Gout

Gout is a type of inflammatory arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two and then resolve.

Overview

Gout is a type of inflammatory arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two and then resolve. Gout flares often begin in your big toe or a lower limb. It arises when high levels of urate build up in your body over a long period of time. Urate comes from purines, which are found in your body’s tissues and many foods. When purines break down, they become urate. Normally, urate passes out of your body in urine. However, when too much is made or too little is removed, urate builds up in your blood and needle-shaped crystals form in your joints, causing inflammation that is experienced as gout flares that cause pain and swelling.

When the body makes too much urate, or removes too little, urate levels build up in the body. Many people with high levels of urate in their blood will not develop gout.

Gout is more common in men than in women. It usually develops in middle age. Women typically do not develop gout before menopause, which is why women tend to develop the disease at a later age than men. When younger people develop gout, the disease tends to be more severe.

With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis. Many people avoid gout flares, decrease the severity of their symptoms, and can even become gout free.

Signs and Symptoms

The most common symptom of gout is pain in the affected joint. Many people have their first flare in one of their big toes, but gout can also affect other joints in the body. Gout flares often start suddenly at night. The intense pain may be bad enough to wake you up. The affected joint may also feel swollen, red, and warm.

Gout flares usually occur in one joint and can be triggered by:

  • Certain foods
  • Alcohol
  • Certain medicines
  • Physical trauma
  • Certain illnesses

Flares typically get better over a week or two. Between flares, you usually have no symptoms. Some people have frequent flares, while others may not have another flare for years. Over time, if left untreated, flares may happen more often and last longer.

Areas of the body that gout can affect include:

  • Joints
  • Bursae: cushion-like sacs between bones and other soft tissues
  • Tendon sheaths: Membranes that surround tendons
  • Kidneys, because high uric acid levels can lead to stones

Stages of Gout

Gout can move through several stages:

  • Hyperuricemia: Elevated urate levels in your blood over a long period of time, even with crystals in the joint, but no symptoms
  • Gout flares: Periodic attacks of intense pain and swelling in your joints
  • Interval or inter-critical gout: The time between gout attacks when you have no symptoms
  • Tophi: A late stage when crystals build up in the skin or other areas of the body

Tophi

If gout goes untreated over long periods of time, tophi can develop. A tophus is the buildup of needle-shaped crystals that cause hard lumps to form under the skin, in and around the joints and other organs. Tophi start out as painless; however, over time, they can become painful and can cause bone and soft tissue damage and misshapen joints. Depending on their location, tophi can permanently damage your joints and other internal organs such as the kidneys. Proper treatment can prevent the development of tophi.

Related Health Effects

Some people with gout may be more likely to have or develop other conditions or complications, especially with the heart and kidneys. Common related conditions include:

Causes and Risk Factors

Gout happens when urate, a substance in your body, builds up and forms needle-shaped crystals in your joints. This leads to pain, swelling, redness, and changes in the movement and use of the affected joint.

Urate comes from purines, which exist in your body’s tissues and many foods. When purines break down, they become urate. Normally, urate passes out of your body in urine. When too much is made or too little is removed, urate builds up in your blood and needle-shaped crystals form in your joints, causing inflammation.

Researchers continue to study how genes and environmental factors contribute to a buildup of urate in the blood. Certain factors may increase your chances of developing gout, including:

  • Having high urate levels
  • Having a family history of gout
  • Being male
  • Being post-menopausal
  • Increasing age
  • Drinking alcohol
  • Drinking sugar-sweetened beverages, such as soda
  • Having an unhealthy diet and eating foods rich in purines, usually from animal sources

Health Conditions That Raise Risk

Some health conditions may increase your risk of developing gout, such as:

  • Overweight or obesity
  • Metabolic syndrome: A group of conditions that include high blood pressure, high blood sugar, abnormal cholesterol levels, and excess fat around the waist
  • Chronic kidney disease: When your kidneys are damaged and cannot filter blood the way they should
  • High blood pressure
  • Conditions that cause your cells to turn over rapidly, such as psoriasis or some cancers
  • Rare genetic conditions (such as Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome) that lead to increased urate

Medicines That Raise Risk

Some medicines can increase your risk of developing gout, such as:

  • Diuretics, which help your body get rid of excess fluid
  • Low-dose aspirin
  • Niacin (vitamin B3) when taken in large amounts
  • Cyclosporine, a drug that suppresses the immune system. It is used for people who have organ transplants, and also to treat some autoimmune diseases

Diagnosis

Gout tends to be straightforward to diagnose. However, a few conditions can mimic it. To help diagnose gout, your healthcare provider may:

  • Ask you to provide your medical history, including your symptoms, any risk factors you have, and any medicines you have taken
  • Examine the affected joints
  • Order a laboratory test to check urate levels in your blood
  • Take a sample of fluid from one of your painful joints, a swollen bursa, or a tophus to look for urate crystals using a special microscope
  • Order an ultrasound or special CT scan to check for urate crystal buildup in the affected joint. This can also diagnose other conditions that may be causing the symptoms

Treatment and Management

The goals for treating gout are the same for each person and include:

  • Reducing the pain from gout flares
  • Preventing future flares
  • Preventing and resolving tophi to stop damage to your joints
  • Caring for other conditions or complications that happen with gout, such as heart and kidney diseases

Treating a Gout Flare

To treat a gout flare, your doctor may recommend medicines including:

  • Over-the-counter or prescription anti-inflammatory medicines, which can reduce pain and swelling
  • Colchicine, which helps relieve gout pain and works best when taken when symptoms first appear
  • Corticosteroids, which can help decrease inflammation, relieve pain, and reduce joint swelling. They may be given by mouth or injected into the affected joint. Because they are potent medicines, your doctor will prescribe the lowest dose possible to achieve the desired benefit.

Managing Hyperuricemia

Another key step in treating gout is managing hyperuricemia, the underlying cause of gout. Medicines available to lower urate levels include:

  • Xanthine oxidase inhibitors, which help prevent the production of urate
  • Uricosuric agents, which help the kidneys flush more urate out of the body
  • Uricase, which breaks down urate into a form that is easily removed from the body. This is recommended for people who have not responded to other medicines

Living With Gout

There are many things you can do to help manage gout. Lifestyle changes can help you have fewer gout flares and manage your symptoms.

Weight and Diet

  • Lose weight. If you are overweight or have obesity, losing weight through a reduced calorie diet and exercise helps reduce urate levels. This can reduce the number of flares you have.
  • Drink fewer alcoholic beverages. This includes nonalcoholic beer.
  • Avoid sugar-sweetened drinks, such as soda.
  • Avoid red meats and organ meats (liver, kidney, tongue, and sweetbreads). These are higher in purines and may increase the risk for other health conditions.
  • Avoid certain seafood, such as shellfish (shrimp and lobster), sardines, and anchovies.

DASH Eating Plan

The Dietary Approaches to Stop Hypertension (DASH) eating plan is helpful for people with gout who also have high blood pressure. The DASH eating plan can help improve high blood pressure and may help lower blood urate levels. By lowering urate levels, this plan may help prevent gout flares. The DASH eating plan includes:

  • Eating plenty of vegetables, fruits, and whole grains
  • Eating low-fat or fat-free dairy products, poultry, and oils
  • Limiting foods high in saturated fats
  • Limiting sugar-sweetened foods and drinks

Managing a Flare at Home

When you have a gout flare, you can do the following to help reduce symptoms:

  • Apply ice to the affected area to help reduce swelling and pain
  • Elevate the affected limb, if possible, to help reduce swelling
  • Rest the affected joint

When Lifestyle Changes Are Not Enough

When gout involves frequent flares or tophi, lifestyle changes alone are not enough to manage gout. Medicines to lower urate levels in your blood are the mainstay for managing gout in these cases. Always taking the medicines prescribed by your doctor is the key to preventing gout flares and preventing or reducing tophi. Maintaining a healthy weight and diet are also important to help lower the risk of common heart and blood complications.

Always talk with your doctor before making any changes to your diet or medicines.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on gout.

Find Treatment

Healthcare providers who may treat gout include:

  • Rheumatologists who specialize in arthritis and other chronic diseases of the bones, joints, muscles, and connective tissue
  • Primary care providers (PCPs), such as internists, who specialize in the diagnosis and medical treatment of adults, as most people with gout are managed by their PCPs
  • Dietitians who can teach you about how to follow a healthy diet to improve your health
  • Nurse educators who help people understand their condition and set up their treatment plans
  • Pharmacists who dispense and teach people about medicines

Community Support

The following organizations provide information and resources related to gout:

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

Over the last several decades, research has increased our understanding of the biology related to gout. NIH continues to support researchers studying ways to better manage gout and its symptoms. Examples include:

  • Studying the biology of the joints to help understand the molecular underpinnings of the disease
  • Researching how genetics and environmental factors are associated with gout
  • Exploring the molecular factors that may trigger recurrent flares in individuals who have gout
  • Determining which medicines and dosages are the most effective and safest
  • Studying new tools to diagnose gout and potential therapies to treat the disease
  • Researching which cells take part in gout attacks
  • Studying how diet can prevent gout flares and affect symptoms

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.