Gout is a common type of arthritis. It’s a sudden and painful inflammation that usually occurs in the big toe, but can affect other joints. It
The inflammation is triggered by a buildup of tiny crystals of uric acid in and around your joints. Your immune system reacts by sending infection-fighting cells to the area, causing inflammation.
Gout attacks tend to be sporadic and may affect more than one joint. Gout can usually be managed with diet and medication. When gout is treated, complications are rare. But untreated gout can be disabling.
Fast facts about gout
- The description of gout goes back almost 5,000 years to ancient Egypt. It’s considered to be the most well understood type of arthritis.
1 percent to 4 percentof the global population has gout.
- Four percent of people in the United States have gout.
- The incidence of gout has been increasing in recent years in developed countries.
- The name comes from the Latin word “gutta,” which means drop. It referred to a medieval belief that one of the four “humors” needed for health “dropped” into a joint.
- Gout was called the disease of kings, because of its association with rich foods and alcohol consumption.
- Benjamin Franklin and Thomas Jefferson both had gout.
Gout attacks usually come on suddenly. Your shoulder pain maybe severe or excruciating.
In addition, the area may be:
- hot or burning
- very sensitive to touch and movement
An excess of uric acid in your bloodstream is thought to trigger gout by forming needle-shaped crystals that build up in your tissues and joints. Excess uric acid is technically known as hyperuricemia.
Uric acid is a waste product produced by the breakdown of purines, chemical compounds naturally present in your body. Uric acid is also produced when you digest foods containing purines.
Normally your kidneys remove uric acid waste via your urine. If your kidneys aren’t functioning properly, uric acid levels can build up in your bloodstream.
The crystals that form from this excess uric acid are attacked by your immune system as foreign bodies. Infection-fighting cells go to the area of the crystals, causing inflammation.
Overproduction of uric acid
Consuming excessive amounts of products that contain purines may contribute to excess levels of uric acid in some people. Products high in purines include:
- red meat
- dried beans
Alcohol, especially high-proof alcohol, also promotes the production and retention of uric acid. But drinking wine in moderate amounts isn’t associated with gout.
- a genetic predisposition
- blood disorders
- cancers such as leukemia
- too little synovial fluid in the joints
- the acidity of joint fluid
- a diet high in purines
- joint injury, infection, or surgery
- high cell turnover conditions like psoriasis
Certain medications may increase uric acid levels in the bloodstream. These include:
- diuretics, used to treat high blood pressure or heart disease
- low doses of aspirin
- cyclosporine, a drug that suppresses the immune system
- levodopa, a drug used to treat Parkinson’s
Any factor that increases the levels of uric acid in your bloodstream may put you at risk for gout. Some specific risk factors are:
Gout is about
Gout usually occurs in men over 40 and in women after menopause. In
Having other family members with gout increases your risk. Specific genes have been identified that are associated with the kidney’s ability to remove uric acid.
Medical conditions that affect kidney function put you at risk for gout. If you have surgery or trauma, this can increase your risk.
Many people with gout also have other medical conditions. Whether gout causes these conditions or increases the risk for these conditions isn’t clear.
Some of the medical conditions that increase your risk of gout, especially if they’re untreated, include:
- high blood pressure
- kidney disease
- some types of anemia
- metabolic syndrome
- obstructive sleep apnea
- lead poisoning
Being overweight or having obesity increases your risk of gout. The extra weight increases your production of uric acid.
Consuming excess foods and beverages that are high in purines may increase your risk of gout. Those who eat diets based on rice and vegetables and low in purines have a lower incidence of gout.
Your doctor will examine you, take a medical history, and ask about your symptoms. They may be able to identify gout based on your symptoms.
But the doctor will want to rule out other possible causes for your shoulder pain by ordering tests.
Imaging tests for your shoulder include X-rays, ultrasound, and MRI scan.
The doctor will also test for blood levels of uric acid. But high levels or uric acid aren’t enough to make a definitive diagnosis.
A more specific test is to take a sample of your shoulder joint synovial fluid using a very thin needle. This is called arthrocentesis or joint aspiration. A laboratory will then look for uric acid crystals under a microscope.
Your doctor may refer you to a rheumatologist for ongoing treatment.
There isn’t a cure for gout, but many medications have been developed in recent years that can help with the shoulder pain of a flare-up and prevent future flares.
Medications aim to decrease pain, lower your levels of uric acid, and reduce inflammation.
Your doctor may suggest over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for pain or prescription drugs that reduce inflammation.
Prescription drugs include indomethacin (Indocin) or celecoxib (Celebrex), and prednisone, a corticosteroid. Prednisone is usually injected into the affected joint, but oral prednisone may be need when many joints are involved.
Depending on the severity of your symptoms, your doctor may prescribe other drugs that:
- inhibit white blood cells from attacking uric acid crystals, such as colchicine (Colcrys)
- reduce the amount of uric acid production, such as allopurinol (Zyloprim) and febuxostat (Uloric), which are called xanthine oxidase inhibitors
- help your kidneys eliminate more uric acid, such as probenecid (Probalan) and lesinurad (Zurampic), which are called uricosurics
All these drugs have side effects, and some may interact with other medications or worsen other conditions you may have. Be sure to discuss your drug treatment plan with your doctor.
Your doctor may also want to try using a new drug “off label,” or for a purpose that it’s not currently approved.
If a medication is approved for rheumatoid arthritis or another condition and not yet approved for gout, your doctor may recommend it off label.
Some of these new drugs are:
- pegloticase (Krystexxa), which reduces uric acid and is approved in the United States for treatment of severe refractory chronic gout
- canakinumab, a monoclonal antibody that suppresses inflammation
- anakinra, an interleukin-1 beta antagonist that suppresses inflammation
You may need to check with your insurance provider for coverage of these medications when used off-label.
The evidence concerning dietary changes is inconclusive, according to the American College of Physicians
Studies showed that reduced intake of red meat, sugars, and alcohol reduced levels of uric acid. But it was not clear that this improved the symptomatic outcomes.
You may get some relief from other treatments for inflammation, such as ice and physical therapy.
Initial flares of gout usually last
You may experience a repeat flare in six months to two years, or anytime in the future if your risk factors don’t change. Gout could become chronic, particularly if you continue to have high levels of uric acid.
Gout may also spread to involve other joints. Shoulder gout could occur in people who have longstanding severe gout.
Your doctor may prescribe low levels of drugs on an ongoing basis to help prevent future flare-ups and possible complications, and to lower the uric acid serum level. It’s important to stick to your treatment plan to minimize flares.
People with chronic long-term gout can develop complications. Uric acid crystals over time can damage the shoulder or other joints.
About 15 percent of people with gout develop kidney stones as uric acid accumulates in the kidneys.
Another complication of chronic gout is the formation of nodules of uric acid in your soft tissue, especially your fingers and toes. The nodule is called a tophus.
These nodules aren’t usually painful, but may become inflamed, infected, or oozy. These nodules can dissolve with appropriate medication treatment.
Gout prevention measures include the following lifestyle measures:
- eating a healthy diet, including limited or moderate amounts of foods and drinks that have a lot of purines
- maintaining a healthy weight
- exercising regularly
- drinking plenty of water
- quitting smoking
You may want to keep track of what seems to trigger a flare-up of your shoulder gout so that you can avoid future flares.
If you have shoulder pain and inflammation, it’s best to see your doctor for a definitive diagnosis and treatment. There are specific tests that can identify gout.
Some of the other conditions that may have similar symptoms include:
There’s also a type of arthritis known as pseudogout, which affects mostly older adults. Pseudogout causes a sudden painful swelling in joints, but uric acid crystals aren’t involved. Pseudogout is caused by the accumulation of crystals of calcium pyrophosphate dihydrate.
Analysis of the crystals in your synovial fluid can determine whether your shoulder inflammation is pseudogout or shoulder gout.
Gout in the shoulder is a very rare condition, but treatment and outlook are the same as for gout in other joints. With all kinds of gout, sticking to your medication and treatment plan will give you a better outcome.
It’s important to see a doctor if you have shoulder inflammation and pain. If it’s gout, treatment will help you manage the condition and help prevent future flares. Your doctor can advise you about new treatments under development.