Gout

What is gout?

Gout is a form of inflammatory arthritis that results from an excess of uric acid in the blood. Uric acid is a chemical that is created in the body when it digests and breaks down certain substances in food called purines. Gout is genetically inherited and affects men more than women by a ratio of about 3 to 1. In people with gout, uric acid crystallizes in the joints, and this causes painful attacks in the affected body part – often, initially, a big toe. Gout is chronic and progressive, but highly treatable.

Other joints that may be affected include the ankle, foot or knees, and in severe cases, the wrists, elbows and fingers. People with gout may also experience kidney stones and damage to their kidneys.

What is pseudogout? How is it different from gout?

Gout and pseudogout have similar symptoms and reactions. In both conditions, white blood cells surround chemical crystals, which leads to inflammation. In pseudogout, the associated crystals are formed from calcium pyrophosphate dihydrate, rather than from uric acid, as in gout. Pseudogout requires different treatment.

What causes gout?

Gout is caused by disordered metabolism of purines. You get purines mostly from food, and they are essential for the body to working properly. Excess purines are normally eliminated in the urine. But sometimes, an excess can lead high levels of urate (a breakdown product of purines) in the blood. This is called hyperuricemia, and it can leave needle-like urate crystals inside your joints.

Quick facts about gout – by the numbers

• 8.3 million people in the United States have gout:
  • 6.1 men
  • 2.2 million women*
• Among people who have gout attacks:
  • 90% have kidneys that don’t remove enough uric acid from their urine.
  • 10% make too much uric acid in their system.
• 90% of gout attacks start in a single joint. Most often, it is the “bunion joint” of the big toe.
• 90% of gout patients have one or more of the following conditions (comorbidities), which make it more difficult to manage gout:
  • Kidney dysfunction
  • Coronary heart disease
  • Obesity high cholesterol and/or triglycerides
  • Diabetes mellitus**

*Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Zhu Y, Pandya BJ, Choi HK. Arthritis Rheum. 2011.
**Comorbidities of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Zhu Y, Pandya BJ, Choi HK. Am J Med. 2012.

How to treat gout

For mild cases, changes in diet may be enough to reduce the inflammation and pain. Your doctor may also prescribe NSAIDs (to alleviate pain and swelling).

For more severe gout, dietary changes are usually not enough to prevent repeated attacks, and medications are needed to lower the uric acid. These may include one or more of the following:

• Allopurinol (Zyloprim)
• Colchicine (Colcrys)
• Febuxostat (Uloric)
• Lesinurad (Zurampic)
• Pegloticase (Krystexxa)

Those suffering from attacks of gout often need to take medication throughout their lifetime. If your doctor has prescribed colchicine to prevent gout attacks, the attacks will return if you stop the drug. If you are given allopurinol to reduce the uric acid in the blood (to reduce gout attacks) or to reduce the uric acid in the urine (to reduce the risk of uric-acid-related kidney stones), the risk returns if you stop the drug.

Whether or not you take medication for your gout, it is important to limit your intake of foods high in purines. For the first six months after starting allopurinol for gout, your diet is especially important in helping to prevent attacks.

Gout study

In an effort to raise awareness about the severity of gout and further explore the connection between gout and diet, HSS is encouraging those who have gout to participate in an online study supported by the University of Alabama at Birmingham. If you have gout, please take a few minutes to answer the survey questions.

Find more detailed information about gout in the articles and other content below, or find a doctor at HSS who treats gout.