Gout

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
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What is gout?

Gout is a kind of arthritis. It can cause an attack of sudden burning pain, stiffness, and swelling in a joint, usually a big toe. These attacks can happen over and over unless gout is treated. Over time, they can harm your joints, tendons, and other tissues. Gout is most common in men.

What causes gout?

Gout is caused by too much uric acid in the blood. Most of the time, having too much uric acid is not harmful. Many people with high levels in their blood never get gout. But when uric acid levels in the blood are too high, the uric acid may form hard crystals in your joints.

Your chances of getting gout are higher if you are overweight, drink too much alcohol, or eat too much meat and fish that are high in chemicals called purines. Some medicines, such as water pills (diuretics), can also bring on gout.

What are the symptoms?

The most common sign of gout is a nighttime attack of swelling, tenderness, redness, and sharp pain in your big toe. You can also get gout attacks in your foot, ankle, or knees. The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years.

See your doctor even if your pain from gout is gone. The buildup of uric acid that led to your gout attack can still harm your joints.

How is gout diagnosed?

Your doctor will ask questions about your symptoms and do a physical exam. Your doctor may also take a sample of fluid from your joint to look for uric acid crystals. This is the best way to test for gout. Your doctor may also do a blood test to measure the amount of uric acid in your blood.

How is it treated?

To stop a gout attack quickly, your doctor can prescribe a large daily dose of one or more medicines. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away.

To prevent future attacks, your doctor can prescribe a medicine to reduce uric acid buildup in your blood.

To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. But don't take aspirin. It can make gout worse by raising the uric acid level in the blood.

Changing the way you eat can help you manage your gout. Eat a healthy mix of foods so you get the nutrients you need. Limit foods like meat, fish, and beer. Drink plenty of water and other fluids.

Frequently Asked Questions

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	Gout: Changing your diet

Gout is caused by too much uric acid in the blood (hyperuricemia). Hyperuricemia usually does no harm, and most people with high levels of uric acid in the blood never develop gout.¹ The exact cause of hyperuricemia sometimes goes undiscovered, although inherited factors (genes) seem to play a role. When uric acid levels in the blood are too high, uric acid may form crystals that accumulate in the joints. Gout can seem to flare up without specific cause or can be brought on by factors such as:^{2, 3, 1}

• Certain conditions related to diet and body weight, such as:
  • Obesity.
  • Moderate to heavy alcohol ingestion, particularly beer.⁴
  • A diet rich in meat and seafood (high-purine foods).⁵
  • Very low-calorie diets.
• Medications that may increase uric acid concentration, such as:
  • Regular use of aspirin or niacin.
  • Medications that reduce the amount of salt and water in the body (diuretics).
  • Medications that cause rapid cell death (chemotherapy, usually used to treat cancer).
  • Medications that suppress the immune system, such as cyclosporine, that are used to prevent your body from rejecting an organ transplant.
• Major illness or certain medical conditions, such as:
  • Rapid weight loss, as might happen in hospitalized patients who have changes in diet or medications.³
  • Chronic kidney disease.
  • High blood pressure.
  • Conditions that cause an abnormal rapid turnover of cells, such as psoriasis, multiple myeloma, hemolytic anemia, or tumors.
  • Lead poisoning.
  • Hypothyroidism.
• Surgery.
• Having been born with a rare condition that causes high blood uric acid levels. People with Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome have a partial or complete deficiency in an enzyme that helps to control uric acid levels.¹

Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissues. Symptoms include:

• Warmth, pain, swelling, and extreme tenderness in a joint, usually a big toe joint. This symptom is called podagra.
• Pain that starts during the night and is so intense that even light pressure from a sheet is intolerable.
• Rapid increase in discomfort, lasting for some hours of the night and then easing during the next 2 to 7 days.
• As the gout attack subsides, the skin around the affected joint may peel and feel itchy.

Other symptoms may include:

• Very red or purplish skin around the affected joint, which may appear to be infected.
• Fever.
• Limited movement in the affected joint.

Symptoms of gout vary.

• Symptoms may occur after an illness or surgery.
• Some people may not experience gout as many painful attacks but rather develop chronic gout. Chronic gout in older adults may be less painful and can be confused with other forms of arthritis.
• Gout may first appear as nodules (tophi) on the hands, elbows, or ears. There may be no classic symptoms of a gout attack.⁶

By the time you experience the symptoms of a gout attack, uric acid has been building up in your blood, and uric acid deposits have been forming on one or more of your joints.

The big toe joint is most commonly affected; however, the joints of the feet, ankles, knees, wrists, fingers, and elbows may also be involved. Inflammation of the fluid sacs (bursae) that cushion tissues may develop, particularly in the elbow (olecranon bursitis) and knee (prepatellar bursitis).¹

There are many other conditions with symptoms similar to gout.

Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissues. A gout attack usually starts during the night with moderate pain that grows worse. A gout attack typically causes pain, swelling, redness, and warmth (inflammation) in a single joint, most often the big toe (this symptom is called podagra), followed by the eventual disappearance of all symptoms.

• Mild attacks may stop after several hours or last for 1 to 2 days. These attacks are often misdiagnosed as "tendinitis" or "sprain" even though there was no trauma or overuse.
• Severe attacks may last up to several weeks, with soreness lasting for up to 1 month.
• Most people have a second attack of gout within 6 months to 2 years after their first attack, but there may be intervals of many years between attacks. If untreated, the frequency of attacks usually increases with time. However, some people never have a second attack.¹

There are four stages of gout.¹

First stage: High blood uric levels (no symptoms)

• The uric acid level in the blood may be higher than normal, but there are no symptoms of gout.
• High uric acid in the blood (hyperuricemia) may never progress beyond this stage, and symptoms of gout may never develop.

Second stage: Acute gout arthritis

• Uric acid crystals begin to form in the joint fluid, usually in one joint—most commonly the big toe—and the body often responds with a sudden inflammatory reaction: a gout attack.
• Although the big toe is the most common site for a gout attack, gout may develop in other joints, including the knee, ankle, and joints in the foot, wrist, and fingers.
• Between 10% and 25% of people with gout develop uric acid kidney stones.
• Between 10% and 40% of people with gout had a uric acid kidney stone before their first gout attack.
• After the gout attack is over, the affected joint and surrounding tissues feel normal within days until the next attack, which often occurs within 2 years.

Third stage: Interval gout

• If you have previously had an attack of gout, you will very likely have another.
• In this type of gout, you have no symptoms for a period of time between acute attacks.
• In many people this period becomes progressively shorter as attacks occur more often. Later attacks may be more severe, last longer, and involve more than one joint.

Fourth stage: Chronic tophaceous gout

• If gout symptoms have occurred off and on without treatment for 10 years or more, they may become ongoing (chronic) and frequently affect more than one joint. There may no longer be periods of time between attacks. This stage of gout is frequently confused with other forms of arthritis, most commonly osteoarthritis.
• By this time, enough uric acid crystals have accumulated in the body to form gritty, nodules called tophi. When located just under the surface of the skin, these deposits are usually firm and movable. The overlying skin may be thin and red. Tophi that are very near the skin may appear cream-colored or yellow.
• At first, tophi are usually found on or near the elbow, over the fingers and toes, or on the outer edge of the ear.
• If the condition progresses without treatment, tophi may form in the cartilage of the external ear or the tissues around the joint (bursae, ligaments, and tendons), resulting in pain, swelling, redness, and warmth (inflammation). Progressive crippling and destruction of cartilage and bone is possible.
• Fortunately, advances in the early treatment of gout have made this stage of gout uncommon.

Gout is caused by too much uric acid in the blood (hyperuricemia). The following risk factors can either cause hyperuricemia or make joints more susceptible to the formation of uric acid crystals:³

• Being male
• Family history of gout
• Obesity
• Moderate, regular, or heavy consumption of alcohol
• A diet rich in meat and seafood, which can be high in purines⁵
• Use of medications that remove salt and water from the body (diuretics)
• Regular use of aspirin (more than 1 to 2 aspirin tablets per day)
• Frequent episodes of dehydration
• Acute illness or infection
• Lead exposure (may occur through work, diet, or hobbies)
• Very low-calorie diets
• Injury to a joint

Gout and other conditions

Certain other conditions and diseases appear more often in people who have gout than in people who don't, though studies have not demonstrated a clear relationship. It is thought that gout shares risk factors (such as obesity, hypertension, and high levels of triglycerides) with certain diseases, including:^{1, 6}

• Diabetes.
• Kidney (renal) disease.
• Hardening of the arteries (atherosclerosis).
• Heart disease.

Call or see your doctor immediately if you have:

• Severe pain in a single joint that comes on very quickly.
• Swollen, tender joints with overlying warm, reddened skin.

Watchful Waiting

During an acute gout attack, you may be able to relieve some of your discomfort by taking nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicines and resting the affected joint until the attack eases. You can use ice to reduce the swelling.⁷

Although aspirin is an NSAID, don't take it for gout. Aspirin can actually make gout worse by abruptly changing the uric acid level in the blood.

It is important that you see your health professional even if the pain from gout has disappeared. The uric acid buildup that caused your gout attack may still be irritating your joints and could eventually cause serious damage. Your health professional can prescribe medications that will prevent and even reverse the uric acid accumulation.

Who To See

The following health professionals can diagnose and prescribe treatment for gout:

• Family medicine doctor
• Physician assistant
• Nurse practitioner
• Internist
• Rheumatologist
• Orthopedist

To prepare for your appointment, see the topic Making the Most of Your Appointment

The only certain way to diagnose gout is to have a joint fluid aspiration (arthrocentesis) test to see whether uric acid crystals are present. However, in people with an acutely swollen, red, painful big toe, where it is often difficult to obtain joint fluid, a diagnosis can be made by the presence of a high blood uric acid level.

The following examinations and tests may help with diagnosis and treatment of gout:

• Medical history and physical examination
• Test to measure levels of uric acid in blood
• Test to measure levels of uric acid in urine

While X-rays of extremities (hands and feet) are sometimes useful in the late stages of the disease, X-rays are not usually helpful in the early diagnosis of gout. When gout is in a late stage, nodules (tophi) or even “punched-out” (worn away or eroded) areas of bone near joints may be seen.⁶ The pain of gout often causes people to seek medical attention before any long-term changes can be seen on an X-ray. However, X-rays may help to rule out other causes of arthritis. See an X-ray of gout in the foot.

The goals of treatment for gout are rapid pain relief and prevention of future gout attacks and long-term complications, such as joint destruction and kidney damage. Treatment includes medications and steps you can take at home to prevent future attacks.

Initial treatment

Gout is treated with medications to relieve symptoms and measures to eliminate causes. Specific treatment depends on whether you are having an acute attack or are trying to prevent future attacks.

To reduce the pain, swelling, redness, and warmth of the affected joint(s) in an acute gout attack:

• Rest the affected joint(s).
• Take one or more of the following medications at the first sign of a gout attack, as prescribed by your health professional.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin because it may abruptly change uric acid levels in the blood and may make symptoms worse.
  • Colchicine
  • Corticosteroids

To prevent recurrent attacks:

• Take a medication that reduces uric acid levels in the blood, which reduces the risk of future attacks.
  • Uricosuric agents increase elimination of uric acid by the kidneys.
  • Allopurinol decreases production of uric acid by the body.
• Take steps to reduce the risk of future attacks.
  • Being overweight is a risk factor for gout. If you are overweight, a diet that is low in fat may help you lose weight. However, very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Healthy Weight.
  • Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.⁴
  • Diets high in meat and seafood (high-purine foods) can raise uric acid levels.⁵
  • Certain medications that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin (81 mg to 650 mg) may raise the uric acid level. Since low-dose aspirin may be important for the prevention of stroke or heart attack, your doctor may want you to continue to take low-dose aspirin.
  • Follow a moderate exercise program.

Most people with gout will need to take medications that lower uric acid levels throughout their lives. However, in a few cases some people may be able to reduce their uric acid levels to normal by controlling their weight, not drinking alcohol, and avoiding certain medications for other conditions.⁸

If the blood uric acid is high but a person has never had an attack of gout, treatment is rarely needed. However, people with extremely elevated levels may need regular testing for signs of kidney damage, and they may need long-term treatment to lower their uric acid levels. Your blood uric acid level may be monitored by your health professional until it is lowered to normal levels.

Ongoing treatment

If you have previously had a gout attack, you are likely to have another, especially if you are not managing the disease with medications or other treatment. The goal of treatment is to prevent future attacks, to reduce high levels of uric acid (hyperuricemia), and to identify and treat the causes of your hyperuricemia. Your health professional will review your health history and current health status to identify other medical conditions and medications that could be causing the elevated uric acid levels. Factors such as alcohol consumption, diet, and body weight can be modified to lower your uric acid levels and reduce the risk of future gout attacks.

To reduce the pain, swelling, redness, and warmth of the affected joint(s) in an acute gout attack:

• Rest the affected joint(s).
• Take one or more of the following medications at the first sign of a gout attack, as prescribed by your health professional.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin because it may abruptly change uric acid levels in the blood.
  • Colchicine
  • Corticosteroids

To prevent recurrent attacks:

• Take a medication that reduces uric acid levels in the blood, which reduces the risk of future attacks.
  • Uricosuric agents increase elimination of uric acid by the kidneys.
  • Allopurinol decreases production of uric acid by the body.
  • Colchicine is often prescribed to prevent flare-ups during the first months that you are taking uric acid-lowering medications.
• Take steps to reduce the risk of future attacks.
  • Being overweight is a risk factor for gout. If you are overweight, a diet that is low in fat may help you lose weight. However, very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Healthy Weight.
  • Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.⁴
  • Diets high in meat and seafood (high-purine foods) can raise uric acid levels.⁵
  • Making changes in your diet may help with your gout. If you want to try an eating plan for gout, see:

    Gout: Changing your diet.

  • Certain medications that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin (81 mg to 650 mg) may raise the uric acid level. Since low-dose aspirin may be important for the prevention of stroke or heart attack, your doctor may want you to continue to take low-dose aspirin.
  • Follow a moderate exercise program.

Long-term medication treatment depends on how high your uric acid levels are and how likely it is that you will have other gout attacks in the future.

Treatment if the condition gets worse

Gout can usually be successfully treated by eliminating its causes and taking medications to relieve symptoms. However, if gout symptoms have occurred off and on without treatment for more than 10 years, they may become ongoing (chronic) and may affect more than one joint. Uric acid crystals may have accumulated in the joints to form gritty, chalklike nodules called tophi. Treatment of gout that has advanced to this stage includes medications.

• Take one or more of the following medications, as prescribed by your health professional.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly change uric acid levels in the blood.
  • Colchicine
  • Corticosteroids
• If you are having pain in the joints from an attack, your health professional may prescribe:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly change uric acid levels in the blood.
  • Colchicine
  • Oral corticosteroids, such as prednisone or medrol.
  • A shot of corticosteroids in a muscle.
  • A shot of corticosteroids directly into the painful joint.

• To prevent recurrent attacks, you may be prescribed:
  • Uricosuric agents to increase elimination of uric acid by the kidneys.
  • Allopurinol to decrease production of uric acid by the body.
  • Colchicine to prevent flare-ups during the first months that you are taking uric acid-lowering medications.

Treatment to eliminate tophi includes:³

• Allopurinol medication, which may shrink the tophi until they disappear.
• In rare cases, surgery to remove large tophi that are causing deformity.

What To Think About

After an acute attack of gout, talk with your health professional about the underlying causes for the elevated uric acid levels in your blood. A review of your overall health may reveal diseases, medications, and habits that could be contributing to your uric acid levels.²

Most health professionals will wait 2 to 4 weeks after a gout attack is over to begin medication to lower the high uric acid levels.⁶ These medications can cause uric acid stored elsewhere in the body to begin moving through the bloodstream and could make symptoms worse if treatment begins during a gout attack.

If there is swelling that causes pressure in a large joint such as a knee or ankle, your health professional may relieve the pain and pressure by aspiration, in which a needle is inserted into the joint and fluid is drawn out (aspirated) with a syringe connected to the needle.⁶

Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissue. You probably won't know that you have an elevated uric acid level in your blood until you have had your first gout attack. However, you can help prevent or reduce the severity of future gout attacks.

• If you have been prescribed medications for gout, it is important that you take those medications as instructed to prevent future attacks.
• If you are overweight, take steps to lose weight. For more information, see the topic Healthy Weight.
• You probably will be advised to reduce or stop your alcohol intake or to modify your diet.
• Making changes in your diet may help with your gout. If you want to try an eating plan for gout, see:

  Gout: Changing your diet.

Gout, an inflammatory joint disease causing acute pain and swelling, usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissue. If you have been diagnosed with gout, take steps to:

• Decrease the pain of an acute attack.
  • Rest the affected joint until the attack eases and for 24 hours after the attack.³
  • Elevate painful joints.
  • Relieve inflammation by taking nonsteroidal anti-inflammatory drugs (NSAIDs). Do not take aspirin, which may abruptly change uric acid levels and may make symptoms worse.
• Prevent recurrences.
  • Being overweight is a risk factor for gout. If you are overweight, a diet that is low in fat may help you lose weight. However, avoid fasting or very low-calorie diets. Very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Healthy Weight.
  • Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.⁴
  • Diets high in meat and seafood (high-purine foods) can raise uric acid levels.⁵
  • Certain medications that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin (81 mg to 650 mg) may raise the uric acid level. Since low-dose aspirin may be important for the prevention of stroke or heart attack, your doctor may want you to continue to take low-dose aspirin.
  • Cold hands and feet can precipitate an attack of gout. Try to keep your hands and feet warm, and take extra care to cover your hands and feet during cold winter months.
• Modify your risk factors.
  • Keep your weight within the normal range for your height.
  • Follow a moderate exercise program.
  • Avoid a diet rich in meat and seafood.⁵ Making changes in your diet may help with your gout. If you want to try an eating plan for gout, see:

    Gout: Changing your diet.

  • Have an evaluation for lead poisoning if you have been exposed to lead in your job or through hobbies.
• Continue to take any medications prescribed to you for gout. However, if you have not been taking medications that lower uric acid (such as probenecid or allopurinol) prior to the attack, do not begin taking it when the attack begins. These medications will not help relieve acute pain and may actually make it worse.

In the past, gout was thought to be due to drinking too much alcohol and eating too many rich foods. Although eating certain foods and drinking alcohol may trigger a rise in the level of uric acid in the body, these habits may not by themselves cause gout. Gout is most often caused by an overproduction of uric acid (due to metabolism problems) or decreased elimination of uric acid by the kidneys.

Medication treatment for gout may be done in two separate stages.

• First, the pain, swelling, redness, and warmth (inflammation) during an attack of gout is treated until the symptoms have gone away.
• Second, after the inflammation has subsided (2 to 4 weeks), other medications may be used to reduce the uric acid level in the blood and reduce the frequency of future attacks.

Medications to lower uric acid levels are not given until a gout attack is over. Starting these medications during a gout attack can cause movement of uric acid stored elsewhere in the body, which can make the gout attack worse.

Long-term medication treatment depends on how high your uric acid levels are and how likely other gout attacks are. In general, the higher the uric acid levels and the more frequent the attacks, the more likely it is that long-term medication treatment will help.

During a gout attack

You may already be taking a medication to lower uric acid levels in the blood at the time of an attack. If so, you should continue taking your medication, even during an attack.

If you have been prescribed a medication to lower uric acid levels (probenecid or allopurinol) and have not been taking the medication, it is more likely that another gout attack will occur. Do not start taking the medication during an attack. Medications that control the uric acid levels in your blood can also make the uric acids stored elsewhere in the body move into your bloodstream. Starting these medications while you are having a gout attack can make your attack much worse.

Medication Choices

Medication treatment for gout usually involves some combination of:

• Short-term treatment, using medications that relieve pain and reduce inflammation during an acute attack or prevent a recurrence of an acute attack. These medications may include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), except for aspirin, which should never be used to relieve pain during a gout attack. Aspirin may abruptly change uric acid levels in the blood and may make the attack worse.⁷
  • Colchicine, which may also be used for long-term treatment.
  • Corticosteroids, which may be given in pills or by a shot for cases of gout that do not respond to NSAIDs or colchicines. They may also be given to people who cannot take NSAIDs for other reasons, such as those with chronic kidney failure, heart failure, gastrointestinal bleeding or those using a blood-thinner, such as warfarin.
• Long-term treatment, using medications to lower uric acid levels in the blood, which can reduce the frequency and severity of gout attacks in the future. This may include:
  • Uricosuric agents to increase elimination of uric acid by the kidneys.
  • Allopurinol to decrease production of uric acid by the body.
  • Colchicine to prevent flare-ups during the first months that you are taking uric acid-lowering medications.

What To Think About

• Relief from symptoms in a gout attack often occurs within 24 hours if treatment is started immediately.
• During a gout attack, your health professional will prescribe a maximum daily dose of one or more medications used for short-term treatment to stop the attack quickly. Doses are then reduced as the symptoms go away.
• NSAIDs other than aspirin are used most often to treat a gout attack.
• Because all medications that lower uric acid levels in the blood have associated risks, an accurate diagnosis of gout is necessary before they are used.
• Aspirin should never be used to relieve pain during a gout attack because it slows the elimination of uric acid and can raise uric acid levels further.
• Gout attacks in older people can take longer to go away.

Some people with gout have continuing problems because they do not take their prescribed medication. Although most people will need treatment for the rest of their lives to keep their uric acid levels in their blood normal, they may feel perfectly healthy the majority of the time and wonder why they should continue taking their medication. If you stop taking your prescribed medication, nothing may happen at first, but after a while another gout attack is likely to occur. Without treatment, future attacks are likely to be more severe and occur more often.

Research to develop new medications to treat the symptoms of gout is ongoing. Scientists also are studying which medications lower uric acid levels safely.

• Losartan is used to treat high blood pressure (hypertension); it also lowers uric acid levels.⁸
• Fenofibrate is used to control certain fats in the blood (triglycerides and very low-density lipoprotein cholesterol); it may also increase elimination of uric acid by the kidneys.
• Pegylated urate oxidase may lower uric acid levels by changing uric acids into an absorbable molecule. This medication is currently being evaluated in the United States.
• Febuxostat and Y-700 medicines decrease the amount of uric acid the body makes. These medicines are being studied and may be used in people who cannot take allopurinol.⁹

Gout can usually be successfully treated by eliminating causes and taking medications to relieve symptoms. However, if gout symptoms have occurred off and on without treatment for more than 10 years, uric acid crystals may have accumulated in the joints to form gritty, chalklike nodules called tophi. If tophi are causing infection, pain, pressure, and deformed joints, and medications have been unsuccessful in shrinking and eliminating the tophi, your health professional may recommend surgery (excision) to remove them.³

Although not proven in scientific studies, complementary therapies may be used by some people to relieve symptoms caused by gout.

• Cherries and an herb called devil's claw are folk medicine remedies that have been used as anti-inflammatories to treat gout.¹⁰ Research is needed to evaluate the usefulness of these and other complementary medicines to treat gout.
• In high amounts, eicosapentaenoic acid (EPA) is known to reduce chronic inflammation. It has not yet been studied to see whether it can help to reduce inflammation in gout episodes.
• Although still just a theory, some studies indicate that folic acid may be helpful in inhibiting the enzyme needed to produce uric acid.¹⁰

Be sure to talk with your health professional if you are considering taking vitamins, minerals, or other remedies to help reduce future gout attacks.

Organizations

• Kidney Stones
• Osteoarthritis

Citations

1. Wortmann RL, Kelley WN (2005). Gout and hyperuricemia. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., pp. 1402–1429. Philadelphia: Elsevier Saunders.

2. Wise C (2004). Crystal-induced joint disease. In DC Dale, DD Federman, eds., Scientific American Medicine, section 15, chap. 9. New York: WebMD.

3. Hellman DB, Stone JH (2005). Arthritis and musculoskeletal disorders. In LM Tierney Jr et al., eds., Current Medical Diagnosis and Treatment, 44th ed., pp. 781–789. New York: McGraw-Hill.

4. Choi HK, et al. (2004). Alcohol intake and risk of incident gout in men: A prospective study. Lancet, 363(9417): 1277–1281.

5. Choi HK, et al. (2004). Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine, 350(11): 1093–1103.

6. Klippel JH, et al. (1999). Gout section of Regional pain and monoarticular disorders. In Primary Care Rheumatology, pp. 117–124. London: Mosby.

7. Rott KT, Agudelo CA (2003). Gout. JAMA, 289(21): 2857–2860.

8. Terkeltaub R (2004). Gout and hyperuricemia section of Crystal deposition diseases. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 22nd ed., vol. 2, pp. 1703–1708. Philadelphia: Saunders.

9. Bomalaski JS, Clark MA (2004). Serum uric acid-lowering therapies: Where are we heading in management of hyperuricemia and the potential role of uricase. Current Rheumatology Reports, 6: 240–247.

10. Murray MT, et al. (1999). Gout. In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 2nd ed., vol. 2, pp. 1253–1259. London: Churchill Livingstone.

Other Works Consulted

• Gravel JW Jr, Pastan RS (2002). Gout section of Rheumatology and musculoskeletal problems. In RE Rakel, ed., Textbook of Family Practice, 6th ed., pp. 969–972. Philadelphia: W.B. Saunders.