Gout is a type of arthritis, a condition that causes pain, swelling, redness and tenderness in your joints. An attack of gout usually strikes your big toe, but it can also affect other joints.
Gout is considered “an ancient disease” because it has been around for a very long time, at least since the time of the ancient Egyptians, says Daniel H. Solomon, MD, MPH, professor of rheumatology at Harvard Medical School, Boston. This means that doctors know a lot about it.
Below, you’ll come to understand how gout affects joints. First, it’s helpful to learn a bit about the substance behind gout: uric acid.
What Is Uric Acid?
“Uric acid is a natural part of the human body’s chemistry,” says Solomon. “Everyone has uric acid circulating in their blood.”
Your body makes uric acid when it breaks down purines. Purines come from your own cells and from some foods, such as red meat, organ meats like liver, some fish and shellfish, and alcohol.
Normally, your kidneys filter uric acid dissolved in your blood and remove it from the body through urine.
The level of uric acid in your blood goes up if:
- You eat purine-rich foods.
- Your body makes a lot of uric acid.
- Your kidneys don’t clear uric acid from your body very well.
Too much uric acid in your kidneys may lead to kidney stones as well as gout. Recent research shows that the way your body handles uric acid depends on your genes. Uric acid levels also tend to increase with age, says Solomon. Overweight and obesity leads to higher uric acid, too.
How Is Uric Acid Involved in Gout?
Sometimes, when uric acid builds up in your blood, it can seep out and form sharp, needle-like crystals in the spaces around your joints. These crystals cause intense pain and swelling in your joints.
"Gout has been causing pain since the time of the ancient Egyptians," says Solomon. "It's an ancient disease and we know a lot about it."
Solomon points out that some people never have a gout attack despite having high levels of uric acid. But the risk of a gout attack increases with higher uric acid levels.
Joint Problems With Gout
Gout often starts in your big toe, but as the condition gets worse, flare-ups can spread to other joints, including your ankles, knees, elbows, wrists, and fingers.
During a gout attack, the affected joints become intensely painful, swollen, tender, warm, and red. You may find it difficult to move your joints normally.
If left untreated, the gout flare-ups may become more painful and harm your joints. “In a small percentage of people with repeated gouty arthritis attacks, the joints will become damaged,” Solomon said.
Uric acid crystals can also form bumps under the skin called tophi (pronounced “TOE-fy”), if high uric acid levels remain untreated for several years. You may get them on your ears, hands, elbows, or feet.
They may not hurt at first, but they can swell and become tender during a flare-up. Tophi in your finger joints can limit your hand movement. Tophi in cartilage or bone can damage your joints. Tophi under your skin can also stand out and may sometimes get infected or painful.
Decreasing Gout Risks
With the right treatment and a few lifestyle tweaks, you can reduce gout flare-ups or even stop them and prevent later complications.
During a flare-up, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids to ease your pain and swelling. Each option has its own side effects, so you should talk to your doctor about the best option for you.
Your doctor may suggest medicine to lower the uric acid in your blood if you have:
- Many flare-ups
- Strong pain
- Signs of joint damage
- Tophi
- Chronic kidney disease
- Kidney stones
Some medicines help your body make less uric acid. Others help your kidneys clear uric acid better. You and your doctor will choose the option that fits your needs best.
When to See Your Doctor
Call your doctor right away if you have sudden, severe joint pain. Seek urgent care if you have a fever and a hot, swollen joint as this can signal an infection.
Focus on Lifestyle Changes
Gout is a type of arthritis that causes sudden pain, swelling, and redness in your joints, often starting in your big toe. It develops when uric acid — a natural substance your body makes — builds up and forms sharp crystals in your joints.
Lifestyle choices are key and help your medicine work well:
- Drink plenty of water each day to help your kidneys clear uric acid.
- Avoid purine-rich foods.
- Cut back on alcohol and sweet drinks since they can raise uric acid levels and trigger gout flare-ups.
- Regular exercise can lower your risk of gout flare-ups.
Extra weight raises uric acid levels and makes it harder for your kidneys to clear it. If you are overweight, losing weight can lower your risk of gout attacks.
Doctors know a lot about gout, but they still want to find the best treatment plan for each person. Solomon is helping to run an NIH-funded study called the TRUST trial that aims to do this.
Some people never have symptoms, but higher uric acid levels can raise the chance of a gout attack. Higher uric acid levels can also lead to joint damage or tophi, which are firm lumps under the skin.
Treatment and lifestyle changes can help ease pain during flare-ups and lower uric acid to prevent future attacks.
Show Sources
Photo Credit: DigitalVision/Getty Images
SOURCES:
Daniel H. Solomon, MD, MPH, professor, rheumatology, Harvard Medical School, Boston.
Matthew H. Liang Distinguished Chair, Arthritis and Population Health in Rheumatology, Brigham and Women’s Hospital, Boston.
Mayo Clinic: “Gout.”
BMC Musculoskeletal Disorders: “Gout: global epidemiology, risk factors, comorbidities and complications: a narrative review.”
Journal of Personalized Medicine: “The role of uric acid in human health: Insights from the uricase gene.”
Nature Genetics: “A genome-wide association analysis reveals new pathogenic pathways in gout.”
Mass General Brigham: “The TRUST trial.”
Arthritis Foundation: “Managing a Gout Flare," “Gout Diet: Dos and Don’ts," “Guidelines for Treating Gout," “4 Stages of Gout and the Early Signs to Watch Out For.”
Harvard Medical School: “Why the wheelchair? Could it be gout?”
MedPageToday: “ACR: Drinking Water May Wash Away Gout Attacks.”
