Uric Acid and Gout: Symptoms, Causes, and Treatment - Verywell Health

Gout is a painful type of inflammatory arthritis characterized by sudden, severe attacks of pain, swelling, tenderness, and redness in one or more joints. Gout can affect any joint but most often affects the big toe. 

Gout attacks occur suddenly. They can wake you up in the middle of the night, feeling like your big toe is on fire. The toe is so inflamed that even the weight of a light bedsheet can lead to severe pain. 

People with gout often experience symptoms that come and go—periods of flare-ups (severe symptoms) and periods of remission (few or no symptoms). Gout treatment typically focuses on managing symptoms and preventing gout attacks. 

This article covers gout causes, symptoms, diagnosis, treatment, and more. 

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Gout Causes

Gout is caused by hyperuricemia (too much uric acid in the body). The uric acid can lead to the development of sharp crystals forming in the joints. 

Hyperuricemia can occur because the body produces too much or the kidneys cannot properly eliminate it. If the uric acid levels get too high, urate crystals build up in the joints. The crystals are the cause of gout. 

It is possible to have high uric acid levels and never get gout. According to a 2021 Biomolecules report, only up to 36% of people with hyperuricemia will develop gout.

Gout Risk Factors

Some risk factors increase your risk for gout. These include:

• Being male: According to a 2019 Advances in Rheumatology review of studies, only 5.1% of people with gout are women. Gout is more prevalent in women after menopause. 
• Body mass index (BMI) of 30 or more
• Metabolic syndrome: This is a cluster of conditions that increase the risk for heart disease, stroke, and type 2 diabetes. Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat at the waist, and abnormal cholesterol or triglyceride levels.
• Decreased kidney function 
• Congestive heart failure
• Genetics or family history 
• Heavy alcohol consumption 
• Eating a diet high in purine-rich foods
• Excessive use of water pills 

What Is Uric Acid?

Uric acid is a waste product created when the body breaks down chemicals called purines. These are released from the body's cells when they are broken down, and they are found in the diet. Most of the time, uric acid will dissolve in the blood, pass through the kidneys, and leave the body through urine.

A diet rich in purine foods and drinks can increase uric acid levels. Purine-rich foods and beverages include: 

• Seafood
• Red meat 
• Organ meats like liver
• Foods and beverages that contain high fructose corn syrup 
• Alcohol, especially beer 
  

Too much uric acid in the body leads to hyperuricemia. Hyperuricemia will cause urate crystals to develop and settle into the joints leading to gout. Urate crystals can also find their way into the kidneys and lead to kidney stones.

What Are Kidney Stones?

Kidney stones can occur as a result of high levels of uric acid. Kidney stones can block the passage of urine and cause severe pain. Most kidney stones will pass on their own without medical intervention, while others will need medicine or surgery to treat.

Gout Symptoms

Periods of increased symptoms of gout are called gout attacks or gout flare-ups. Gout attacks are very painful and can come on quickly. 

Symptoms of a gout attack might include:

• Intense pain felt with even the slightest touch, such as from your bedding 
• Swelling 
• Stiffness 
• Redness 
• Tenderness 
• Warmth or a feeling that the inflamed joint is on fire
• Tophi (lumps formed by uric acid crystals below the skin and around the joints that are common in people who have severe or chronic gout)
  

A gout attack generally affects one joint at a time. Gout usually affects the big toe but can affect other joints, including the knees, ankles, feet, hands, wrists, and elbows.

Gout attacks are the worst in the first 12–24 hours. The earliest signs of a gout attack are itching, burning, stiffness, or minor soreness of the affected joint. Symptoms will worsen and then slowly resolve. 

Most people will recover from a gout flare within a week or two. Once the flare has resolved, you might go a long time (several months to a year or more) without symptoms. 

Diagnosis

A diagnosis of gout is usually made based on symptoms, medical history, physical examination, lab work, and imaging. 

Your healthcare provider will ask questions about the onset of symptoms and any symptom patterns. They will also ask about any family history of gout or other inflammatory conditions you might have.

The physical examination looks at the affected joint for swelling, redness, or tenderness. Your healthcare provider will also examine the affected joint's range of motion (joint movement) and look for signs of tophi.

Blood work might be done to measure uric acid levels in the body. While high uric acid levels are a sign of gout, it is possible to have high levels and never develop gout. 

A joint aspiration test is the most accurate test for diagnosing gout. This test requires collecting synovial fluid (the fluid that lubricates joints). To collect the fluid, the healthcare provider will insert a needle in the skin near the affected joint and withdraw the fluid into a tube. The fluid is then examined under a microscope to look for urate crystals.

Imaging of affected joints can rule out other causes of your joint symptoms. An ultrasound scan (uses sound waves to produce images) can detect urate crystals in the joints and soft tissues.

Some hospitals now use dual-energy computed tomography (CT) scanning (uses X-rays and a computer) to evaluate for gout also, if the diagnosis is not clear from other tests.

Treatment

Treating gout focuses on reducing pain and symptoms during a gout attack and preventing future gout attacks. 

Medications that improve symptoms during gout attacks include: 

Your healthcare provider might also prescribe a medication to help lower uric acid levels in your body and prevent future gout attacks. Medicines for this purpose include:

• Zyloprim (allopurinol): Available as a pill
• Uloric (febuxostat): Available as a pill
• Benemid, Probalan (probenecid): Available as a pill
• Krystexxa (pegloticase): Available as an intravenous infusion 
  

Prevention

While medication can help improve symptoms or prevent attacks, you should also consider your diet as treatment, such as:

• Avoid high-purine beverages: Limit alcohol and sugary drinks.
• Avoid foods high in purines: Red meats, organ meats (like liver), and purine-rich seafood (anchovies and sardines) are all foods that can increase uric acid levels.  
• Drink plenty of water: Increasing your water intake will keep your kidneys healthy and flush out uric acid from the body.
• Eat a healthy diet: A healthy, balanced diet includes plenty of vegetables, fruits, whole grains, and beans. Low-fat dairy products might help decrease uric acid in the blood and decrease your risk for future attacks.
• Try cherries and cherry juice: These are also believed to prevent gout flares. One large crossover study using online surveys found cherry intake over two days was associated with a 35% reduced risk for gout attacks, and cherry extract reduced risk by 45%.
• Lose weight: Weight loss can help reduce uric acid levels and prevent gout attacks. Studies suggest weight loss can help people with gout achieve long-term goals, such as lowering uric acid levels and experiencing fewer gout attacks. Weight loss might also benefit joint health, reduce tophi and joint damage, improve physical function and quality of life, and lessen the potential for gout complications or comorbidities.
  

Summary 

Gout is a type of inflammatory arthritis that causes sudden, painful attacks of swelling, tenderness, and redness in one or more joints. Gout can affect any joint but most often affects the big toe. 

The cause of gout is too much uric acid in the body. The uric acid will crystalize and make its way in and around the joints leading to severe inflammation of the affected joint. Some people have a higher risk for gout, including males and people with a family history of gout.

Gout is a treatable condition and can be managed with medication and diet. You may be able to prevent gout attacks by eating healthy, avoiding foods and beverages that increase uric acid, losing weight, and staying hydrated.

A Word From Verywell

Gout is a lifelong condition. Most people can have a good quality of life if gout is diagnosed early and managed appropriately. But untreated gout can lead to joint damage. 

Some people with gout might develop tophi, which occur when there is a buildup of uric acid in the joints and soft tissues. Others might develop other health problems, including kidney stones or severe arthritis. Let your healthcare provider know about all the symptoms you experience, whether related to gout or another health condition. 

Frequently Asked Questions

• Some foods can help to lower uric acid. For example, low-fat dairy can lower uric acid levels and reduce future attacks. Cherries are also believed to help prevent attacks.
  

• A gout flare might start with burning, itching, or tingling of the affected joint an hour or two before the flare becomes worse. The joint might also feel stiff or a little sore. Some people do not experience any early signs and wake up in the middle of the night with a severely inflamed joint. 
  

• There is no cure for gout, but the condition is treatable. Treatment aims to reduce symptoms during gout attacks and prevent future attacks. Healthcare providers will also prescribe medicines to reduce uric acid levels, which might prevent future flares.