Gouty arthritis - acute; Gout - acute; Hyperuricemia; Tophaceous gout; Tophi; Podagra; Gout - chronic; Chronic gout; Acute gout; Acute gouty arthritis
Gout is a type of arthritis. It occurs when uric acid builds up in blood and causes inflammation in the joints.
Acute gout is a painful condition that often affects only one joint. Chronic gout is the repeated episodes of pain and inflammation. More than one joint may be affected.
Gout is caused by having higher-than-normal level of uric acid in your body. This may occur if:
When uric acid builds up in the fluid around the joints (synovial fluid), uric acid crystals form. These crystals cause the joint to become inflamed, causing pain, swelling and warmth.
The exact cause is unknown. Gout may run in families. The problem is more common in men, in women after menopause, and people who drink alcohol. As people become older, gout becomes more common.
The condition may also develop in people with:
Gout may occur after taking medicines that interfere with the removal of uric acid from the body. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have a higher level of uric acid in the blood.
Symptoms of acute gout:
The pain and swelling most often go away after the first attack. Many people will have another attack in the next 6 to 12 months.
Some people may develop chronic gout. This is also called gouty arthritis. This condition can lead to joint damage and loss of motion in the joints. People with chronic gout will have joint pain and other symptoms most of the time.
Deposits of uric acid can form lumps below the skin around joints or other places such as the elbows, fingertips, and ears. The lump is called a tophus, from Latin, meaning a type of stone. Tophi (multiple lumps) can develop after a person has had gout for many years. These lumps may drain chalky material.
Tests that may be done include:
A uric acid level in the blood over 7 mg/dL (milligrams per deciliter) is high. But, not everyone with a high uric acid level has gout.
Take medicines for gout as soon as you can if you have a new attack.
Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin when symptoms begin. Talk to your health care provider about the correct dose. You will need stronger doses for a few days.
You may need to take daily medicines such as allopurinol (Zyloprim), febuxostat (Uloric) or probenecid (Benemid) to decrease the uric acid level in your blood. Lowering the uric acid to less than 6 mg/dL is needed to prevent deposits of uric acid. If you have visible tophi, the uric acid should be lower than 5 mg/dL.
You may need these medicines if:
Diet and lifestyle changes may help prevent gouty attacks:
Proper treatment of acute attacks and lowering uric acid to a level less than 6 mg/dL allows people to live a normal life. However, the acute form of the disease may progress to chronic gout if the high uric acid is not treated adequately.
Complications may include:
High levels of uric acid in the blood are associated with increased risk of kidney disease. Studies are being done to find out whether lowering uric acid reduces the risk for kidney disease.
Call your provider if you have symptoms of acute gouty arthritis or if you develop tophi.
You may not be able to prevent gout, but you may be able to avoid things that trigger symptoms. Taking medicines to lower uric acid can prevent progression of gout. Over time, your deposits of uric acid will disappear.
Dalbeth N. Clinical features and treatment of gout. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 101.
Edwards NL. Crystal deposition diseases. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 257.
FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the management of gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. PMID: 32391934 pubmed.ncbi.nlm.nih.gov/32391934/.
FitzGerald JD, Neogi T, Choi HK. Editorial: do not let gout apathy lead to gouty arthropathy. Arthritis Rheumatol. 2017;69(3):479-482. PMID: 28002890 pubmed.ncbi.nlm.nih.gov/28002890/.
Liew JW, Gardner GC. Use of anakinra in hospitalized patients with crystal-associated arthritis. J Rheumatol. 2019;46(10)1345-1349. PMID: 30647192 pubmed.ncbi.nlm.nih.gov/30647192/.BACK TO TOP
Review Date: 5/2/2021
Reviewed By: Diane M. Horowitz, MD, Rheumatology and Internal Medicine, Northwell Health, Great Neck, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2022 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.