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Guide to Gout: What to Know About the Painful Condition

Learn the facts about this increasingly common form of arthritis and how to lower your risk of flare-ups

Gout-related pain is on the rise, possibly due to increasing obesity and high blood pressure rates.
Jan-Otto / Getty Images

Gout was historically known as a “disease of kings” because many of those who suffered from it overindulged in rich foods and alcohol.

These days, however, it’s more of a disease of the masses.

In the last 30 years, the prevalence of gout in the United States and the world has more than doubled, research shows. About 4 percent of U.S. adults — more than 8 million people — have been diagnosed with gout, a painful condition that is now the most common form of inflammatory arthritis, according to a 2019 study in Arthritis & Rheumatology.

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Experts believe the recent rise in gout cases is linked to the increasing prevalence of obesity and high blood pressure. Being overweight and taking diuretics for high blood pressure are both risk factors for gout.

Risk also increases with age. An estimated 13 percent of men and 6 percent of women have the disease by age 75, according to research.

Men are twice as likely to develop gout, at least until age 60, because women’s hormones help protect them from the condition, says Jasvinder Singh, M.D., a professor of medicine and epidemiology at the University of Alabama Birmingham and director of rheumatology research at Birmingham Veterans Medical Center. After menopause, women become more susceptible.

It brings on intense joint pain

Gout, one of the earliest recorded diseases, is caused by a buildup of extra uric acid in the body. The uric acid deposits crystals in the joints, causing swelling and extreme pain.

The most common joint affected is the one at the base of the big toe. But gout can affect any joint — including your ankle, knee or elbow — and when it does, you’ll know it.

“You’ll be normal, feel fine, and then you suddenly have this really intense pain,” says Philip Chu, M.D, a rheumatologist at Duke Health.  

The pain is so bad that many patients end up in the emergency room.

“Patients go from zero to 10-out-of-10 pain quickly,” Chu says. “The lightest touch or movement makes it worse. People describe that even having a bed sheet on it is uncomfortable.”

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To diagnose gout, a doctor will do bloodwork to check your uric acid levels or take a fluid sample from the painful joint and look for urate crystals.

Gout attacks, called flares, usually last several days to a week. Anti-inflammatories, steroids or a medication called colchicine can ease pain during that time.

How to prevent gout attacks

After the first attack, some patients may not experience a second one for five to 15 years, Singh says. But the third one will usually happen faster, within six months to a year. Over time, the attacks become more and more frequent.

Without treatment, gout attacks can cause stiffness, disabling joint pain, nodules that form under the skin called tophi, and eventually, permanent bone or joint damage.

Lifestyle changes such as losing weight, giving up alcohol and switching to a healthy diet may help prevent gout attacks. Drinking low-fat milk and eating low-fat cheese can reduce uric acid levels. And your doctor may recommend avoiding beer, seafood, sugar-sweetened juices and red meat (especially organ meats) because they are high in purines, a chemical that can incite a flare.

Lifestyle changes alone are unlikely to combat or reverse gout, however. For most patients, the best way to prevent future gout attacks is to take a uric-acid-lowering medication such as allopurinol or febuxostat, Singh says.

The American College of Rheumatology (ACR) recommends the medication for patients who have had at least two flares in a year, or who have had one flare but also have high uric acid levels, certain kidney issues, tophi nodules or evidence of joint damage.

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Making medication available to more people

Many patients who could benefit from gout medications aren’t taking them, Chu and Singh say. One study published in Arthritis & Rheumatology found that only about a third of gout patients are on uric-acid-lowering therapy. Another published in BMC Medicine found that only half of those with frequent flares take the medication.

Research shows many patients stop taking gout medication because they don’t believe they need it. Others, particularly those who see a primary care physician for their gout, may never get a prescription to begin with.

“One issue we see is that primary care doctors only treat the flares but don’t start the uric-acid-lowering treatment,” Chu says. “So the flares are addressed but the underlying disease process is not being controlled.”

Primary care doctors follow gout guidelines published by the American College of Physicians (ACP) that differ from those of the rheumatology group. The ACP guidelines recommend gout medication only for those who have frequent attacks, and even then, with caveats.

Some rheumatologists have expressed frustration about the discrepancy, saying it doesn’t make sense to wait for a patient to suffer from a gout attack to provide treatment. Studies are underway to more convincingly prove the benefits of prescribing uric-acid-lowering medication for all gout patients, Singh says. Early research indicates it could help prevent inflammation of the body and early mortality.

Singh already recommends uric-acid-lowering medication to all of his gout patients, even after one attack, as a way to prevent future flares and to stop the progression of joint damage. Sometimes, he says, it can be a challenge to persuade patients to take a daily medication for a condition they can’t always see or feel.

“Gout is not hard to treat,” Singh says. “The hardest thing is for the patient to be convinced they need to be treated.”