What is gout?

Gout^[1] is a complex form of arthritis characterized by sudden and severe attacks of pain, swelling, redness, and tenderness. Gout is most commonly found in the joint at the base of the big toe. An attack of gout can be sudden, usually featuring an intense burning sensation. The affected joint will feel hot, swollen, and incredibly tender. The symptoms of gout can ebb and flow, ranging from minor to incredibly severe and painful.Gout is caused by an excess of a waste product called uric acid in the bloodstream. The body produces uric acid as a byproduct of the breakdown of purines (which are found in the foods you eat). When too much uric acid is present in the body, uric acid crystals form and accumulate in the body’s joints, fluids, and tissues. Gout flares up, or worsens, as a result of the body’s response to the formation of these crystals in the joints. The flare-ups can last days, or weeks, and go through periods of worsening and remission. Gout is relatively common: it has been reported that 8.3 million Americans were affected by gout in the past year. It is the most common form of inflammatory arthritis in men, while women are more likely to develop gout as they age. While there is no cure^[2] for gout, there are ways to effectively treat and manage it, including both medication and self-management strategies. If left untreated, gout flare-ups can become constant and cause hard lumps called tophi to form in the joint. This can cause chronic gouty arthritis, which can lead to permanent joint damage, deformity, and persistent pain.

How common is gout?

Gout affects roughly 8 million Americans^[3], with 50% of reported cases affecting the big toe. In the last two decades, gout has become more common; as it is linked with obesity, the national obesity crisis has increased its incidence. American’s average uric acid levels have also increased: 21% of adults have levels that are too high. This further explains the rising instances of gout, as the condition is caused by the crystallization of uric acid inside the joints. Research has also shown that gout is more common in people with psoriasis and sickle cell anemia. This is due to increased cell turnover in people with these conditions and their tendency to have higher levels of uric acid. With weight and age being the two main risk factors for the condition, gout is commonly found in individuals who are older and/or overweight. However, the condition can affect anyone. While gout is also found most commonly in men, the likelihood of any individual developing gout increases with age.

What causes gout?

Uric acid is a waste byproduct of the body breaking down purines (substances found naturally in the body and in certain foods). Gout^[4] occurs when an excess of uric acid crystallizes and accumulates in the joints. These deposits cause inflammation (swelling), as well as intense pain and tenderness. Normally, uric acid dissolves in the blood and passes through the kidneys, exiting the body in the urine. Sometimes, however, the body produces too much uric acid, or the kidneys excrete too little uric acid. When this happens, uric acid builds up, forming sharp urate crystals that surround joints or tissues, causing pain, inflammation, and swelling. Certain foods, such as steak, seafood, alcoholic beverages, and drinks with high fructose content, can all contribute to higher purine levels (and, as a result, gout). That being said, there are also high-purine foods that are healthy and do not increase the risk of gout attacks. These include kidney beans, lima beans, mushrooms, spinach, cauliflower, and asparagus. Aside from food, certain medications, including aspirin and some diuretics^[5], are known to increase purine levels in the blood, thus increasing the risk of gout. Dehydration can also contribute to gout, as the kidneys rely on sufficient hydration to eliminate excess uric acids.

Risk factors for gout

The main risk factors^[6] for gout are modifiable (meaning they are caused by changeable lifestyle choices). However, other non-modifiable factors, such as genetics, may increase your risk of developing gout, as well. Common risk factors include^[7]:

• Body fat: According to research^[8], high levels of body fat may increase the risk of developing gout.
• Genetic factors: Genetics represents a non-modifiable risk factor for gout. Some genetically linked diseases identified as being linked to gout include hereditary fructose intolerance, Kelley-Seegmiller syndrome, Lesch-Nyhan syndrome, and medullary cystic kidney disease.

While you cannot change your inherited genes, it is important to note whether you have a family history of gout. If you do, you can take some precautions, such as improving your diet and lifestyle choices, to help prevent a gout attack.

• Family history: If a blood relative has had gout, you have a higher risk of developing the disease, as well.
• Medical factors: Certain medical conditions can make you more predisposed for gout. Some of the most common include: kidney disease, type 2 diabetes, hypertension, lymphoma, psoriasis, and psoriatic arthritis. These diseases and conditions cause a change in the uric acid levels within your body, potentially catalyzing a gout attack.
• Medication: Certain medications increase the concentration of uric acid in the body, including diuretics, aspirin, and niacin (also known as vitamin B3).

Gout symptoms

The signs and symptoms of gout can range from mild to severe. At their worst, these symptoms can impact daily life and limit mobility. Some common signs and symptoms^[9] of gout include:

• Sudden and severe pain: A typical gout attack is characterized by the sudden onset of severe pain. Sometimes, gout pains can be so bad that they wake you up in the middle of the night. One sign that your gout may be getting worse is pain that is more severe or longer-lasting than usual.
• Swelling: Joints that are affected by gout can become incredibly swollen. This is one of the main symptoms of gout (and one of the most noticeable). Over-the-counter pain relievers called NSAIDs (nonsteroidal anti-inflammatory drugs) can be used to relieve joint swelling and discomfort.
• Inflammation/redness: Visible inflammation on the affected area(s) is another component of gout. If your gout is in your toe, for example, it may become sausage-like, very swollen, and red. Redness and inflammation can also be accompanied by a burning sensation.
• Tenderness: Severe tenderness^[10] is one sign of gout in a joint. This tenderness can be so severe at times that even gentle pressure is unbearable. Even though gout may affect only one joint, tenderness can become so severe that the entire area around that joint is affected.
• Stiffness: Stiffness generally presents with limited range of motion. It is often felt the most in the morning right after waking up and at night right before sleep. The best way to treat this stiffness is constant hydration, stretching, and making sure that your diet is supporting proper uric acid levels. Massaging the affected area can also help provide temporary relief.
• Lingering discomfort: Gout causes extreme discomfort in the joint and often surfaces in sudden attacks. While the apex of the pain may be short-lived, lingering pain can last up to days (or even weeks). Generally, however, the pain caused by gout, while severe, is relatively brief. Pain lasting for a significant amount of time warrants speaking to a healthcare provider.
• Limited range of motion: This is a direct result of the buildup of uric acid in the joint. Buildups can cause stiffness and pain, causing normally easy tasks, like walking, to become incredibly difficult.

If you experience any of the signs or symptoms of gout, speak to your healthcare provider as soon as possible. They will be able to assess your signs and symptoms in order to provide the right diagnosis and treatment.

Complications from gout

Especially when left untreated, gout can lead to a number of complications^[11], including:

• Tophi: Tophi are clumps of uric acid crystals that harden under the skin, forming clusters. These clusters most commonly form on the ears, but can also be found on the joints and cartilage of the hands, feet, fingers, and ankles. While they aren’t painful, tophi do consistent damage to cartilage. If left untreated, tophi can cause permanent joint damage (and, in some cases, deformity).
• Joint damage/deformity: Joint swelling can become an issue for people with chronic gout. Between this constant swelling and the potential formation of tophi, the joints can become permanently damaged, and, when severe, lead to deformities.
• Kidney stones: Gout is the direct result of uric acid building up in the joints. One other place that uric acid can build up if there is too much in the bloodstream, is in the urinary tract. As a result, it builds up and creates stones that become Kidney Stones. Kidney Stones are potentially dangerous and incredibly painful to pass, so it is important to keep your uric acid levels as low as possible.
• Kidney disease: Accumulations of excess uric acid can cause crystalline deposits, called kidney stones, to form in the urinary tract. In some cases, this leads to kidney disease. Kidney disease is the result of the damage and scarring that the stones can cause, especially if the urate crystals are left to form over time and increase in size. It is important for patients with gout to have their kidneys checked regularly.
• Emotional issues: The chronic and severe pain that comes with gout can wear you down over time. Aside from dealing with pain, limited mobility—paired with possible difficulties at work or school—can lead to stress, anger, and depression.
• Bone loss: This is another type of deformity that can occur as a result of gout. The inflammatory cascades that happen during a gout attack can produce an increase in cytokines, preventing calcium from getting to the bones and leading to bone resorption.