Gout develops in some people who have high levels of uric acid in the blood (hyperuricemia). Uric acid is a substance that forms when the body breaks down purines (found in human cells and many foods). The acid is moved by the blood to the kidneys and removed from the body in the urine. Some people’s bodies make too much uric acid, or they eat foods and drinks that cause acid levels to build up. Others produce a normal amount of this acid, but their kidneys can’t remove it properly.
When uric acid levels get high, they can form crystals, which lodge in and around the joints, causing a gout attack. But not everyone with high uric acid levels develop painful gout.
People are more likely to develop gout if they:
Gout causes sudden and severe joint pain that usually starts in the big toe. But other joints and areas around the joints can be affected, such as the ankle, knee and foot. It’s the most common type of inflammatory arthritis. Men are three times more likely than women to develop gout. It tends to affect men after age 40 and women after menopause. Gout symptoms can be confused with another type of arthritis called calcium pyrophosphate deposition (CPPD). However, the crystals that irritate the joint in this condition are calcium phosphate crystals, not uric acid.
When uric acid builds up in the blood, it forms needle-like crystals in the joints, causing inflammation. That’s why the first gout symptom is sudden, intense pain. It usually affects the big toe and often occurs at night. Joints get swollen and may be warm and very tender when touched. Sometimes the next attack may not happen for months or even years. Over time, uric acid buildup can form lumps under the skin around the joints and on the rims of the ears.
There are no symptoms, but uric acid levels are high and crystals are forming in the joints. This is called “asymptomatic hyperuricemia.”
Uric acid levels spike or crystals in the joint move around. The attack (flare) may be caused by an injury (like stubbing the toe), alcohol, drugs an infection or illness. The pain usually strikes at night and gets worse over the next 8–12 hours. The symptoms ease after a few days and likely go away in 10 days. Some people never experience a second attack, but many people will have a second attack within a year.
This is the time between attacks. Although there’s no pain, the gout isn’t gone. Low-level inflammation may be damaging joints.
Gout attacks happen more often for people who have high uric acid levels for 10 years or more. Pain comes and goes more frequently.
A medical history, physical examination and blood tests are used to diagnose gout. The doctor needs to know:
The doctor will need to rule out other reasons for the joint pain and inflammation such as an infection, injury or other type of arthritis. The doctor may also take an X-ray, do an ultrasound or order a magnetic resonance imaging scan (MRI) to examine soft tissue and bone. The doctor might also remove fluid from the painful joint and examine it under a microscope for uric acid crystals or bacteria indicating an infection.
If untreated, gout may damage joints, limit mobility and cause chronic (long-lasting) pain. The uric acid may build up in the kidneys and cause hard deposits of minerals and salts (kidney stones). Health risks, such as obesity, high blood pressure, diabetes, heart disease and chronic kidney disease, may be more likely to occur.
Treating an Acute Gout Attack
Here are the steps for getting the pain and swelling of a gout attack under control as quickly as possible:
Medications for Acute Gout Attack
Here are the medications that your doctor may prescribe at the first sign of an attack:
Reducing Uric Acid Levels
The doctor will wait until the acute attack ends before starting medications to reduce your uric acid levels. Sometimes, these drugs can cause an attack at first because uric acid levels drop and crystals in the joints shift. But sticking with the treatment plan is the best way to prevent future attacks. The doctor may prescribe a low, but regular dose of colchicine along with one of the medications below to prevent attacks.
Medications for Reducing Uric Acid Levels
The doctor will wait until the acute attack ends before starting medications to reduce your uric acid levels. Sometimes, these drugs can cause an attack at first because uric acid levels drop and crystals in the joints shift. But sticking with the treatment plan is the best way to prevent future attacks. The doctor may prescribe a low, but regular dose of colchicine along with one of the medications below to prevent attacks.
All drugs come with risks. To learn more about these drugs and their side effects, visit the drug guide.
Diet
Drink lots of water and avoid alcohol, beer, high-purine foods and sugary drinks to help reduce uric acid buildup.
Source: https://www.arthritis.org/diseases/gout