Gout is a general term for a variety of conditions caused by a buildup of uric acid. This buildup usually affects your feet. If you have gout, you will probably feel swelling and pain in the joints of your foot, particularly your big toe. Sudden and intense pain, or gout attacks, can make it feel like your foot’s on fire.
There are four stages of gout: asymptomatic hyperuricemia, acute gout, interval gout, and chronic tophaceous gout. These stages vary in symptoms and treatment.
Hyperuricemia happens when you have too much uric acid in your blood. If you have no other symptoms, it’s called asymptomatic hyperuricemia.
Acute gout happens when hyperuricemia causes uric acid crystals to develop in one of your joints. It causes intense pain and swelling. Your joint may also feel warm. Your symptoms will probably show up suddenly and last for three to 10 days. You may experience multiple acute gout attacks over a period of months or years.
Interval gout is the period between acute gout attacks. It’s also called intercritical gout. You won’t have any symptoms during this stage.
Chronic tophaceous gout can happen if you leave your gout untreated. It can take 10 years or longer to develop. In this stage, hard nodules (tophi) develop in your joints and the skin and soft tissue surrounding them. Tophi can also develop in other parts of your body, such as your ears. They can cause permanent damage to your joints.
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 lead to excess uric acid.
Certain foods can also cause gout when you eat too much of them. These include:
- red meat
- organ meat
- sweet juices
You can also develop gout if your body isn’t eliminating uric acid properly. If you’re dehydrated or starved, it can make it difficult for your body to excrete uric acid. This causes 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 can also make it hard for your body to eliminate uric acid. For example, these medications include diuretics and immunosuppressive fungal medications, such as cyclosporine.
Risk factors for gout include:
- Age: Men between 40 and 50 years old and post-menopausal women are more likely to develop gout.
- Gender: Men are more likely than women to develop gout.
- Family history: If you have someone in your family with gout, you may be more likely to develop it as well.
- Diet: Eating too much purine-rich food raises your risk for gout. For example, red meat, organ meat, and certain fish contain a lot of purines.
- Drinking alcohol: Drinking more than two drinks a day puts you at higher risk of gout.
- Medications: Some medications, such as diuretics and cyclosporine, can put you at risk of gout.
- Other health conditions: High blood pressure, kidney disease, thyroid disease, and diabetes can all raise your risk of gout.
Your doctor can make a diagnosis of gout based on a review of your medical history, a physical exam, and your symptoms. Your doctor will likely base your diagnosis on your description of your joint pain, how often you’ve experienced intense pain in your joint, and how red or swollen the area is.
Your doctor may also order a test to check for a buildup of uric acid in your joint. They will collect a sample of fluid from your joint to learn if it contains uric acid. They may also want to take an X-ray of your joint.
In most cases, your regular doctor can treat your gout. If you have severe complications or develop chronic tophaceous gout, your doctor may refer you to a rheumatologist. This type of doctor specializes in arthritis.
Your doctor’s prescribed treatment plan will depend on the stage and severity of your gout. Your doctor may prescribe medications, such as:
- colchicine to reduce pain in your joint
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to reduce inflammation and pain in your joint
- corticosteroids, such as prednisone, to reduce inflammation and pain in your joint
- medications to reduce your body’s production of uric acid, such as allopurinol
- medications to help your body eliminate uric acid, such as probenecid
Along with medications, your doctor may recommend lifestyle changes to help manage your symptoms and reduce your risk of future gout attacks. For example, they may encourage you to:
- adjust your diet
- reduce your alcohol intake
- lose weight
- quit smoking
If left untreated, gout can eventually cause tophi to develop near your inflamed joints. This can lead to arthritis, a painful condition in which your joint is permanently damaged and swollen.
You can take many steps to help prevent gout. For example:
- Limit how much alcohol you drink.
- Limit how much purine-rich food, such as shellfish, lamb, beef, pork, and organ meat, you eat.
- Eat a low-fat, nondairy diet that’s rich in vegetables.
- Lose weight.
- Stop smoking.
- Stay hydrated.
If you have medical conditions or take medications that raise your risk of gout, ask your doctor how you can lower your risk of gout attacks.