What is Gout?
Gout is a type of arthritis. It usually causes severe, sudden attacks of inflammation in a joint. Gout symptoms include severe, sharp pain; redness; swelling; and/or tenderness in your joint. Your joint may be visibly swollen and even feel warm when you touch it. Gout episodes may come on very quickly. They often happen at night or when you wake up in the morning. You may go to bed feeling fine and wake up with severe gout symptoms.
Gout typically affects a single joint – about half the time, it strikes in your big toe. Gout can affect more than one joint at the same time in some people. A gout attack can come on very quickly, and last anywhere from a few days to up to 10 days or longer.
Gout may affect other joints in your lower extremities too, such as your foot, ankle or knee. It may affect joints higher on your body too, such as your elbow, hand or wrist, or even small joints in your fingers. Your spine is rarely affected by gout. Gout may also affect soft tissues, like your bursae (fluid-filled sacs that cushion joints like your shoulder, elbow or hip) or the sheaths around your tendons (fibrous, rope-like tissue that connects bones and helps your joints move).
Gout attacks often subside on their own after a week or two, but medications can help speed up healing. More importantly, medications that lower your uric acid (also called urate) levels, when used regularly over time, are very effective in preventing future gout flares.
What happens if you don’t treat gout?
Gout may affect the same joint over and over, or you may have symptoms that crop up in different joints over time. Without treatment, your gout flares could become more frequent, spread to other joints, and become more severe. These attacks could damage the affected joint over time. Also, you can develop tophi, or large swellings near the affected joint or in other locations. Tophi are made up of a substance called urate that hardens. Tophi look and feel like hard lumps under your skin. They release inflammatory chemicals that may damage your joint if you don’t get treatment.
If you have gout that isn’t controlled by treatment and persists for years, you could develop chronic gouty arthritis.
This can result in permanent joint damage, joint deformity and persistent pain. However, available treatments for gout can prevent this in most people. Don’t ignore your gout, but don’t worry that there is no hope for getting it under control. Getting control of your gout early is ideal, but treatments can help gout at any point.
Acute gout episodes can cause severe pain that keeps you from your normal activities during that time. You may be in so much pain that you have to stay home from work. Many people can’t put on their shoe during an episode of gout due to the severe pain and swelling in their joint. You may struggle to get up and down the stairs of your house, or to do your household chores like laundry or standing at the stove to cook your family a meal. You may not be able to do something as simple as accompany your kids to the school bus stop or walk your dog during an acute episode of gout. Depending on your situation, gout attacks could be a “big deal,” even if others around you don’t really understand what you’re going through.
If gout attacks become more frequent or severe, or if you develop chronic arthritis due to your gout, it can have a strongly negative impact on your life. Pain and disability could become a chronic problem that disrupts your work and home life. That’s why treatment and management are so important. Don’t dismiss gout as just “something you have to live with” for the rest of your life – your physician can help you control these attacks and effectively manage gout.
What Causes Gout?
Gout is caused when an excessive amount of urate builds up in your blood. Urate (also called uric acid) is a natural substance or chemical. Urate is produced by your own body as it metabolizes, or breaks down, a substance in the foods and drinks you consume called purines.
Purines are found in many foods and drinks, and they’re also made naturally by your body. Certain foods and drinks are very high in purines. These include red meats, organ meats like liver or kidneys, shellfish like mussels or scallops, thick soups and gravies, oily fish like mackerel or anchovies, and beer. Excessive consumption of purine-rich foods can increase your risk of getting gout, since the purines are broken down in your body to make urate.
Genetics are a key part of how we get gout. About 10% of people with gout make too much urate due to genetic factors. About 90% of people with gout reabsorb too much urate in their kidneys because of genetic factors. People with decreased kidney function for any reason (such as hypertension or diabetes) can increase their urate since the kidney has more trouble filtering the urate from the blood.
People who either make too much or excrete too little urate are especially sensitive to foods, drinks or medications that increase urate levels. This is what happens when you drink alcoholic beverages: they stimulate the kidney to pull more urate back into your bloodstream. The same thing happens when you take medications such as some diuretics, like hydrochlorothiazide (Hydrodiuril®) or furosemide (Lasix®). Beer increases urate level in two ways. It contains proteins that are broken down to form purines that then break down to form urate in your body. As with all alcoholic drinks, it also makes your kidney reabsorb more urate. That’s why beer is often talked about as a potent stimulus for gout flares.
High-fructose corn syrup, which is found in many sweetened soft drinks and other beverages, can raise urate levels too. People with gout are often surprised when their friends who eat or drink the same things they do don’t get gout. Why does this happen? The reason is that people who develop gout have a genetic tendency to high urate (for either of the reasons discussed above) and are much more sensitive to the further increase that comes from particular foods or drinks.
Once you have high urate in your blood, the urate crystals can deposit in your joints (and other locations). When the urate crystals in your joints are recognized by your immune system, they are identified as “foreign bodies” and are attacked the way bacteria would be. This involves all the signs of inflammation: redness, heat and swelling, with white blood cells rapidly entering the joint. Urate crystals also can build up and form hard deposits called tophi (or the singular, tophus). That’s why gout is considered a “crystal” arthritis or crystal disease. Urate crystals can also form kidney stones, which can be extremely painful to “pass” through your urine.
What is Hyperuricemia?
High urate in your blood is also called hyperuricemia. One of the goals of your gout treatment plan, including medications and diet/lifestyle changes, will be to keep your uric acid level below 6.0 milliliters per deciliter, or mg/dL. People with gout with tophi will have a lower urate goal, which is below 5 mg/dL. Your doctor can test your uric acid levels at regular appointments so you know your current number. You should always ask about your urate level and know that your goal is below 6.0.
When you have a gout flare, and the body sees the urate crystals as “foreign,” you are seeing the results of your body’s attempts to destroy the crystals. White blood cells attack and ingest the crystals, and inflammatory chemicals are released that bring in even more white blood cells. The result is inflammation. Your big toe (gout’s favorite spot) may swell up suddenly, turning red and hot, so you think it may be infected or even fractured. It’s not an infection or a fracture, however – it’s inflammation.
Whether a person with gout makes too much urate or their kidneys excrete too little, the end result is high blood urate, and lowering it is the key treatment goal. Adjusting your diet and keeping well hydrated are important, but for most people with gout, one or multiple medications will be needed to get the urate to goal.