- WHAT YOU NEED TO KNOW:
- What causes gout?
- What increases my risk for gout?
- What are the stages of gout?
- How is gout diagnosed?
- How is gout treated?
- How can I manage gout?
- How can I prevent gout attacks?
- When should I seek immediate care?
- When should I contact my healthcare provider?
- Further information
- Learn more about Gout
- Separating Gout Facts and Myths
- Gout is a cripplingly-painful malady that prevents me from walking for up to weeks. So do me a favour and stop telling me I quaff too much port and eat too much swan.
- My Swollen Ankle Turned Out to Be Gout, the ‘Disease of Kings’
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Medically reviewed by Drugs.com. Last updated on Sep 24, 2019.
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WHAT YOU NEED TO KNOW:
Gout is a form of arthritis that causes severe joint pain and stiffness. Acute gout pain starts suddenly, gets worse quickly, and stops on its own. Acute gout can become chronic and cause permanent damage to your joints.
What causes gout?
Gout develops when uric acid builds up in your joints. Uric acid is made when your body breaks down purines. Purines are found in some medicines and foods. Your body gets rid of most uric acid through your urine. When your body cannot get rid of enough uric acid, it can build up and form crystals in your joints. The crystals cause your joints to become swollen and painful. This is called a gout attack.
What increases my risk for gout?
You may have been born with a decreased ability to break down and get rid of purines. Your body’s ability to break down purines may be very slow. Gout is more common in men than in women. Any of the following can also increase your risk:
- A family history of gout
- Kidney disease or problems with how your kidneys work
- Eating foods that are high in purines, such as red meat
- Alcohol or tobacco use
- Diuretic medicine (water pills), or aspirin
- A medical condition such as diabetes, high blood pressure, or high cholesterol
- A condition such as an irregular heartbeat or a blood clot in your lungs
What are the stages of gout?
- Hyperuricemia is a high level of uric acid. Hyperuricemia is not gout, but it increases your risk for gout. You may have no symptoms at this stage, and it usually does not need treatment.
- Acute gouty arthritis starts with a sudden attack of pain and swelling, usually in 1 joint. This may be in your big toe. The attack may last from a few days to 2 weeks.
- Intercritical gout is the time between attacks. You may go months or years without another attack. You will not have joint pain or stiffness, but this does not mean your gout is cured. You will still need treatment to prevent chronic gout.
- Chronic tophaceous gout develops if gout is not treated. Large amounts of uric acid crystals, called tophi, collect around your joints. The crystals can destroy or deform the joints. Gout attacks occur more often, and last hours to weeks. More than 1 joint may be painful and swollen. At this stage, gout symptoms do not go away on their own.
How is gout diagnosed?
Your healthcare provider will ask about your medicines, health problems, and allergies. Tell him or her when your joint pain and swelling started. He or she will need to know if the swelling and pain were worst within 1 day or if got worse over time. He or she will check the skin over your joints for redness. You may also need any of the following:
- Blood tests are used to check the level of uric acid. You may need to have blood tested more than once.
- A synovial fluid test is used to collect a sample of fluid from around your painful joint. The fluid is sent to a lab to check for uric acid crystals. Synovial fluid surrounds and protects your joints.
- An x-ray, ultrasound, CT, or MRI may show the gout or damage to bones caused by gout. You may be given contrast liquid to help your joints show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
How is gout treated?
The following can make your symptoms stop sooner, prevent attacks, and decrease your risk for joint damage:
- NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
- Gout medicine decreases joint pain and swelling. It may also be given to prevent new gout attacks.
- Steroids reduce inflammation and can help your joint stiffness and pain during gout attacks.
- Uric acid medicine may be given to reduce the amount of uric acid your body makes. Some medicines may help you pass more uric acid when you urinate.
- Surgery called a bone graft may be needed for tophi that are painful or infected. Bone in the joint may be replaced with bone taken from another place in your body. Ask your healthcare provider for more information about bone graft surgery.
How can I manage gout?
- Rest your painful joint so it can heal. Your healthcare provider may recommend crutches or a walker if the affected joint is in a leg.
- Apply ice to your joint. Ice decreases pain and swelling. Use an ice pack, or put crushed ice in a plastic bag. Cover the ice pack or bag with a towel before you apply it to your painful joint. Apply ice for 15 to 20 minutes every hour, or as directed.
- Elevate your joint. Elevation helps reduce swelling and pain. Raise your joint above the level of your heart as often as you can. Prop your painful joint on pillows to keep it above your heart comfortably.
- Go to physical therapy if directed. A physical therapist can teach you exercises to improve flexibility and range of motion.
How can I prevent gout attacks?
- Do not eat high-purine foods. These foods include meats, seafood, asparagus, spinach, cauliflower, and some types of beans. Healthcare providers may tell you to eat more low-fat milk products, such as yogurt. Milk products may decrease your risk for gout attacks. Vitamin C and coffee may also help. Your healthcare provider or dietitian can help you create a meal plan.
- Drink more liquids as directed. Liquids such as water help remove uric acid from your body. Ask how much liquid to drink each day and which liquids are best for you.
- Manage your weight. Weight loss may decrease the amount of uric acid in your body. Exercise can help you lose weight. Talk to your healthcare provider about the best exercises for you.
- Control your blood sugar level if you have diabetes. Keep your blood sugar level in a normal range. This can help prevent gout attacks.
- Limit or do not drink alcohol as directed. Alcohol can trigger a gout attack. Alcohol also increases your risk for dehydration. Ask your healthcare provider if alcohol is safe for you.
When should I seek immediate care?
- You have severe joint pain that you cannot tolerate.
- You have a fever or redness that spreads beyond the joint area.
When should I contact my healthcare provider?
- You have a fever, chills, or body aches.
- You are confused or more tired than usual.
- You have new symptoms, such as a rash, after you start gout treatment.
- Your joint pain and swelling do not go away, even after treatment.
- You are not urinating as much or as often as you usually do.
- You have trouble taking your gout medicines.
You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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Learn more about Gout
- Gouty Nephropathy
- Uric Acid Nephrolithiasis
Symptoms and treatments
Mayo Clinic Reference
The foods that can raise your uric acid levels include oily fish (sardines, herring) Seafood (prawns, mussels), Yeast extracts (Marmite), Game and Offal, and ideally should only be eaten in moderation. Sugar-sweetened soft drinks which are high in Fructose can also cause the Uric acid levels to rise.
What are the symptoms?
The typical Gout ‘attack’ develops quickly over a few hours and affects one joint at the time. The big toe is the most common site for a flare up. Normally the joint becomes extremely painful, swollen and red and is difficult to use because of the intense pain. A small number people can have milder symptoms affecting several joints at one time. A gout ‘attack’ typically takes 7-10 days to fully resolve.
Is it painful?
Gout can be extraordinarily painful, and my male patients often tell me “It’s the worse pain I’ve ever experienced” (admittedly they have never experienced Childbirth!). Lady Montagu, an 18th century writer, once stated “People wish their enemies dead- but I do not: I say give them the gout”.
Does drinking booze give you gout?
Yes it can-alcohol can be one of the main causes of a high uric acid level. In particular, beer and spirits can cause it to rise.
Its therefore important to ensure your alcohol consumption is within recommended limits:- 21 units a week for men, 14 units for women (1unit is about 1/2pint of beer). This should be spread throughout the week rather than taken in ‘binges’.
Separating Gout Facts and Myths
Think gout only strikes old men? That cherries will cure it? Or that since the pain comes and goes, it’s not a big deal if you ignore treatment? Wrong, wrong, and wrong. Considering how common gout is — six million adults have ever had it — it may be shockingly misunderstood. And if you suspect you may have gout or have recently been diagnosed, believing these myths could make your pain worse and cause serious, or even life-threatening, complications.
Gout Myths and Gout Facts
Myth No. 1: Over time, gout will go away on its own.
Gout Fact: Although it is true that most gout attacks eventually subside even without treatment, it is important to get diagnosed and treated as soon as possible. Gout attacks commonly recur if you do nothing to prevent them. Gout treatments include medications to lower uric acid levels and reduce pain from uric acid formation in joints and other areas of the body. These medications can get a gout attack under control and reduce your chances of future attacks. Many people need to take uric acid-lowering medications over the long term to keep their gout under control.
Myth No. 2: Gout is a mild form of arthritis.
Gout Fact: Gout is actually one of the most painful forms of arthritis, and many people compare gout-associated pain with childbirth or breaking a leg. “People describe as the worst pain of their life,” says Daniel Solomon, MD, MPH, associate professor of medicine at Harvard Medical School and a physician in the rheumatology, immunology, and allergy department at Brigham and Women’s Hospital in Boston. Over time, gout can lead to serious complications, such as permanent joint damage, kidney stones, and serious kidney damage.
Myth No. 3: Gout is a rare condition.
Gout Fact: The truth is that gout is a relatively common condition, especially in men and in older people. In 2005, an estimated 1 percent of Americans reported having gout, making it a condition that affects about three million adults at any one time. Older men and postmenopausal women are most frequently affected, and gout is the most common type of arthritis in men over the age of 40. While there’s some truth to the statement that gout is a condition that affects older people, younger people can develop gout, too. In fact, the hereditary form of gout often affects men younger than 30, and this form of gout tends to be severe.
Myth No. 4: Gout only affects the big toe.
Gout Fact: While the joint of the big toe seems to be the most vulnerable to a gout attack, gout can also affect other joints, including the ankles, knees, wrists, fingers, other parts of the feet, and elbows. Even so, it is estimated that 9 out of 10 people with gout will eventually have a gout attack in their big toe, most likely due to the pressure on it from walking and standing.
Myth No. 5: A gout attack never lasts longer than 10 days.
Gout Fact: While most people experience acute gout attacks, which usually last one day to one week, some people experience chronic gout episodes that can go on for longer periods of time and lead to joint damage, Dr. Solomon says. These more chronic cases tend to cause less severe pain.
Myth No. 6: Gout goes away between gout attacks.
Gout Fact: Even if you are not experiencing a gout attack, you still have gout and your uric acid levels may continue to be elevated between attacks. This is why it is important to keep taking your gout medications, even when you don’t have symptoms. “People sometimes stop taking , and they often end up having a gout flare,” notes Solomon.
Myth No. 7: Eating cherries can cure gout.
Gout Fact: There is currently no cure for gout. Even though a very small study suggested that eating cherries may help lower uric acid levels, this finding has not yet been confirmed, and you should talk with your doctor about the right adjustments to make to your diet before trying unproven methods of managing your condition.
Ask the experts
My mother is suffering from gout in both her knees. She doesn’t want to exercise because it hurts. Isn’t exercise a great way to break up the crystals in her knees where the gout is concentrated?
When gout is actively causing inflammation in a joint (arthritis), all efforts should be directed toward eradicating the inflammation. This generally means resting the joint, ice/cold applications, and anti-inflammatory medications.
Exercising a joint that is already inflamed can prolong the inflammation and cause more pain. Gently moving the joint through its range of motion can sometimes prevent stiffness.
After the inflammation of the joint has quieted down, gradual exercise is often encouraged to re-establish strength and movement of the muscles around the joint.
Exercise has no benefit or effect on breaking up tiny crystals of gout (monosodium urate crystals) in the joints. These tiny (microscopic) crystals are only as long as a white blood cell is wide. They dissolve (disappear) and form according to the body’s metabolism (processing of substances), state of hydration (amount of water), and in response to medications that influence the uric acid level in the blood.
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Gout is a cripplingly-painful malady that prevents me from walking for up to weeks. So do me a favour and stop telling me I quaff too much port and eat too much swan.
Chris WardFollow Mar 28, 2017 · 6 min read
My first gout attack was at 25. I was mildly overweight, but not excessively so. I was on the train back to host a reception in Guildford’s council chamber that evening and I kept getting flashes of sharp pain in my left toe. I assumed I’d stubbed it earlier and that it would pass.
By the time I’d reached the council chamber, the pain was such that I had to take my shoes off. I could barely walk. Hobbling past the council leader of the time, he asked what was wrong and I said that I had absolutely no idea, just that I was getting close to cutting my toe off. “Ah! Gout!” he said. I’d never heard of it before, but I was compelled to do some Googling that night, as the pain suddenly became agonisingly unbearable. The weight of bedsheets felt like knifes driven vertically into my toe and even just keeping the foot still, the pain whirled in the joint as if some sort of shredder was whirring inside.
“The Disease of Kings”, was how it was described in one article. Another recounted an anecdote of a young chap in the city, being patted on the back by his fellow hedonistic bankers — for gout was an unofficial initiation into higher society, apparently. Among the famous sufferers include Henry VIII, which is probably where “the disease of kings” label originates. The next day I literally could not walk without pain screaming through my body. For two weeks I was off work, followed by two weeks of working from home (which was the only point at which the pain wasn’t completely distracting). A whole month of my life was lost to the most painful experience I’ve ever known.
My first attack was my worst. Since then, I have drugs at the ready, I know which foods to avoid and which I can enjoy in moderation and the first warning sign that comes along prompts me to guzzle gallons of water. I was very lucky back then in that I had a very sympathetic boss, and his boss was also a gout sufferer. It really does take another person who has endured it to quite appreciate what you’re going through and, as such, the tolerance from your employers will vary on that alone.
In a subsequent job, at one time when I arrived late (I was a slave to train delays, but when I had gout, the 30 minute walk at either end of the journey became a challenge) the HR director called me into the office. “You do know that lifestyle changes can impact on your gout?”, I was told, presumably from the article they’d just googled that minute. No shit, was my immediate reaction. This is an illness that literally prevents me from walking and puts me in excruciating pain, and you honestly think that I don’t know the causes, symptoms and treatments back to front? But herein lies the problem. Any other malady, even those with an element of self-infliction, is met with sympathy and concern. Mine? Well, I clearly sit around all day eating offal and drinking port. It’s a myth that we’ve allowed for too long to rattle through societal expectations of gout and it’s about time we tackled it.
What is gout?
Your body breaks down a compound from your food known as purine into uric acid. Normally, you expel said acid from your body when you urinate. However, for whatever reason, if you have too much uric acid in your body, it occasionally crystallises and deposits itself in joints, typically at the end of your limbs, so fingers, toes, ankles, etc. Your joints require fluid to move freely, so imagine what it feels like to have sharp bits of crystal there instead? Yup. Pretty damn painful.
So you can get it from food. Presumably unhealthy stuff?
This is what everybody assumes, but not quite. It’s not food that’s unhealthy, so dairy rarely causes problems. Certain types of seafood, so mackerel, sardines, etc. are very high in purine. Broccoli is fine for gout, spinach is really bad, and mushrooms aren’t great either. It all depends which are high in purine.
Another problem is that because this is an affliction that affects everybody differently (the NHS formally links risk of gout to you having a close relative that suffers), there’s no one-size-fits-all answer. This means that the Internet has *a lot* of bollocks on what fixes it. You’ll see plenty of “natural” remedies from the herbal/homeopathy bullshitters. You’ll see different people citing different foods as triggers — my dad can’t eat Quorn products, for example, but I’ve never really had a problem with them.
So actually, gout is caused food-wise by a mixture of healthy and unhealthy things. However, obesity increases the risk of gout, so this is often where the link between unhealthy eating is made.
So if everybody is different, how do you know what to do to prevent it?
Million dollar question. If gout was preventable all the time, then the author of the solution would probably be very rich. This is also why the “Oh, too much of the good life eh?” responses really get my goat. If anybody ever endured gout, they would know full-well that it’s not something we choose to have or happily take as a compromise for enjoying beer.
There are some proven ways of keeping the foot demons away:
- Drink lots of water. The more you keep yourself hydrated, the less likely you’ll find your body overloaded with uric acid.
- Moderate what you eat. There are some risk foods that I’d argue you should still enjoy (red meat, spinach, mushrooms, seafood), but do so in moderation and keep an eye on your intake.
- Avoid extremely high-risk foods. Offal is among these.
- Keep an eye on the booze. There’s conflicting evidence as to which alcohol flares gout up the most. The NHS says that beer and spirits are more likely to give you gout, but other studies conclude that any alcohol is bad.
- If you get gout occasionally, the doctor will prescribe you with medication. The types I have tried are colchicine and naproxen. Colchicine had some very nasty side-effects, whereas naproxen (an anti-inflammatory) I found was more effective for me. You can take naproxen with paracetamol or codeine (but DO NOT take it with ibuprofen). The moment you feel an attack coming on, take the medication.
So, if people respond differently, I guess some people will have a full-on attack from a trigger, whereas for others they’ll manage just fine?
Precisely, and this changes over time and with your health too, which is why it’s rather silly for people to automatically assume that if you’ve had an attack, you have only yourself to blame. I am currently writing this whilst recovering from one. In the past few months I’ve lost weight, which has thrown my known-tolerances entirely out of kilter.
Bottom line — gout is a form of arthritis. It can be caused by your lifestyle, but there are many points where your lifesyle doesn’t make a jot of difference. It is a crippling and painful illness that anybody who has had it will know you do everything you can to prevent it. Joking about it is one thing. Being inconsiderate or unsympathetic is quite another. Between around 3am and 7am, it will be at its worst, depriving you of sleep. During the day, you have to contend with the subsequent tiredness and the knockout effect of the medication. It fucking sucks. Society laughs at it, whilst those of us who suffer from it lose a week at a time. You wouldn’t laugh at any other form of arthritis, or any other debilitating illness. You wouldn’t laugh if somebody broke their leg through their own fault. So why laugh at this?
My Swollen Ankle Turned Out to Be Gout, the ‘Disease of Kings’
Years ago, when I was editor of a men’s magazine, waking up with a pounding head after a night out wasn’t exactly unusual. (Hey, those booze reviews weren’t going to research themselves.) But this summer after having just two civilized beers the night before at a work event, I woke up with a totally different kind of bodily pounding—it was in my foot.
At first I thought I must have slept on it funny. But as I tried to walk it off and felt the pain in my ankle and foot explode with each step, I began to wonder if maybe I had dropped a piano on it and somehow forgot. It was red, hot, swollen, tender—not at all a happy foot. Had I twisted my ankle at the gym? I tackled this medical issue the way men tend to (i.e., ignored it, hoping that if I said, “I’m fine, I’m fine,” enough, I would trick my body into actually being fine).
When I woke up in the middle of the night with pain so bad I wanted to chop my foot off, I knew Advil wasn’t going to save me. I finally I gave in to my wife’s gentle suggestions that I “stop being so stubborn and go to the doctor.”
The doctor checked me out, ran some blood tests, and called me with the official diagnosis: “You have gout.”
RELATED: 9 Surprising Triggers of Gout Pain
Gout? Wait, wasn’t that “the king’s disease” I vaguely remembered from 6th grade history? Isn’t that something only Benjamin Franklin and dead French people named Louis got?
No, I learned that gout—a form of inflammatory arthritis brought on by a build-up of uric acid crystals in the joints—is an increasingly common diagnosis: 8-12 million Americans have it, according to rheumatologist Michael Pillinger, MD, Professor of Medicine, Biochemistry and Molecular Pharmacology at NYU Langone Medical Center.
Men typically first develop the condition in their 20s and 30s (I’m in my 40s). Women rarely get it that young because female hormones are protective. Go hormones! But don’t get too excited, ladies, Dr. Pillinger cautions: “After menopause women become much more vulnerable to gout and begin to catch up.”
My big question was what could I do to avoid future flare-ups? It was not fun for the two weeks that I had to get around with a cane. When someone says, “Oh my God, what happened?” you want to be able to tell the story of how you fought off a bear or even got hit by a bus. When I explained to an intern that I had gout, her look said, “Oh my God, I hope I never get that old.”
Scouring the Internet for prevention information led me to a lot of contradictory advice (I know, shocker) but Dr. Pillinger and Health’s contributing nutrition editor, Cynthia Sass, RD, were able to debunk some of the junk science out there and put me on the right path to preventing another attack. Here’s what I learned that may help you, and Jared Leto, too.
RELATED: 8 Gout-Causing Foods
Watch the surf and turf
Compounds called purines—found in our bodies and also in some foods—break down into uric acid. Eating a lot of high-purine foods like red meat and seafood, such as scallops, mussels, and tuna, can trigger a gout flare-up, says Sass, so think moderation. You don’t have to limit high-purine veggies like spinach and asparagus though, according to the Mayo Clinic. A recent study showed that the produce-rich, low-fat DASH diet helps reduce uric acid levels and prevent gout flares.
Beware of beer
Beer is the worst drink for your uric acid levels because it’s not only dehydrating but contains purines; wine seems to have the least impact. Hard liquors sit somewhere in-between on the swelling scale. In general, staying well-hydrated is helpful.
RELATED: 15 Foods That Help You Stay Hydrated
Listen to your body
While some people—I’m looking at you, Tom Brady—believe that nightshade vegetables trigger inflammation, there are no well-designed scientific studies that show a link, says Dr. Pillinger. Still, if you notice that tomatoes make your joints puffy, leave them behind at the salad bar, he adds: “Never ignore personal experience.”
Take my wife’s advice and go to the doctor
“Even a very strict diet may not be enough to resolve gout,” says Dr. Pillinger. Drag. The reality is that many people require pharmaceutical help to manage the pain and swelling and prevent painful flare-ups. Common treatments include OTC and prescription anti-inflammatory meds, steroids, and preventive drugs such as Allopurinol.
RELATED: 13 Great Recipes If You Have Gout
The good news and the bad news
Gout is a chronic condition, and can run in families. But the good news, Dr. Pillinger said, is that a low-purine diet isn’t too restrictive and doesn’t require a total reboot of what you eat and drink. And for the most part, it tracks with what you already know about healthy eating: Have less red meat, down water instead of sweetened drinks, don’t put away too much booze, and eat more plants.
My gout seems to be manageable through diet and anti-inflammatories, which honestly is nice and a bit of a bummer. I have a friend who has gout and he takes Rx medicine for it, so he can, as he puts it, “eat and drink whatever the hell I want.” Since I don’t have a bottle of magic pills waiting for me, I am constantly pestered by whispers from my foot. “You sure you want a third beer?”
No, foot, I guess I don’t.