Gout is a general term used to describe a variety of conditions caused by the accumulation of uric acid in the body. This buildup of uric acid most commonly affects the feet. If you are afflicted with gout, you’ll likely experience swelling and pain in the joints of your foot, in particular your big toe. Sudden and intense pain, or gout attacks, can make it feel like someone set fire to your foot.
Symptoms of Gout
Some people have an abundance of uric acid in their blood, but they experience no symptoms. This is called asymptomatic gout. For acute gout, the symptoms come on quickly, caused by the buildup of uric acid crystals in your joints. Acute gout attacks can last anywhere from 3 to 10 days. Most people experience intense pain and swelling, and their joints may feel warm to the touch. However, between gout attacks, the afflicted rarely experience symptoms.
If gout is left untreated, it can become a chronic condition. Hard lumps called tophi can develop in your joints, and the skin and soft tissue surrounding them. These deposits can permanently damage your joints, thus leading to chronic pain. Prompt treatment is important to prevent gout from becoming a chronic condition. Learning how to identify the symptoms of gout can help you address the issues before gout causes permanent health issues.
Causes of Gout
The buildup of uric acid in your blood stream is caused by the breakdown of purines. Certain health conditions, such as blood and metabolism disorders or dehydration, can cause your body to produce too much uric acid. These problems can be compounded by kidney or thyroid problems, which make it more difficult for your body to remove excess uric acid. You’re more likely to develop gout if you:
- are a middle-aged man or postmenopausal woman
- have parents, siblings, or other family members with gout
- drink alcohol
- take medications such as diuretics and cyclosporine
- have a condition like high blood pressure, kidney disease, thyroid disease, diabetes, or sleep apnea
In some people diagnosed with gout, diet and lifestyle are the primary cause. Pay special attention to your diet to determine which foods are high in gout-producing purines, such as meat and alcohol.
A competent doctor will diagnose gout based on a review of your medical history, a physical exam and a thorough discussion of your symptoms. The doctor will likely base your diagnosis on these three factors:
- your description of your joint pain
- how often you’ve experienced intense pain in your joint
- how red or swollen the area is
The doctor may also send you for a test to determine if there’s a buildup of uric acid in your joints. A sample of fluid extracted from your joint can determine whether it contains uric acid. The doctor may also request an X-ray of your joint to confirm. If you have symptoms of gout, you might begin with a visit to your primary care doctor. If your gout is severe, you will likely need to see a specialist in joint disease.
Treatment of Gout
If left untreated, gout will very likely lead to joint pain and arthritis. This painful condition can leave your joints permanently damaged and swollen. The treatment plan that your doctor proposes will very much depend on the stage and severity of your gout. Medications to treat gout work in one of two ways: They either relieve pain and bring down inflammation, or they prevent future gout attacks from occurring by reducing uric acid levels.
Drugs commonly used to relieve gout pain include:
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Bufferin), ibuprofen (Advil, Motrin), and naproxen (Aleve)
- colchicine (Colcrys, Mitigare)
Drugs commonly used to prevent gout attacks include:
- xanthine oxidase inhibitors, such as allopurinol (Lopurin, Zyloprim) and febuxostat (Uloric)
- probenecid (Probalan)
Along with medications, the doctor will likely recommend specific lifestyle changes to help manage your symptoms and reduce your risk of future gout attacks. For example, the doctor may advise you to:
- reduce your alcohol intake
- lose weight
- quit smoking
Medications and lifestyle changes aren’t the only way to manage gout and gouty arthritis, as there have been some alternative therapies which have also shown promising results.
Gout Foods to Avoid
Some foods have a naturally high concentration of purines, which your body breaks down into uric acid. Most people don’t have issues with high-purine foods, but if your body has difficulty removing excess uric acid, you may want to avoid certain foods and drinks. A few examples include:
- red meats
- organ meats
- certain seafood
Additionally, foods and beverages containing fructose can also be problematic, even though they don’t contain purines. However, there are a number of foods that can help reduce uric acid levels in the body, so take the time to learn which foods are good for you if you’ve been afflicted with gout.
Gout Home Remedies
A number of natural remedies can provide relief from the signs and symptoms of gout. Evidence from various studies suggests that these natural remedies can help lower uric acid levels and help to prevent gout attacks:
- tart cherries
- apple cider vinegar
- nettle tea
- milk thistle seeds
Please note, simply eating these foods may not be enough to reign in the painful symptoms of gout. Speak with a doctor or a dietitian to learn how these foods can help reduce your symptoms.
In most instances, gout can be treated and managed without surgery. However, after many years, this condition can damage the joints, rupture the tendons and cause infections in the skin near your joints. Hard deposits, called tophi, can build up on your joints and in other places, like your ear. These lumps can be extremely painful, and they can cause permanent damage to your joints.
Three surgical procedures can be used to treat tophi:
- tophi removal surgery
- joint fusion surgery
- joint replacement surgery
Which of these surgeries your doctor recommends depends on the extent of the damage in your joints, where the tophi are located. Consult with your doctor to learn how surgery might help stabilize the joints that have been impacted by gout and gouty arthritis.
A number of foods, drinks, medications and conditions can trigger a gout attack. If diagnosed with Gout, it’s very likely you’ll need to avoid or limit the following foods and drink which are high in purines:
- red meat, such as pork and veal
- organ meats
- fish, such as cod, scallops, mussels, and salmon
- fruit juice
Certain medications that you may take to treat other conditions could increase the level of uric acid in your blood. Again, speak with your doctor if you take any of these drugs:
- diuretics, or water pills
- blood pressure-lowering medications, such as beta-blockers and angiotensin II receptor blockers
Your general health may also be a factor in gout flare-ups. All of these conditions have been linked to gout in some way or another:
- diabetes or pre-diabetes
- joint injury
- congestive heart failure
- high blood pressure
- kidney disease
It can be difficult to pinpoint which of these factors is causing your gout attacks. As such, maintaining a diary is one way to keep track of your diet, medications, and general health to help identify the cause of your symptoms.
To reiterate, there are a number of steps you can take to help prevent gout:
- Limit how much beer, wine and alcohol you drink.
- Limit how much purine-rich food (shellfish, lamb, beef, pork, organ meat, etc.) you eat.
- Eat a low-fat, non-dairy diet that is rich in vegetables.
- Lose weight.
- Stop smoking.
- Stay hydrated.
If you have a pre-existing medical conditions or take medications that increase your risk of a gout attack, please ask your doctor for their advice on lowering your risk of gout and gouty arthritis.
Gout with Tophus
As uric acid crystals build up in your joints over time, they produce dense, crystal deposits called tophi under the skin. Without treatment, these tophi can damage your bone and cartilage, leaving your joints permanently disfigured.
Tophi are swollen lumps around the joints resembling knots on a tree trunk. They are found mainly in the joints of your fingers, feet and knees, but they can also occur on the ears. Tophi don’t cause pain directly, but the inflammation they cause can be immensely painful.
Is Gout painful?
Yes, gout can be terribly painful. In fact, pain in the big toe is often one of the first symptoms that people report. The pain is accompanied by more common arthritis symptoms, such as swelling and warmth in the joints.
Gout pain can vary in severity. Pain in the big toe can be very intense at first. After the acute attack, it may subside to a dull, bothersome ache.
The pain, swelling and other symptoms, are the result of your immune system launching a robust attack against the uric acid crystals accumulating in the joints. This attack leads to the release of chemicals called cytokines, which promotes the painful inflammation.
Is Gout hereditary?
Gout is partly due to heredity. Researchers have discovered dozens of genes that increase one’s susceptibility to developing gout, including SLC2A9 and ABCG2. The genes associated with gout influence the amount of uric acid the body holds onto and releases.
Due to these of genetic factors, gout does indeed run in families. People with a parent, sibling, or other close relative who has gout are more likely to develop this condition.
However, genetics merely set the stage for gout. Environmental factors, such as diet, actually trigger the disease.
Gout and alcohol
Alcohol, like red meat and seafood, is high in purines. When your body breaks down purines, the process releases uric acid. This increase in uric acid production increases your risk of having gout and gouty arthritis. Alcohol can also impact the rate at which your body removes uric acid.
However, not everyone who drinks alcohol will develop gout, but drinking more than 12 drinks per week can increase the risk — particularly in men. Oddly, beer consumption is more likely than hard liquor to increase the risk of an attack. In various studies, patients have reported that drinking alcohol triggers their gout flare-ups and increases their arthritis pain, so you may want to consult with your doctor regarding your drinking habits.