Gout (High levels of uric acid) - Symptoms, Causes & Treatments (2022)

What is gout?

Gout is a type of inflammatory arthritis caused by small crystals of a chemical called uric acid that form in the joints. The body’s immune system attacks these crystals, causing pain, redness and swelling in the joint and sometimes in the surrounding tissue. Gout has both active and inactive periods. Active periods of gout are known as “attacks” and can vary in severity and length.

High levels of uric acid cause gout but not everyone with high uric acid levels develops gout. Uric acid results when our bodies break down certain chemicals that occur naturally in our cells and in some high-protein food. Uric acid is taken by the blood to the kidneys where it is disposed of in the urine. When the amount of uric acid in the blood is too high (either because the body produces too much uric acid or because the body cannot get rid of the uric acid it produces), small crystals can form in the joints. These crystals can build up under the skin and form hard bumps called tophi. Uric acid crystals can also deposit in the kidneys causing kidney stones.

Gout attacks can happen in any joint but often impact those in the lower limbs such as the knees, ankles and feet. Many people experience their first gout attack in the base of the big toe. Initial attacks usually stop after three to 10 days; however, without treatment, attacks can occur again and can last longer. Most people with gout will have another attack within a year. Over time, these attacks may become more frequent, last longer and impact more joints. Recurring gout attacks can cause permanent joint damage so early diagnosis and treatment are key.

Unlike other forms of arthritis, gout can start sudden but can also stop suddenly.

  • FAQs
  • Treatment
  • Self-Management
  • What Now

FAQs

What are early signs of gout?

Gout attacks, particularly early ones, seem to come on suddenly and at the same time as the appearance a red, painful, swollen joint; but in reality, uric acid had been building up for a period of time. Attacks are often “triggered” by something that causes uric acid levels to spike. Triggers include a protein-rich meal, a night of drinking alcohol (especially beer) or a period of dehydration.

Symptoms often appear at night and get worse over the next eight to twelve hours. Although the initial attack often takes place in the base of the big toe, gout can also attack the knee, heel, ankle or instep. Gout pain is persistent and intense and swelling can progress beyond the original joint.

(Video) Gout, Pathophysiology, Causes, Symptoms, Risk Factors, Diagnosis and Treatments, Animation.

How is gout diagnosed?

To diagnose gout, your doctor will ask about recent medications and diet. They will want to know when the symptoms began, how long they last, how intense they are and which joints are involved. A blood test can determine uric acid levels, but high levels do not necessarily indicate a gout attack. Your doctor may also ask you to repeat blood tests after attacks have gone away as uric acid level tends to drop during an attack.

Gout can be diagnosed by inserting a needle into the joint and taking a sample of fluid, but a combination of physical examination, blood tests and imaging studies (X-rays and/or ultrasound) are often enough for an accurate diagnosis.

What are the bumps on my body?

Bumps can form when uric acid crystals build up. These bumps, called tophi, are usually small and hard and can form anywhere on the body. Often they form on the toes, knees, heels, fingers, ears, forearms or elbows. Tophi are usually painless; however, sometimes they can become inflamed and ooze a thick discharge. Tophi often form several years after the first gout attack and in some cases they appear in people who have never had a gout attack. Tophi can be irritating and are often surgically removed.

What are the risk factors for gout?

Since gout is directly related to uric acid levels in the blood, risk factors are primarily associated with the production and excretion of uric acid.

  • Diet:Red meat, certain seafoods (such as shrimp and oily fish), alcoholic beverages (especially beer) and sugar (especially fructose found in soft drinks) all increases uric acid levels.
  • High blood pressure:High blood pressure and some medications used to treat high blood pressure (diuretics) increase the risk of gout. Taking low dose aspirin also increases uric acid levels.
  • Obesity:People with high body weight are more likely to develop gout and at a younger age than those with lower body weight. Over the past twenty years the incidence of gout has nearly doubled, probably due to an increase in obesity in the general population.
  • Medication:Some medications block the excretion of uric acid in the kidney. In general, diuretics and medications that repress the immune system can increase risk of gout.
  • Trauma:Gout can be brought on by surgery, heart attack or other physical and even emotional trauma.
  • Kidney disease:Even mild kidney disease can result in reduced excretion of uric acid from the body.
  • Heredity:If someone in your family has gout, you have a higher chance of developing the disease since gout does run in some families. However, many people who develop gout do not have a family history of the disease.
  • Dehydration:Dehydration can contribute to gout attacks.

How common is gout?

Gout is the most common inflammatory arthritis for men, affecting about 5.2% of all adult Canadian men. In contrast, only 2.4% of Canadian women have gout. People aged 65 years or older are more commonly affected.

Why is treatment for gout so important?

Gout attacks tend to increase in length and frequency without treatment and can even become chronic. The ongoing presence of the uric acid crystals in and around the joint can lead to destruction of the joint and the soft tissues around the joint.

Fortunately, with proper medical attention and treatment, few patients progress to this advanced stage. Most people living with chronic gout can control the condition with medication. Lifestyle changes are an important part of treatment and can help prevent and manage many conditions associated with gout. Early identification and treatment reduces the chance of permanent joint damage and can reduce the number and severity of attacks.

Treatment

When having an attack

When having a gout attack, take these steps to bring pain and swelling under control:

  • Take an anti-inflammatory medication as soon as possible, but only on the advice of your doctor
  • Ice, elevate and rest the joint
  • Drink plenty of fluids—but no alcohol, pop or sugary drinks
  • Pay attention to the joint(s) involved, the intensity and changes in pain, the length of the attack
  • Call your doctor to set an appointment to be assessed and have blood work done
  • Relax —avoid stress since it can aggravate gout

Medications

Preventing further gout attacks, and the joint damage they can cause, is the goal in treating gout. A number of medications do a good job of preventing pain and swelling in the short-term and others lower uric acid levels over the long-term. You should discuss both short- and long-term options with your doctor.

Non-steroidal anti-Inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat pain and inflammation. The term “non-steroidal” means that they do not contain steroids. NSAIDs are a commonly used drug and there are many different types and brands. Many can be obtained without a prescription. These medications control the symptoms of gout, but do not alter the course of the disease. NSAIDs can be taken as needed or taken regularly to control symptoms. You and your doctor can decide what is suitable for you.

(Video) Gout - causes, symptoms, diagnosis, treatment, pathology

Colchicine

For those unable to take NSAIDs, colchicine is an option. Colchicine has been used to treat gout for more than 2,000 years, and helps relieve the pain and swelling of gout attacks. A high percentage of patients cannot take colchicine due to its side effects. You and your doctor can decide if colchicine is suitable for you.

Corticosteroids

For those who cannot take either NSAIDs or colchicine, corticosteroids can be a good alternative. These are given either orally or as injections into the affected joints. Injections tend to work quickly; within a few days or even within a few hours for some patients. Steroid injections are safe for most people; however, steroid injections should only be given three or four times per year.

Medications that reduce uric acid levels

Medications that reduce uric acid levels will prevent future gout attacks and keep the condition from becoming chronic. Going on these medications can end up being a lifetime commitment since going on and off medications that control uric acid levels can bring on gout attacks. For this reason, doctors typically wait to see how regular gout attacks are before prescribing such medications. Two to three attacks a year is often the number looked at before prescribing this type of medications.

Surgery

Fortunately, surgery is rarely required for gout. Occasionally surgery must be considered for patients who have suffered from gout over a long period of time. It is used to remove particularly problematic tophi or to repair badly damaged joints. Generally, with proper medication and treatment, these severe situations are avoided.

Self-Management

Given its direct link to uric acid levels, managing gout depends primarily on a strategy for eating well and managing the intake of foods that contribute to increased uric acid levels. Healthy kidney function is important as well since uric acid is removed from the blood by the kidneys. The kidneys rely on the heart to efficiently pump the blood through the body. People who are overweight are more prone to heart disease, so staying physically active and managing weight assist in controlling gout.

Food choices

Managing gout is as much about what not to eat as it is about what to eat. In general, those suffering from gout need to avoid the following foods:

  • Processed meat
  • Red meat and organ meats (liver, tongue and sweetbreads)
  • Shellfish (such as shrimp, lobster and mussels)
  • Oily fish (such as herring, sardines and mackerel)
  • Sugary beverages (including pop and some juice)
  • Any food, drinks or sauces that contain corn syrup
  • Excessive alcohol (any amount of alcohol affects uric acid production and disposal, but more than one drink/day for women and more than two drinks/day for men is especially dangerous)
  • Beer, in particular, has been linked to gout attacks

There are some foods that gout patients had found helpful:

  • Skim milk and other low-fat dairy products
  • Cherries and citrus fruits
  • Vitamin C supplements (500–1,000 milligrams daily)
  • Coffee

Eating well to control weight

Gout is more common in overweight people so losing weight and maintaining a healthy body weight helps manage gout. Losing weight reduces uric acid levels in the blood and for many the more weight they lose, the more their uric acid levels decrease. Maintaining a healthy weight also decreases the risk of heart disease which has been shown to contribute to gout symptoms.

Proper nutrition is vital to controlling body weight. Here are three ways to cut back on excess calories:

  • Reduce fat intake:A healthy diet should include a small amount of unsaturated fats and limited amounts of saturated and trans fat. Choosing the right amount and types of fats help you achieve and maintain a healthy body weight.

    (Video) uric acid foods to avoid symptoms treatment to reduce gout attack in tamil | dr karthikeyan | கவுட்

  • Reduce sugar intake:Sugar contains “empty” calories and has no nutritional value.

  • Eat more vegetables and fruit:Vegetables and fruit should make up the largest component of your diet. Having said that, people suffering from gout need to choose the least sweet fruits to reduce sugar intake. Try to have at least one vegetable or fruit at every meal and while snacking. Besides being an excellent source of energy, vegetables and fruit boost your fibre intake, which helps with weight management. They are also loaded with antioxidants, which help boost the immune system and may help maintain healthy joints.

Try to avoid triggers

Gout is often brought on by external stresses so being aware of these and avoiding them where possible can assist in preventing further attacks. These are some of the triggers that can bring on gout attacks:

  • Joint injury
  • Surgery
  • Infection
  • Diuretic medications
  • Forgetting to take your gout medication
  • Crash diets and fasting
  • Drinking too much alcohol
  • Eating large quantities of foods high in purines
  • Dehydration

Cold therapy and heat

During a gout attack using cold can help reduce pain. Cold reduces blood flow to the injury which helps reduce swelling and inflammation. Cold should not be applied for longer than 20 minutes at a time. As a general rule, 20 minutes on, 20 minutes off, works well. Always use a protective barrier, such as a towel, between any cold pack and the skin.

Heat should NOT be used DURING a gout attack since applying heat can make symptoms worse. However, between attacks, taking a warm shower and using warm packs (such as hot water bottles or microwavable heating pads) are great ways to help reduce general pain and stiffness. Heat is ideal for:

  • relieving pain and stiffness
  • relieving muscle spasms and tightness
  • enhancing range of motion

Using a commercial cold pack or a homemade one (from crushed ice, ice cubes or a bag of frozen vegetables) can be helpful. Cold is ideal for:

  • swelling
  • decreasing pain
  • constricting blood flow to an inflamed joint

Relaxation and coping skills

Developing good relaxation and coping skills can help you maintain balance in your life, giving you a greater feeling of control over your gout and a more positive outlook. Relaxing the muscles around a sore joint can help to reduce pain. Although gout attacks tend to be very painful, there are ways to help you relax. Try deep breathing exercises, a relaxation podcast or listen to music. Imagine or visualize a pleasant activity, such as lying on a beach.

What Now

Living well with arthritis

There is a lot you can do to take control and actively manage your arthritis. Below we have listed a few resources to help you learn more about actively managing your arthritis to live better.

Flourish

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(Video) Gout Signs and Symptoms (& Why They Occur)

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Contributors

This information was last updated September 2017, with expert advice from:

Gregory Choy, MD, FRCPC
Rheumatology Division, Sunnybrook Health Sciences Centre, University of Toronto

Paul MacMullan, MB BCh, BAO, CCST, MRCPI
Internal Medicine & Rheumatology; Clinical Associate Professor, University of Calgary

View All Arthritis Types (A - Z)

FAQs

What causes high uric acid gout? ›

Eating or drinking food and drinks high in fructose (a type of sugar). Having a diet high in purines, which the body breaks down into uric acid. Purine-rich foods include red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna.

What organs are affected by high uric acid? ›

If untreated, high uric acid levels may eventually lead to permanent bone, joint and tissue damage, kidney disease and heart disease. Research has also shown a link between high uric acid levels and type 2 diabetes, high blood pressure, and fatty liver disease.

What treatment when uric acid is high? ›

Drugs such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) help limit the amount of uric acid your body makes.

What is the fastest way to cure uric acid? ›

This article reviews natural ways to help lower uric acid levels.
  1. Limit purine-rich foods. ...
  2. Eat more low purine foods. ...
  3. Avoid medications that raise uric acid levels. ...
  4. Maintain a healthy body weight. ...
  5. Avoid alcohol and sugary drinks. ...
  6. Drink coffee. ...
  7. Try a vitamin C supplement. ...
  8. Eat cherries.
29 Jun 2022

What food raises uric acid? ›

Procedure Details
  • Sugary drinks and sweets. Standard table sugar is half fructose, which breaks down into uric acid. ...
  • High fructose corn syrup. ...
  • Alcohol. ...
  • Organ meats. ...
  • Game meats. ...
  • Certain seafood, including herring, scallops, mussels, codfish, tuna, trout and haddock.
  • Red meats, including beef, lamb pork and bacon.
  • Turkey.
14 Mar 2022

Is lemon good for uric acid? ›

Lemon juice may help balance uric acid levels because it helps make the body more alkaline. This means it slightly raises the pH level of blood and other fluids. Lemon juice also makes your urine more alkaline.

Is Egg good for uric acid? ›

Certain foods, such as red meat, are rich in purines. You should avoid such foods if you have gout or are at a high risk for it. This means you need to choose sources of protein that are low in purines. Eggs are a good option.

What problems can high uric acid cause? ›

Uric acid is a waste product in the body. Sometimes, uric acid can build up in the joints and tissues, causing a range of health problems. These include gout, a form of arthritis.

What should be avoided in high uric acid? ›

Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid. Red meat. Limit serving sizes of beef, lamb and pork. Seafood.

Can gout be cured? ›

Gout is one of the most common inflammatory arthritides. The disease is due to the deposition of monosodium urate crystals. These deposits are reversible with proper treatment, suggesting that gout is a curable disease.

At what age does uric acid increase? ›

Uric acid increased rapidly in girls at the age of 9 years and boys at the age of 10 years, and this was consistent with the development of puberty. In China, it's normal for girls to enter puberty after 9 years old, and 10 for boys (15). Before puberty, SUA levels were almost the same between males and females.

What is a dangerously high uric acid level? ›

Uric acid formation may occur when the blood uric acid level rises above 7 mg/dL. Problems, such as kidney stones, and gout (collection of uric acid crystals in the joints, especially in your toes and fingers), may occur.

How do you flush out gout? ›

Staying hydrated helps flush out uric acid (the cause of your joint pain) and prevent kidney stones, another possible problem associated with high uric acid levels. Aim for eight to 16 cups of fluids a day, at least half of them water.

How can I flush uric acid at home? ›

Body stores of Uric Acid

It is important to have regular check-ups on uric acid level in body, which can be detected through a simple blood test. Nutritionists usually advise us to drink plenty of water to flush out the excess uric acid from the body and consume a lot of fresh fruits and vegetables.

What fruits are not good for gout? ›

Fruit, Fructose, and Gout

Researchers report a correlation between foods high in fructose and gout symptoms, which can include chronic pain. These fruits include apples, peaches, pears, plums, grapes, prunes, and dates.

Do bananas raise uric acid? ›

Bananas are low in purines and high in vitamin C, which makes them a good food to eat if you have gout. Changing your diet to include more low-purine foods, like bananas, can lower the amount of uric acid in your blood and reduce your risk of recurrent gout attacks.

What vegetable is high in uric acid? ›

Some vegetables contain higher levels, so limit: asparagus, cauliflower, spinach, mushrooms, green peas, and dried lentils, peas and beans to only one serving per day.

Is Ginger good for uric acid? ›

Ginger. Ginger is known to help with digestion and ease nausea, but it can also help with inflammation, including gout. One animal study, for example, found ginger lowered uric acid levels in subjects who consumed ginger internally.

What organ is responsible for gout? ›

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid.

Is salt good for uric acid? ›

Sodium and uric acid levels

The authors, however, do not recommend that people with gout start adding salt to their diet. “More than 70 percent of people with gout have high blood pressure,” says Dr. Juraschek. “If one was to consume more sodium to improve uric acid, it could worsen blood pressure.”

Is chicken good for uric acid? ›

A high intake of purine-rich foods such as beef, seafood, and chicken is associated with high serum uric acid levels and increased gout risk16,35. Uric acid is the end-product of purine nucleotide metabolism. Purine bases are converted to hypoxanthine and xanthine by many enzymes.

Is Potato good for uric acid? ›

Pros of Potatoes for Uric Acid:

Provide Fiber: Potatoes are a good source of fiber and vitamins, but they don't have much purine. This means that they're unlikely to trigger gout or raise uric acid levels. Promote Waste Excretion: In fact, potatoes may even help to lower uric acid levels by promoting urinary excretion.

Is peanuts high in uric acid? ›

One serving of these nuts has 21 milligrams of purines--that's about one-fifth of your daily allowance. You may want to stay away from peanuts, as they contain higher levels of uric acid, in addition to being high in fat and calories-approximately 190 calories per ounce (28 grams).

Which vegetables are not good for uric acid? ›

However, if you are diagnosed with high level of uric acid, vegetables such as spinach, asparagus, peas and cauliflower should be avoided a they may contribute to increase the uric acid levels. Tomatoes, broccoli, and cucumbers are some of the veggies that you need to start including in your meals.

Can walking cure gout? ›

In fact, doing joint friendly activities such as walking can help improve gout-related pain. Gout is a form of arthritis that usually affects the big toe joint, but it can also affect the lesser toes, ankles, and knees. It normally affects one joint at a time.

What is the last stage of gout? ›

Chronic tophaceous gout

This is the final stage of gout, which is a form of chronic arthritis characterized by permanent damage to the cartilage and bone in the joint.

Can gout affect kidneys? ›

Some studies show that gout and high uric acid may harm the kidneys. It's very important to treat your gout early to protect your kidneys from more harm. High uric acid may not cause problems for many people, but it may cause gout in some people.

What level of uric acid needs treatment? ›

In most patients, a serum uric acid level of below 6 mg/dL is the initial target for therapy. Urate-lowering agents should be started after the complete resolution of a gouty attack because a rapid decrease in serum urate levels sometimes exacerbates a subsequent attack.

How long does it take for uric acid levels to drop? ›

It is thought that it can take up to two years for the body to get rid of all uric acid crystals. To prevent gout attacks during this time, low-dose colchicine is often also prescribed for the first six months. That effectively reduces the risk of those kinds of attacks.

How is uric acid tested? ›

A uric acid test can be done as a blood test or a urine test. During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial.

Does high uric acid mean kidney failure? ›

Uric acid is an independent risk factor for kidney failure in earlier stages of CKD, and has a 'J-shaped' relationship with all-cause mortality in CKD.

Is high uric acid life threatening? ›

Although gout is not directly fatal, without treatment, it can lead to dangerous complications, including joint damage, cardiovascular problems, and kidney disease.

Is milk good for uric acid? ›

Studies show that drinking low-fat milk and eating low-fat dairy can reduce your uric acid levels and risk of a gout attack. The proteins found in milk promote excretion of uric acid in the urine.

Can high uric acid affect liver? ›

Elevated serum uric acid (UA) levels strongly reflect and may even cause oxidative stress, insulin resistance, and metabolic syndrome, which are risk factors for the progression of liver disease.

What disease is associated with uric acid? ›

Uric acid is the end product of nucleic acid metabolism. High levels of blood uric acid have long been associated with gout. Gouty arthritis (gout) is a medical condition characterized by red, tender, hot, and swollen joints caused by recurrent attacks of acute inflammatory arthritis.

Does high uric acid affect kidney function? ›

Some studies show that gout and high uric acid may harm the kidneys. It's very important to treat your gout early to protect your kidneys from more harm. High uric acid may not cause problems for many people, but it may cause gout in some people.

Does high uric acid affect the heart? ›

Uric acid is known to contribute to endothelial dysfunction by impairing nitric oxide production, which could lead to damage to the heart. Another possibility is that high uric acid levels cause inflammation that eventually result in heart failure.

Should I worry about high uric acid? ›

Having a high uric acid level is not a disease or a condition that necessarily needs to be treated or searched for in the absence of other symptoms. But if you have an attack of gout or have a certain type of kidney stone, your doctor may check for high levels of uric acid.

Is gout a serious disease? ›

If left untreated, gout can cause erosion and destruction of a joint. Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie).

Can gout cause kidney failure? ›

This allows uric acid to build up, which may cause an attack of gout. Recent studies have found that compared with people who do not have gout, people with gout are: 29 percent more likely to suffer from advanced chronic kidney disease (CKD). 200 percent more likely to have kidney failure.

Can gout cause a stroke? ›

Patients with gout have a 4 times greater risk of a cardiovascular episode within the 60 days following their flare up. For patients with gout, a flare up could increase their risk of heart attack or stroke for 4 months after the event, according to research published by experts at the University of Nottingham in JAMA.

What level of uric acid causes kidney failure? ›

In a fully adjusted spline model, the risk for incident kidney disease increased roughly linearly with uric acid level to a level of approximately 6 to 7 mg/dl in women and 7 to 8 mg/dl in men; above these levels, the associated risk increased rapidly.

Is gout linked to other diseases? ›

Health problem linked to gout go beyond the joints, however. Excess uric acid can also damage kidneys, blood vessels, and other organs, and gout raises the risk for several disorders. These include kidney and cardiovascular disease, as well as diabetes, depression and sleep apnea.

How does uric acid leave the body? ›

Most uric acid dissolves in your blood, then goes to the kidneys. From there, it leaves the body through your urine. If your body makes too much uric acid or doesn't release enough into your urine, it can make crystals that form in your joints.

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