Gout Pain

Gout is a potentially debilitating form of inflammatory arthritis that causes pain, redness, stiffness, and swelling in your joints. More than 8 million people in the United States have gout.

The condition usually affects one joint at a time. About half of all gout attacks begin in the big toe, but it also can occur in the ankles, heels, knees, wrists, fingers, and elbows.

Although gout can cause pain, it can be managed with proper treatment.

What Causes Gout?

Gout is caused by a buildup of uric acid, a waste product that comes from natural body processes and can be found in some foods.

Normally kidneys dispose of uric acid through urine. Sometimes a buildup can occur if too much uric acid is produced or the kidneys can’t properly dispose of it.

If your uric acid levels get too high, hard, needle-like crystals can form in your joints, fluids, or tissues and cause pain.

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Who Is at Risk of Gout?

Gout is sometimes called the “disease of kings” because of a false link to overindulgence in food and alcohol. Anyone can get the condition, but certain factors can increase your risk:

  • Gender: Males are more likely to get gout than females.
  • Age: Middle-aged and older men and women after menopause are more at risk for gout.
  • Obesity
  • Family history
  • Diet: A diet high in purines, which are broken down into uric acid, can lead to gout. High purine foods include meats like bacon, turkey, veal, venison, and liver, and seafood like anchovies, sardines, mussels, codfish, scallops, trout, and haddock. High fructose foods and drinks such as soda pop also can increase your risk.
  • Alcohol use
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Congestive heart failure
  • Poor kidney function
  • Chemotherapy
  • Stress
  • Lead exposure
  • Certain medicines, such as diuretics, niacin, and aspirin
  • Previous gastric bypass surgery

Stages of Gout

Gout occurs in several stages.

  • Asymptomatic hyperuricemia: Uric acid levels are high and crystals are forming in your joints. But people usually don’t have any symptoms during this stage.
  • Gout attacks: Occur when uric acid levels increase greatly, or the crystals in the joints are activated. Alcohol, stress, medical conditions, and injury can trigger attacks. During gout attacks, joints become inflamed and painful. Flares usually happen at night and can occur more frequently over the following days.
  • Interval gout: This is the period in between gout attacks. You may not be experiencing pain, but inflammation still may be damaging your joints.
  • Chronic gout: If your uric acid levels remain high for several years, you can develop chronic gout. This can lead to frequent gout attacks, pain, and joint damage.

What Are the Symptoms of Gout?

The symptoms of gout usually begin at night. While attacks typically occur in the big toe, they can happen in other joints. Symptoms include:

  • Sharp, intense pain
  • Redness
  • Swelling
  • Heat

Pain from a gout attack can last days or weeks before it lessens.

How Do Doctors Diagnose Gout?

To diagnose gout, doctors usually will evaluate your symptoms and ask about your medical and family history. They also will examine the affected joint and may take a fluid sample from the joint to look for uric acid crystals.

Other potential diagnostic tests for gout include blood tests for uric acid levels and screenings and ultrasound tests or x-rays.

How Is Gout Treated?

To treat a gout attack or reduce your chances of another, try this mix of medicine and lifestyle changes:

  • Elevate the joint and apply ice.
  • Drink fluids, but avoid sugary drinks and alcohol.
  • Change your diet: Restrict your use of high purine foods, high fructose drinks, and alcohol.
  • Medicines: Certain medicines can be used during an attack to relieve symptoms. Others can be used after an attack to lower uric acid levels.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen (Motrin or Advil) and naproxen (Aleve) can relieve pain during an attack. Aspirin should not be taken because it can raise uric acid levels.
    • Corticosteroids: These can be taken by mouth or injected into your joints during a gout attack.
    • Colchicine: While this drug can relieve gout pain and inflammation, it has significant side effects.
    • Drugs to lower uric acid levels: Following an attack of gout, your doctor may prescribe a drug to help your body lower or eliminate excess uric acid.

Complications of Gout

With proper treatment, most symptoms of gout will go away within 3 to 10 days. Without treatment or lifestyle changes, other health conditions that can occur include:

  • Chronic gout: If your uric acid levels remain high, you run the risk of chronic gout. This may mean two or more gout attacks per year, affecting more than one joint. You may have shorter periods between attacks and feel symptoms more often.
  • Tophi: Hard crystals of uric acid that form under the skin. They can form on most joints and cartilage and can damage joints, bones, and cartilage.
  • Joint damage: Chronic gout and tophi both can cause permanent joint damage and deformity.
  • Kidney stones: If urate crystals build up in your urinary tract, they can cause kidney stones. These can cause severe pain, especially during urination, and are one of the most common gout complications.
  • Kidney disease: The buildup of urate crystals in your kidney can cause damage, potentially leading to future kidney disease and failure.
  • Heart failure: Some of the risk factors for gout also are risk factors for heart disease. Inflammation from gout can increase your risk of heart problems.
  • Diabetes: Obesity and excess alcohol are risk factors for both gout and diabetes.
  • Sleep problems: Because gout attacks occur most often at night, the resulting pain and other symptoms may cause sleep problems. Chronic gout may cause persistent symptoms, leading to long-term sleep problems.
  • Mental health issues: Stress, anxiety, and depression can occur with continued physical pain from gout. For some, gout can carry a stigma because of its reputation as “the disease of kings.”
  • Bone problems: Inflammation from gout can cause thinning bones, which can make it easier for breaks to occur.

Can I Manage Gout?

Although it can’t be cured, gout can be managed effectively with medicine and lifestyle changes.

If your uric acid levels remain high after a gout attack, doctors may prescribe medication that can lower your levels. This can lessen your risk of long-term problems.

Self-care also is important if you have gout. A diet that avoids foods high in purine, high-fructose drinks, and alcohol can lessen your long-term risks. Losing weight also can lower your chances of gout. If you use medicines like diuretics, stopping that use can help prevent gout as well.

If you have a family history of gout or suspect you may have it, schedule an appointment with your doctor.

Sources
What Is Gout? . Alliance for Gout Awareness. Gout . American College of Foot and Ankle Surgeons. Gout . American College of Rheumatology. Complications of Gout . American Kidney Fund. What Is the Difference Between Acute and Chronic Gout? . American Kidney Fund. Gout . Arthritis Foundation. Safe Foods for Gout. Arthritis Foundation. Gout . Centers for Disease Control and Prevention. 8 Gout Complications You Need to Know About . CreakyJoints. Gout . U.S. National Library of Medicine.

About UPMC Orthopaedic Care

As a national leader in advanced orthopaedic care, UPMC treats a full range of musculoskeletal disorders, from basic to complex. We offer treatments for both acute and chronic conditions. Whether you have bone, muscle, or joint pain, we provide access to UPMC’s vast network of services for both surgical and nonsurgical treatments. UPMC Presbyterian Shadyside appears on U.S. News & World Report’s rankings of the top hospitals in the country for orthopaedics. We strive to use the most advanced treatments. We are leaders in research and clinical trials, seeking even more cutting-edge tools and techniques.