What is Gout? Causes, Risk Factors and 7 More Things to Know

More than 3 million Americans experience gout, a type of arthritis caused by too much uric acid buildup in your body. Gout causes swelling, redness, heat and significant pain in the affected joint. The pain can at times be debilitating.

While gout primarily affects joints in the feet – particularly the big toe – it also can attack other joints, including those in your fingers and wrist. When it does, it can be difficult to use the impaired finger.

Episodes of gout can come and go. While painful, the flareups usually subside within a few days.

Some people have only one gout attack throughout life, while others experience a recurrence every few years.

 What causes gout?

Gout is the most common type of inflammatory arthritis. It is considered a disease, just like diabetes, high blood pressure, high cholesterol, obesity and kidney disease.

It occurs when urate crystals accumulate and get stuck in joints, causing inflammation and intense pain. High levels of uric acid in your blood can cause urate crystals to form. If the levels get too high and if the kidneys cannot remove enough of it, uric acid can crystalize and settle into a joint. That can cause pain, swelling and redness in the joints.

A good way to understand this is to compare your blood to a glass of water; if you add a teaspoon of salt, it dissolves, but if you add a ton of salt, it does not dissolve and settles down, which is what happens in gout.

What is uric acid?

Uric acid is a natural substance in your blood that your kidneys filter every day.

The body makes uric acid after it breaks down purine, a substance that is found both naturally in the body and in many foods. Normally, uric acid dissolves in your blood and makes its way out of the body in urine.

Uric acid can build up, however, either because the kidneys don’t properly excrete it or because of a purine-rich diet. Purine-rich foods include red meat, organ meat, some fish and alcohol.

Can you get gout in your finger?

Gout most commonly affects the big toe, but other joints can be affected including ankles and knees. You also can get gout in your wrists, hands, fingers and elbows, though it’s rare.

What does gout feel like?

Gout causes sudden and severe pain attacks in the joints. If untreated, gout flares can be debilitating and intensely painful.

Gout flares often come on without warning at night. The pain can be severe enough to wake you up. The affected joint may feel warm, and look swollen and red.

The flares can happen in one or more joints. They are triggered by certain foods, alcohol or by undergoing physical trauma or illness. Most gout flares will last for a week. They can happen frequently or rarely. There are symptom-free periods in between, but the bursts will increase in frequency and severity with time.

If you experience pain and swelling in a joint that starts suddenly and is intense, you should seek medical attention immediately.

Gout risk factors

The following may make it more likely for you to experience gout:

• Age: Women get gout more frequently after menopause than women before menopause.

• Sex: The risk of getting gout is three times higher for men. Obesity – The chances of developing gout for the first time are very high. Therefore, losing weight helps reduce uric acid levels and gout flares.

• Fluid pills: Water pills, or diuretics, will increase urination. That reduces the amount of fluid in your body and the remaining fluid is more concentrated, which can increase the risk for developing the urate crystals that cause gout.

• Low-dose aspirin: Aspirin in low doses can block the release of uric acid from the kidneys.

• Blood pressure medications: Diuretics taken to lower high blood pressure increase uric acid levels, so the treatment and the disease are associated with gout.

• High blood pressure, high blood sugar, abnormal cholesterol levels and excessive body fat around the waist.
• Chronic kidney disease: When you have kidney disease, your kidneys cannot filter out uric acid as well as they should.

• Psoriasis: Doctors have noticed for decades that there’s a connection between psoriasis and gout, according to the Arthritis Foundation. The common denominator is uric acid. In psoriasis, uric acid is thought to be a byproduct of rapid skin cell turnover and systemic inflammation.

How is gout diagnosed?

Doctors have several ways to diagnose gout and to rule out other reasons for joint pain and inflammation, such as an infection or injury. Tests used to diagnose gout include:

• Joint fluid analysis: Regarded as the best tool for a diagnosis, this test involves withdrawing fluid from the painful joint and examining it under a microscope for uric acid crystals.
• Blood test to check uric acid levels: Many people who have high blood uric acid never develop gout, and some people with gout have normal uric acid levels.
• Imaging tests, such as X-rays, ultrasound, magnetic resonance imaging and dual-energy computerized tomography: These help visualize uric acid crystals in joints.

How do you get rid of gout?

Combating gout can be approached from several directions. Non-steroidal anti-inflammatory medications, like aspirin and ibuprofen, and corticosteroids can help lessen the pain and inflammation that come with gout attacks.

Other medication can be used to reduce uric acid levels by stymieing its production or flushing more of it through the kidneys.  

If you have gout, discuss which type of medication is right for you with your doctor. Their recommendation will depend on the frequency and severity of your symptoms, along with any other health conditions you may have.

What foods trigger gout?

Avoiding foods high in purines can help reduce uric acid levels in the blood and lower the risk of gout attacks. Some foods to avoid or consume in moderation include:

• Foods and drinks containing high-fructose corn syrup
• Fatty cuts of meat and high-fat dairy products
• Organ meats, which have high levels of purine
• Shellfish, anchovies and sardines, all of which are high in purines
• Alcoholic beverages, including beer — especially during a gout attack

An anti-gout diet could include:

• Fruits, vegetables and whole grains
• Non-meat proteins such as low-fat dairy products, beans and lentils
• Lean meats and poultry
• Water for hydration
• Coffee
• Cherries or cherry juice

Can gout go away?

There is no cure for gout, but you can treat and manage the condition with medication and self-management strategies. With simple changes made throughout your daily activities, you can improve the quality of life of gout.