Gout – Causes, Risk factors, Symptoms, Diagnosis, Treatment, Prevention

(Arthritis, gout, gouty arthritis)

What is Gout

Gout occurs when uric acid crystals accumulate in the joints. This increase causes the joints to swell. If the crystals accumulate in the kidneys, kidney stones can occur.

Causes of Gout

It is common for gout to occur if you have high levels of uric acid in your blood (called hyperuricemia). But it may also be possible to have normal uric acid levels and still have gout.

The liver metabolizes uric acid and the kidneys eliminate it through urine. Uric acid levels accumulate when:

  • Too much uric acid is produced
  • Not enough uric acid is removed

If you have gout and hyperuricemia, the body does not eliminate enough uric acid.

Risk factors of Gout

These factors increase the chances of developing gout. All causes of hyperuricemia are risk factors for such a condition.

Risk factors include:

  • Obesity, sudden weight gain or rapid weight loss
  • Age: more than 40 years
  • Sex: male
  • Family members with Gout
  • Diuretics, such as hydrochlorothiazide
  • Some medications, such as aspirin

A diet with high purine content (uric acid manifests when purines are broken down), for example:

  • Liver meat and other organs
  • Dry beans and peas
  • Anchovies
  • Meat sauces
  • Consumption of alcohol, especially in excess
  • Certain types of cancer or treatments for cancer (eg, cytotoxic drugs)
  • Medications (eg, anticonvulsants, anti-rejection medications)
  • Dehydration
  • Hypercholesterolemia
  • Renal disease

Symptoms of Gout

Symptoms include:

Acute gouty arthritis

  • Sudden onset of severe pain in an inflamed joint, usually starts in the big toe
  • Red, hot, swollen and very sensitive joints
  • Increased pain 24 to 36 hours after onset of symptoms

Recurrent gouty arthritis

Most people with gout experience a second attack within two years. This attack can affect several different joints. When recurrent gout attacks occur, tophi can form. Tophi are calcareous deposits of uric acid that often occur in the elbows and ear lobes.

Diagnosis of Gout

The doctor will ask about your symptoms and medical history, and perform a physical exam. A sample of fluid will be removed from the affected joint. This fluid will be examined for uric acid crystals.

Other tests may include:

  • Blood and urine tests: to measure the level of uric acid in the blood and to assess kidney function
  • X-ray -a test that uses radiation to take a picture of the structures inside the body, especially the bones, and is used to detect the destruction of the joints

Treatment of Gout

Treatment depends on whether the gout is acute or recurrent.

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Acute gouty arthritis

In general, the sooner you start treatment for an acute attack, the more effective the results are. The treatment depends on:

  • Start of symptoms
  • Number of joints affected
  • Responses prior to treatment
  • Health in general

General measures

Applying a hot or cold compress on the joint can relieve pain. It can also help if you remove the weight of the clothing or the bedspread from the joint.


Non-steroidal anti-inflammatory drugs (NSAIDs), for example:

  • Indomethacin
  • Ibuprofen
  • Naproxen
  • Corticosteroids: used if NSAIDs are not effective or recommended
  • One study showed that people receiving corticosteroids plus paracetamol had fewer side effects than those who received NSAIDs along with paracetamol. 
  • Colchicine: used to prevent gout attacks, but is rarely used as a treatment for an acute attack. Note: This medication has many side effects and therefore, it is not common to administer it in the first instance.

Recurrent Gout

General measures

  • Eat a diet low in purine.
  • Avoid alcohol.
  • If you are overweight, lose weight gradually. Rapid weight loss can cause a gout attack.
  • Ask your doctor if some of your medications cause high levels of uric acid.
  • Drink plenty of liquid.


If you have recurrent gouty arthritis or an initial attack with hyperuricemia, you may take medication:

  • To reduce the production of uric acid (eg, allopurinol)
  • To increase the excretion of uric acid by the kidneys (eg, probenecid or sulfinpyrazone)
  • In certain cases, low doses of colchicine may also be administered to prevent recurrence of seizures.

If you are diagnosed with gout, follow your doctor’s instructions.

How to Prevent Gout

In order to reduce the likelihood of getting gout:

  • Eat a diet low in purine.
  • Limit the amount of alcohol you drink. Avoid drinking alcohol in excess.
  • Drink plenty of liquid.
  • Lose weight gradually.
  • Ask your doctor about your risk of developing high blood pressure and heart attacks. These conditions are associated with gout.
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