What is Gout?

June 27, 2023

3 min read

Gout is a form of inflammatory arthritis that causes joint pain and swelling. Typically gout can cause sudden flares causing intense pain, swelling, and tenderness in the joints, often in the big toe.

The flares are followed by times when there are no symptoms, known as remission. Repeated bouts of gout can create gouty arthritis.

Gouts have no known cure. Treatments are available to manage and control the symptoms with the help of medications.

Causes of Gout

Gout can happen when a high amount of serum urate builds up in the body, causing the formation of needle-like crystals in the joints. This creates inflammation in the affected joints leading to arthritis.

Gout can affect body parts like:

The joints
Membranes surrounding tendons
Cushion-like sacs between the bones and the soft tissues called bursae
Kidneys where a high level of uric acid can create stones and often cause kidney damage

Stages of Gout

Gout can have several stages. They are:

Hyperuricemia, where a high level of urate in the blood, causes a build-up in the form of crystals in the joints. It may or may not have symptoms.
Gout flares that cause an intense attack of pain and swelling in the joints.
The remission period in between flares when there are no gout symptoms.
Tophi, a later stage of gout when crystals of urate build in the skin or other areas of the body, causing joint and kidney damage.

Symptoms of Gout

The symptoms of gout happen in the form of a sudden flare at night and include:

Intense joint pain, usually in the big toe
Inflammation and redness in the affected joint
Warmth in the joints
Lingering discomfort that may last for a few days to weeks
Chills, fever, and a general feeling of illness
Hard lumps of crystals of urate under the skin

Risk Factors for Gout

Certain factors can increase your risk of developing gout.

A family history of gout
Increasing age
A high-purine diet that includes red meat, organ meat, and certain seafood
Drinking alcohol
A high fructose diet
Men and post-menopausal women
Health conditions like high blood pressure, obesity, diabetes, psoriasis
Certain medications, like diuretics, niacin
Surgery, severe illness, or an infection can trigger gout

Complications of Gout

Some people may develop medical conditions, especially with the kidneys and the heart, because of gout. They are:

Diabetes
Kidney stones
Heart attack
Hypertension
Congestive heart failure

Diagnosing Gout

The doctor will examine your family history and conduct the following tests to diagnose gout:

Blood test: This is done to check the uric acid level, although many people with a higher uric acid level may not develop gout;
Joint fluid analysis: Fluid is drawn from the affected joints and later examined for uric acid crystals;
Imaging tests: X-rays, MRIs, and ultrasounds are done to check for uric acid crystals in joints.

Treatments for Gout

The gout treatment will depend on the frequency and severity of its symptoms and your personal preferences.

Anti-inflammatories: These include over-the-counter painkillers (Ibuprofen), which can treat pain and inflammation during periods of gout flares.
Corticosteroids: These can be effective in treating inflammation quickly, although they can have serious side effects.
Uric acid lowering drugs: In patients with frequent gout flares or those with tophi or joint damage, drugs like allopurinol and febuxostat are prescribed to reduce the uric acid levels in the blood.

New Drugs for Gout Treatment

The FDA recently approved lesinurad, which can effectively treat hyperuricemia in gout patients when combined with uric acid-lowering drugs like allopurinol and febuxostat.
Lesinurad (Zurampic) are selective uric acid reabsorption inhibitors (SURIs) to be approved in the USA.
Recent studies showed that using mycophenolate mofetil (MMF), an immunomodulation drug with Pegloticase, an intravenous gout treatment used to dissolve crystallized uric acid in the joints, can keep the uric acid level in the blood low with greater efficacy.

Mental Health and Gout

The stigma of gout and fear of getting a painful flare can cause severe mental stress and trauma, affecting the mental health of gout patients. The increased anxiety and depression can cause further inflammation and aggravation of the gout symptoms.

Getting enough restorative sleep, exercising regularly, and having a healthy diet can help maintain mental health and manage gout better.