Gout is a general term for a variety of conditions that are caused by a buildup of uric acid. This buildup usually affects the feet, particularly the big toe. People who have gout feel swelling and pain in the joints of the foot. Sudden and intense pain, or gout attacks, can make it feel like your foot is on fire.
Hyperuricemia, acute gout, and tophus gout are all different types of clinical presentations of gout that vary in symptoms and treatment. Hyperuricemia is an overproduction of uric acid and is seen in the beginning stage of gout. Acute gout is a condition in which you have several attacks, typically affecting the joints, over several years, depending on the uric acid in your system. Tophus gout is a condition that happens when gout is left untreated. The symptoms of this form of gout can become more symptomatic with acute episodes of gout arthritis. It is characterized by hard nodules (tophi) that develop in the skin and soft tissue surrounding joints as well as in the joints themselves, leading to arthritis.
Gout is a complex disease. There are a variety of factors that can play a role in causing it. Certain conditions, such as blood and metabolism disorders, can cause your body to produce too much uric acid. Drinking too much alcohol can also cause you to produce too much uric acid. Certain foods can also cause gout when you eat too much of them. These include:
- sweet juices
Gout can also be caused by your body’s inability to eliminate uric acid. Being dehydrated or starved can make it difficult for your body to excrete the uric acid, causing it to build up as deposits in your joints. Some diseases and disorders, such as kidney or thyroid problems, can also impair your body’s ability to eliminate uric acid. Certain medications, such as diuretics and immunosuppressive fungal medications like cyclosporine, can make elimination of uric acid difficult.
Risk factors for gout include:
- age: Men between 40 and 50 and post-menopausal women are more likely to develop gout.
- gender: Men are overall more likely than women to get gout.
- family history: If you have someone in your family with gout, you may be more likely to have it as well.
- other conditions: High blood pressure, kidney or thyroid disease, and diabetes can all put you at risk for gout.
- medications: Some medications (diuretics, cyclosporine) can put you at risk for gout.
- diet: Eating excessive amounts of food that have purine puts you at risk for gout.
- drinking alcohol: Drinking excessively (more than two drinks a day) puts you at risk for gout.
Your doctor can make a diagnosis of gout based on a review of your medical history, a physical exam, and your symptoms. The doctor usually bases the diagnosis on your description of the joint pain, if you have had more than one an episode of intense pain in your joint, and how red or swollen the area is. If your doctor isn’t sure, they may order a test to see if you have a buildup of uric acid in your joint. If the test confirms this, a diagnosis of gout is provided.
Your doctor may want to confirm the diagnosis of gout by taking a sample (culture) of the fluid in your joint to see if it contains uric acid. Your doctor may also want to take an X-ray of the joint.
Your doctor will treat your gout in based on how serious it is. Some medications that are normally prescribed include:
- anti-inflammatory medications: colchicine, non-steroid anti-inflammatory drugs (NSAIDs)
- corticosteroids to reduce inflammation in the joint
- anti-gout medications to reduce the uric acid in your body (allopurinol)
- anti-gout medications that help your body eliminate uric acid
Along with medications, your doctor may recommend lifestyle changes to manage gout and reduce your risks for more attacks. Diet changes, reducing alcohol intake, weight loss, and quitting smoking can help treat gout.
Your regular doctor can treat your gout. If you have severe complications or develop tophus gout, your doctor may recommend that you see a doctor that specializes in arthritis (a rheumatologist).
If left untreated, gout can eventually lead to a buildup of tophi near the site of inflammation. This can lead to arthritis, a painful condition in which the joint is permanently damaged and swollen.
Fortunately, there is a lot you may be able to do to prevent gout. You can take the following measures:
- Limit how much alcohol you drink.
- Limit how much foods with purine (shellfish, lamb/pork/meat) you eat.
- Eat more vegetables and a low-fat non-dairy diet.
- Lose weight.
- Stop smoking.
- Exercise and make sure you are hydrated.
If you have medical conditions or take medication that can cause gout, work closely with your doctor to determine the best way to avoid attacks.