Gout
Uric acid crystals deposit in a joint, causing sudden attacks of extremely painful, hot, swollen joints — classically the base of the big toe.
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What happens in the body
Persistently high blood uric acid forms monosodium urate crystals, which trigger intense inflammation.
Causes
- High uric acid from under-excretion by the kidneys or over-production
Risk factors
- Male sex
- Obesity
- Alcohol (especially beer) and sugary drinks
- Red meat and seafood
- Diuretics
- Kidney disease
- Metabolic syndrome
Symptoms
- Sudden severe joint pain, often at night
- Red, hot, swollen joint
- Tophi (chalky lumps) in chronic gout
Diagnosis — tests and examinations
- Joint fluid microscopy showing needle-shaped crystals
- Serum urate (measure after the attack)
- Dual-energy CT or ultrasound
Treatment
Medicines and medical treatment
- Attacks: NSAIDs, colchicine or steroids
- Long-term urate-lowering therapy: allopurinol or febuxostat to a target urate below 360 µmol/L (6 mg/dL)
Self-care, home remedies and lifestyle
- Rest and ice the joint during attacks
- Reduce alcohol, sugary drinks and purine-rich foods
- Lose weight
- Stay hydrated
Possible complications
- Chronic gouty arthritis and joint damage
- Tophi
- Kidney stones
Prevention
- Urate-lowering therapy and lifestyle changes
Outlook
Excellent when urate is kept at target; attacks stop.
When to see a doctor
See a doctor for a hot swollen joint — urgently if you have fever (to exclude septic arthritis).
Sources and further reading
These sources cover this condition. They have not been checked against every statement on this page.
Related conditions
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