Gout: What Is It, Symptoms, Causes & Treatment Options

Dr. Francisco Couto Valente
About the author: Dr. Francisco Couto Valente
Orthopedic Surgeon
April 2021

Gout is an inflammatory disease that is caused by elevated levels of uric acid in the blood, also known as hyperuricemia, in which the concentration of urate in the blood is higher than 6.8 mg/dL. Symptoms include swelling, redness, and pain when moving the affected joint. The most common joint to get affected is the big toe, which gets sore especially when walking.

It's important to highlight that not everyone who has a high uric acid in the blood will develop gout, as there are other factors involved.

To reduce the symptoms caused by gout it's recommended to do some dietary changes, in order to reduce the levels of uric acid in the blood, but anti-inflammatory medication can also be used, specially to control intense pain and inflammation. Learn how to make a gout diet.

A rheumatologist or a G.P. will be able to prescribe medication to block the production of uric acid, such as Allopurinol, or medication to help the kidneys get rid of uric acid through the urine, such as Probenecid, in order to control uric acid levels in the blood. 

Main symptoms 

Symptoms of gout happen when uric acid crystals deposit in the joints, resulting in intense joint pain, and which gets worse with movement.

Alongside, other symptoms are also common, such as:

  • Redness over the joint;
  • Swelling;
  • Increase in temperature.

The pain, which usually occurs very early in the morning, is intense enough to wake the person up and can last from 12 to 24 hours. After the pain ceases, however, the person may feel discomfort in the affected joint, especially when moving, and this can last a few days, especially if the condition is not treated properly.

Any joint can be affected, however, gout is more frequent in the lower body joints, especially the toe. There may also be kidney stones and uric acid crystal deposits under the skin, forming protuberances in the fingers, elbows, knees, toes, feet, and ears.

How to confirm the diagnosis

Gout diagnosis is done according to the patient's clinical history, physical exam, uric acid in urine tests, and radiography.  

The gold pattern for diagnosing gout is observing the urate crystals through a microscope.

What causes gout

Hyperuricemia, which is an increase in uric acid levels in the blood, is what causes gout. Hyperuricemia can happen due to an increase in uric acid production, or through deficient removal of this substance.

Other causes include:

  • Inappropriate use of medication;
  • Excess use of diuretics;
  • Alcohol abuse;
  • A diet with excess protein, such as red meat, seafood, and legumes like peas, beans, or lentils;
  • Diabetes;
  • Obesity;
  • Uncontrolled high blood pressure;
  • Arteriosclerosis.

Due to the high amounts of circulating uric acid, monosodium urate crystals (the crystallized form of uric acid) deposit in the joints, especially the big toe, ankles, and knees.

Gout is more common in patients who are overweight or obese, those who have a sedentary life, and those that have chronic diseases that are not under control. In addition, gout is more common in men between 40 and 50 years old, and women after menopause, usually from 60 years old.

Treatment options

Gout treatment can be divided into two stages: managing the acute crisis and long-term therapy. Treatment for gout crises involves anti-inflammatory medication prescribed by a doctor, such as Ibuprofen, or Naproxen, to relieve pain and inflammation in the joint. Another anti-inflammatory medication that is commonly used to manage pain and inflammation is Colchicine, which also acts on uric acid levels.

Corticosteroid medication, such as prednisone, can also be used to treat pain and inflammation in the joint, however, this type of medication is usually only used when the patient can't take other anti-inflammatory medication, or when the other medication does not have the desired effect.

Besides these medications, a rheumatologist or G.P. may also prescribe medication to control uric acid levels in the blood to avoid new crises from happening and to prevent complications, such as allopurinol or probenecid. 

It's also important to change dietary habits, as this can influence the levels of circulating uric acid, and consequently, the crystals depositing in the joints, as well as treating base conditions, which can also encourage the occurrence of gout if not treated, such as hypertension and diabetes.  

Foods to avoid

To relieve symptoms and avoid a new crisis, it's important that you change your diet so that your uric acid levels regulate.

Therefore, it's recommended to decrease or avoid foods rich in purines, such as cheese, lentils, soya, red meat, or seafood, as they increase the levels of uric acid in the blood, and drink around 2 to 4 liters of water a day, as water helps remove excess uric acid from the urine.

Learn more about what you should avoid and what you can eat to help treat gout.

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References

  • SOCIEDADE BRASILEIRA DE REUMATOLOGIA. Gota. Available on: <https://www.reumatologia.org.br/doencas-reumaticas/gota/>. Access in 25 Sep 2019
  • AZEVEDO, Valderilio F. et al. Revisão crítica do tratamento medicamentoso da gota no Brasil. Revista Brasileira de Reumatologia. Vol 57. 4 ed; 346-355, 2017
About the author:
Dr. Francisco Couto Valente
Orthopedic Surgeon
Orthopedic Surgeon with medical degree from the Souza Marques University. Registered under CRM-RJ # 52.92679-5. Active member of the Brazilian Association of Orthopedics.