Disclaimer: This article is for informational and educational purposes only and does not substitute professional medical advice. It is important to always consult a medical professional for any health issues.
Gout is a chronic condition that some people experience, which causes sudden and severe pain, redness, and swelling in one or more joints. It can be a debilitating condition and may lead to damage in the joints and other complications if it is left untreated. If you or someone you know is suffering from gout, then you probably know that it can be extremely painful and uncomfortable.
Fortunately, there are different treatment options available to help relieve pain and manage the condition. These include both traditional treatments and natural remedies. It is very important to seek treatment as soon as possible when you experience a gout flare-up to prevent further health issues.
If you are interested in learning more about gout and the options available to manage its symptoms, we are here to help you. In this post, we are giving you more information about gout and its treatments.
What is Gout?
Gout is placed by doctors under the umbrella term “arthritis,” which is a broad range of joint diseases and joint pain. There are some types of arthritis that inflame the joints, while others don’t. Gout is a type of inflammatory arthritis, and it is brought on by an excessive buildup of a crystal known as uric acid. It can also be due to the inability of the body to excrete uric acid properly. It causes pain and swelling in one or more joints, and it usually affects the big toe. But it can also occur in other joints, such as the knee, foot, ankle, hand, elbow, and wrist. [1]
A gout attack may suddenly occur, which often wakes people up in the middle of the night with the sensation that the big toe is on fire. [2] The condition mainly affects men over 30 and women after menopause, but overall, it is a more common condition among men than women. [3] Its symptoms may come and go, but there are different ways in order to manage them and prevent flares, which we will further discuss in this article.
Symptoms of Gout
Any joint can be impacted by gout, but the joints at the tips of the limbs, such as the toes, fingers, knees, and ankles, are most commonly affected. Its signs and symptoms almost always occur suddenly and usually at night. Below are some of the common signs and symptoms of gout: [2]
Intense Joint Pain: Gout commonly affects the big toe but can also affect other joints, as mentioned earlier. The first 4 to 12 hours after the flare-up starts, the pain is most likely to be at its worst.
Lingering Discomfort: There may be lingering joint pain after the most intense pain has subsided for a few days to a few weeks. It is also likely to experience later attacks that may last longer and affect more joints.
Redness and Inflammation: The affected joint or joints become red, warm, tender, and swollen.
Limited Range of Motion: As gout progresses, it may be difficult to move the joints normally.
The symptoms of gout may develop rapidly over a few hours and may last 3 to 10 days. After that, the pain should pass, and the joint should return to normal. The majority of people with gout will eventually have more bouts within a year. [3] These symptoms may also come and go, with periods of no symptoms between gout attacks.
Causes and Risk Factors of Gout
The body makes uric acid during the breakdown of chemicals referred to as purines, which are found in certain food and drinks, such as meat, liver, sardines, mussels, scallops, tuna, and trout. It is a typical waste product that leaves the body when you urinate after passing through the kidneys. However, there are circumstances in which the body overproduces uric acid or circumstances in which the kidneys are unable to adequately handle it.
Uric acid crystals can gather in the joints when the body has hyperuricemia or high amounts of uric acid. These sharp, needle-like crystals are what causes gout. But note that hyperuricemia does not always cause gout, and without any symptoms, it does not need to be treated. [1]
A person is more likely to develop gout if he or she has high levels of uric acid in the body. There are several factors that increase the uric acid level in the body, and below are some of them: [2]
Diet: A diet rich in red meat, shellfish, and beverages sweetened with fruit sugar (fructose) may increase levels of uric acid, which, in turn, increases the risk of gout. Aside from that, alcohol consumption, particularly beer, also increases the risk of gout.
Weight: If a person is overweight, the body produces more uric acid. With this, the kidneys have a more difficult time eliminating uric acid.
Medical Conditions: There are also certain diseases and medical conditions that increase the risk of gout. Untreated high blood pressure and chronic health conditions such as metabolic syndrome, diabetes, obesity, and heart and kidney problems are some of these.
Certain Medications: There are certain medications that may also increase the levels of uric acid. These include low-dose aspirin and some medicines used to control hypertension, such as thiazide diuretics and beta blockers. Aside from these, the use of rejection drugs prescribed for those who have undergone an organ transplant may also contribute to high levels of uric acid.
Family History of Gout: You have a very high likelihood of getting gout if other family members have the condition.
Age and Sex: As mentioned earlier, gout occurs more often in men as women tend to have lower uric acid levels. However, after menopause, the uric acid levels of women approach those of men. This means that men are more likely to develop gout earlier, commonly between the ages of 30 and 50.
Recent Surgery or Trauma: It is also possible for a recent surgery or trauma to trigger a gout attack. Also, in some people, receiving a vaccination may also trigger a gout flare.
The Different Types of Gout
Gout also comes in different types, which are classified depending on the stage or severity of the condition, as well as the specific characteristics of the gout attack. Below are the different types of gout:
Asymptomatic Gout: This type of gout occurs when the body has high uric acid levels, but no symptoms are present. This means that the person does not feel any kind of pain. No medication is needed for asymptomatic gout. But taking care of your diet is important to control the levels of uric acid in the body.
Acute Gout: This is the most common type of gout, which symptoms include sudden, severe pain, swelling, and redness in one or more joints. It often starts in the big toe, and the attacks may last for a few days to a few weeks.
Intercritical Gout: This is the type of gout that occurs between acute gout attacks. Intercritical gout is characterized by a period of remission where an individual experiences no symptoms.
Chronic Gout: Compared to acute gout, chronic gout is far more painful. This type of gout needs major medical treatment. When a person suffers from this type of gout, he or she has fully restricted movement with major pain in the different types of joints in the body. Chronic gout commonly impacts the body when acute gout has not been treated properly. It may take a person several years to recover from chronic gout.
Chronic Tophaceous Gout: This is a type of gout that is characterized by the formation of tophi, which are hard, white lumps in and around the joints. It is the most debilitating type of gout that may result in permanent damage to the joints and the kidneys. It usually occurs after many years of acute gout attacks. But this type of gout is unlikely to occur for those who receive proper treatment. [4]
Recurrent Gout: Some people may never experience signs and symptoms of gout again. However, others may experience gout attacks several times each year, which are referred to as recurrent gout. There are medications that may help prevent gout attacks in people who have recurrent gout. If it is left untreated, it may cause erosion and destruction of a joint.[2]
Gout Diagnosis
If you experience sudden or severe pain in a joint, it is very important to consult your primary care provider immediately. They may send you to a rheumatologist, which is a doctor who specializes in gout and other kinds of arthritis. There are several things that doctors consider when diagnosing or confirming gout. Below are some of them: [1]
Symptoms: You will be asked to describe the symptoms that you are experiencing, as well as how often they occur and how long they last.
Physical Examination: Doctors will also examine the affected joint or joints to look for redness, swelling, and warmth.
Blood Tests: A blood test is usually done in order to measure the level of uric acid in the blood. Although gout can be diagnosed if there is a high amount of uric acid in the blood, this is not always the case because some gout sufferers have normal levels of uric acid.
Imaging Tests: Pictures of the affected joint or joints may also be taken with X-rays, an MRI, or an ultrasound. This way, the joint can be visualized and checked for any damage that may have occurred due to gout.
Aspiration: A doctor may also use a needle to pull fluid from the affected joint. To confirm gout or another issue, such as bacteria with infection or other types of crystals, a microscope is used to examine for uric acid crystals.
Gout symptoms may be similar to other conditions, such as rheumatoid arthritis, osteoarthritis, and septic arthritis. That is why it is important to have a proper diagnosis in order to get a correct treatment plan.
Different Treatments for Gout
Gout should be treated by a doctor or a team of doctors who specialize in the care of gout patients. The condition can be treated effectively and managed with medical treatment and self-management strategies. Doctors may recommend a medical treatment plan in order to manage the pain of a flare, prevent future flares, and prevent tophi and kidney stones from forming. Below are the different treatments for gout:
Medications
The treatment of pain and inflammation can be achieved with NSAIDs, colchicine, or corticosteroids. Based on the patient’s co-morbid medical problems, other drugs, and side effect profile, the best course of treatment should be decided. Below are more information about the medications used for gout:
NSAIDs: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used during an acute gout attack. An example is taking ibuprofen three to four times daily or indomethacin four times daily. But when symptoms resolve, treatment should be discontinued. [5]
Colchicine: Another medication that is commonly used to treat gout is colchicine. However, intravenous colchicine is associated with serious toxicities and side effects. Therefore, it should only be used as an oral formulation. High-dose oral colchicine is usually poorly tolerated due to gastrointestinal side effects. On the other hand, lower doses are far more well-tolerated and can be combined with various NSAIDs. [5]
Corticosteroids: There are patients who have contraindications to the use of NSAIDs. For them, the next choice to treat gout is corticosteroids. These medications can be administered as an injection into the affected joint, which are referred to as intra-articular steroids. But they can also be given systematically, such as orally, like Medrol or prednisone. Intra-articular steroids are only useful if only one or two joints are affected and if the doctor is proficient in injecting the joints. [5]
In addition to these, there are also other uric-acid-lowering medications that can be prescribed by doctors, such as allopurinol, pegloticase, and febuxostat. They are commonly used to prevent future gout attacks by decreasing the amount of uric acid in the body.
Uric Acid Lowering Therapy
Individuals who have multiple episodes of acute gout attacks in a year or those who have tophi on the exam are qualified for uric acid lowering therapy. This therapy uses uric acid-lowering agents that will reduce the frequency of gout attacks. Over time, it reduces tophi formation and diminishes the risk of joint destruction. Uric acid lowering therapy may also be done after the failure of colchicine prophylaxis of acute gouty arthritis and when there are extremely high levels of serum uric acid. [5]
Lifestyle Changes
Gout can affect many aspects of daily living, and these include work and leisure activities. Fortunately, aside from taking medications and undergoing therapy, there are also many low-cost self-management strategies that are proven to improve the quality of life for people who are living with gout. According to the Centers for Disease Control and Prevention, below are the lifestyle changes that may help in managing gout and its symptoms: [6]
Eat a Healthy Diet: If you have gout, you need to avoid foods that may trigger a gout flare. These include foods that are high in purine, such as red meat, organ meat, and seafood. Limiting your alcohol intake is also essential, particularly beer and hard liquor.
Lose Weight: For people who are obese or overweight, losing weight may help reduce pressure on joints, especially on weight-bearing joints like the knees and hips. Reaching and maintaining a healthy weight can help relieve pain caused by gout, improve function, and slow the progression of gout and other types of arthritis.
Be Physically Active: According to experts, adults need to engage in 150 minutes a week of at least moderate physical activity. Any activity is better than none, and every minute of activity counts. These can be moderate, low-impact activities like walking, biking, or swimming. Having regular physical activity can also help reduce the risk of developing other chronic diseases.
Drink Plenty of Water: Increased water intake can help keep the kidneys healthy and help them flush out uric acid from the body. The recommended daily intake of fluids depends on the age, weight, sex, and other factors of an individual.
Conclusion
Gout is indeed an extremely painful condition that many people experience. But with the right diagnosis and treatment, it does not have to be debilitating. That is why if you are experiencing any of the common symptoms of gout, it is important to consult with your doctor immediately to get a proper diagnosis and treatments that are tailored specifically for you.
Taking medications prescribed by your doctor to reduce pain and inflammation associated with an acute attack, along with making lifestyle changes like maintaining a healthy weight and eating a balanced diet low in purines, can help lower your risk of experiencing gout flare-ups. However, while medications and lifestyle changes can help relieve the symptoms of gout and prevent future attacks, they are not a cure for gout. Note that gout is a chronic condition that needs ongoing management and monitoring by a doctor. We hope this post helped you learn more about gout and its treatments.
References
[1] Cleveland Clinic, E. (2020, November 15). Gout: Causes, symptoms, treatment & prevention. Cleveland Clinic. Retrieved January 27, 2023, from https://my.clevelandclinic.org/health/diseases/4755-gout
[2] Mayo Clinic, E. (2022, November 16). Gout. Mayo Clinic. Retrieved January 27, 2023, from https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897
[3] NHS Inform, E. (2023, January 20). Gout symptoms and treatments. symptoms & treatments – Illnesses & conditions | NHS inform. Retrieved January 27, 2023, from https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/gout
[4] McIntosh, J. (2021, June 21). Gout: Symptoms, causes, and treatment. Medical News Today. Retrieved January 27, 2023, from https://www.medicalnewstoday.com/articles/144827
[5] Johns Hopkins Arthritis Center, E. (2019, March 27). Gout treatment: Medications and lifestyle adjustments to lower uric acid. Johns Hopkins Arthritis Center. Retrieved January 27, 2023, from https://www.hopkinsarthritis.org/arthritis-info/gout/gout-treatment/
[6] Centers for Disease Control and Prevention, E. (2020, July 27). Gout. Centers for Disease Control and Prevention. Retrieved January 27, 2023, from https://www.cdc.gov/arthritis/basics/gout.html#treat