability and function. At that point, medication won’t help—you might develop permanent functional loss and/or need surgical correction.
Thankfully, patients can avoid these detrimental complications with early intervention.
One gout attack is reason enough to talk about gout prevention with your doctor. While rheumatologists like myself specialize in advanced gout treatment, primary care providers can help you prevent or manage gout.
