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:
Only one or a few joints are affected. The big toe, knee, or ankle joints are most often affected.
The pain starts suddenly, often during the night. Pain is often described as throbbing, crushing, or excruciating.
The joint appears warm and red. It is usually very tender and swollen (it hurts to put a sheet or blanket over it).
There may be a fever.
The attack may go away in a few days, but may return from time to time. Additional attacks often last longer.
People will have no symptoms after a first gout attack. Many people will have another attack in the next 6 to12 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.
Tophi are lumps below the skin around joints or other places such as the elbows, fingertips, and ears. Tophi can develop after a person has had gout for many years. These lumps may drain chalky material.
A uric acid level in the blood over 7 mg/dL 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 sudden attack.
Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or indomethacin when symptoms begin. Talk to your health care provider about the correct dose. You will need stronger doses for a few days.
Your provider may prescribe strong painkillers such as codeine, hydrocodone, and oxycodone.
A prescription medicine called colchicine helps reduce pain, swelling, and inflammation.
Corticosteroids (such as prednisone) can also be very effective. Your provider may inject the inflamed joint with steroids to relieve the pain.
The pain often goes away within 12 hours of starting treatment. Most of the time, all pain is gone within 48 hours.
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.
You may need these medicines if:
You have several attacks during the same year or your attacks are quite severe.
Diet and lifestyle changes may help prevent gouty attacks:
Decrease alcohol, especially beer (some wine may be helpful).
Limit your intake of red meat and sugary beverages.
Choose healthy foods, such as dairy products, vegetables, nuts, legumes, fruits (less sugary ones), and whole grains.
Drink coffee and take vitamin C supplements (may help some people).
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 not treated.
Call your health care provider if you have symptoms of acute gouty arthritis.
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.
Burns CM, Wortmann RL. Clinical features and treatment of gout. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 95.
Choi HK. A prescription for lifestyle change in patients with hyperuricemia and gout. Current Opin Rheumatol. 2010;22(2):165-72. PMID: 20035225 www.ncbi.nlm.nih.gov/pubmed/20035225.
Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431-46. PMID: 23024028 www.ncbi.nlm.nih.gov/pubmed/23024028.
Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64(10):1447-61. PMID: 23024029 www.ncbi.nlm.nih.gov/pubmed/23024029.
Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.