Gout is a form of arthritis caused by excess uric acid in the bloodstream. The excess uric acid forms small urate crystals that get deposited in the joint(s). These crystals cause intense pain, swelling and stiffness in a joint. Gout attacks are sudden and extremely painful.

Gout progresses through various stages, also referred to as different types of gout. 

Asymptomatic hyperuricemia

A person can have increased uric acid levels without any symptoms. Although urate crystals may accumulate in the tissue and cause slight damage, treatment is not required at this stage. 

Acute gout

This stage occurs when the urate crystals accumulated cause sudden intense pain and inflammation. This sudden onset of symptoms is called a “flare”, and it typically subsides within 3 to 10 days. Some stressful events, drugs, alcohol, and cold weather can trigger flares. 

Interval or intercritical gout

This stage is the dormant period between attacks of acute gout. Although subsequent flares may not occur for months or years, uric acid will continue to build up, plotting its next attack. If not treated, the attacks can occur more frequently and last longer, over time. 

Chronic tophaceous gout

Chronic tophaceous gout is the most debilitating type of gout. It takes a long time (up to 10 years) for a patient to reach this stage. It mostly occurs when gout is not treated. At this stage, the patient can have permanent damage to the joints and kidneys. Chronic arthritis can occur, and tophi (big lumps of uric acid crystals) can develop in cooler areas of the body such as the joints. 

Gout occurs when uric acid crystallises (urate crystals) and are deposited in your joint, causing intense pain and inflammation. Urate crystals are formed when there are high levels of uric acid in your blood. 

Your body produces uric acid when it breaks down purines. Normally, the uric acid gets dissolved in your blood, passes through kidneys into your urine. However, sometimes your body produces too much uric acid, or your kidneys excrete too little uric acid. This cause uric acid to build up, forming urate crystals that are deposited in a joint. This causes intense pain, swelling and inflammation. 

You’re more likely to get gout if you have high levels of uric acid in your body. Factors that increase the uric acid level are: 

• Diet. Eating a diet rich in meat and seafood, drinking beverages sweetened with fruit sugar (fructose) and consuming alcohol increase levels of uric acid.

• Medical conditions. Certain diseases, including untreated high blood pressure, diabetes, heart and kidney diseases, increase your risk of gout. 

• Age and sex. Gout is more common in men than women because men have high uric acid levels. However, after menopause, women too can get gout because their uric acid levels are as high as that of men. 

• Obesity. When you are overweight, your body produces more uric acid, and your kidneys are not able to eliminate uric acid.

• Family history of gout. If gout runs in the family, you are likely to develop it. 

• Certain medications. Low-dose of aspirin and thiazide diuretics (used to treat hypertension) increases uric acid levels.

• Recent surgery or trauma. Recent surgery or trauma can be a risk factor for developing gout.

Gout commonly affects the large joint of the big toe. But it can affect any joint in the body, including:

• Elbow

• Knee

• Wrist

• Ankle

• Fingers

The most common symptoms of gout are:

• Intense pain in one or more of your joints

• Swelling in and around the joint

• Your joint(s) become hot and tender 

• The skin over the joint might look shiny and red.

• Once the swelling goes down, the skin may peel off or become flaky and itc

The doctor will recommend certain tests to diagnose gout. These tests include: 

• Joint fluid test. Your doctor may draw fluid from the affected joint using a needle and examine it under the microscope to confirm the presence of urate crystals. 

• Blood test. Your doctor may recommend a blood test to measure the uric acid and creatinine levels in your blood. 

• X-ray imaging. This test can rule out other cause of inflammation of the joints.

• Ultrasound. This test helps detect urate crystals in a joint or in a tophus.

• Dual energy CT scan. This test can detect the presence of urate crystals, even when the joint is not acutely inflamed. 

The treatment plan your doctor prescribes will depend on the stage and severity of your gout. The treatment plan generally includes: 

Medications

Medications are used to treat the gout symptoms, prevent future flares, and reduce the risk of gout complications such as the development of tophi and kidney stones. 

Commonly used medications to relieve gout pain include:

• nonsteroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac and Naproxen

• colchicine 

• corticosteroids

Medicines prescribed to prevent gout attacks include:

• xanthine oxidase inhibitors like allopurinol to reduce the production of uric acid

• probenecid to improve the kidney’s ability to remove uric acid from the body 

Lifestyle Changes

Along with medications, your doctor may recommend the following lifestyle changes to help manage your symptoms and reduce your future risk of gout attacks: 

• reduce your alcohol intake

• quit smoking

• lose weight

• avoid purine-rich food, such as shellfish, beef, lamb, organ meat, pork, etc. 

• eat a low-fat, vegetable-rich diet

• exercise

• stay hydrated

What foods can make your gout worse?  

Avoid consuming certain foods that are naturally high in purines, such as: 

• organ meats (liver, kidney, brain)

• some meats (bacon, turkey, veal, venison, beef)

• certain seafood (sardines, anchovies, scallops, mackerel, mussels, herring, trout, codfish, and haddock)

• alcohol

What does gout look like?

Acute gout attacks start with a rapid onset of pain in the affected joint. This is followed by swelling, reddish discolouration, warmth, and marked tenderness. 

Why gout flares up?

When the higher than normal levels of uric acid is present in your body, it builds up around a joint in the form of uric crystals. This causes painful gout flare. 

How long does a gout flare last?

A gout flare lasts for up to 14 days without treatment and about 3 days with treatment. 

Why is gout more common in males?

Gout is more common in men because men produce more uric acid than women. However, after menopause, women’s levels of uric acid approach those of men. 

Why gout attacks the big toe? 

Uric acid is sensitive to temperature changes. It turns to crystals at cooler temperatures. The big toe is the farthest from the heart, and it is also the coolest part of the body. Hence gout is most likely to target the big toe. 

When happens when gout becomes worse? 

When gout gets worse, it starts affecting other joints, including knee and ankle. It forms bumps under the skin. When the uric acid crystals start collecting in the soft tissue, lumps called tophi are formed. 

Is gout a sign of kidney failure?

When you have a kidney problem, the kidneys may not be able to filter out the uric acid effectively. Hence, there is too much uric acid in the body. Gout can be a warning sign of kidney disease. 

Will gout go away by itself?

Gout attacks last for up to 14 days or more, but the symptoms often subside on their own after a week or two. Medication helps speed the healing process and prevent future gout flares. 

Why is gout pain worse at night?

The exact reason why gout pain is worse at night is not known, but it could be associated to the body temperature being low at night, a drop in the blood cortisol level, and dehydration during sleep.  

Can stress bring on a gout attack?

Stress may trigger a gout attack, and it can aggravate the symptoms of a gout attack.

Can women get gout?

Gout is more common in men because they have high uric acid in their body. However, post-menopausal women can have gout as the levels of the uric acid level in their body is as high as that of men. 

Is gout an autoimmune disease?

No. Gout is an inflammatory disorder. 

Can gout spread?

Yes. Gout can spread throughout the body. When gout worsens, it can affect other joints as well.