Causes and Risk Factors
Gout develops when the body makes too much uric acid or the kidneys remove too little of it. Several factors raise the risk:- Diet: Red meat, organ meats, and certain shellfish are rich in purines, which the body breaks down into uric acid. Beer, liquor, and drinks sweetened with high-fructose corn syrup also raise uric acid levels.
- Medical conditions: High blood pressure, obesity, kidney disease, and diabetes are all associated with gout.
- Medications: Diuretics ("water pills") and low-dose aspirin can reduce how much uric acid the kidneys clear.
- Family history: Gout often runs in families, and genes influence how the body handles uric acid.
- Other triggers: Dehydration, fasting, recent surgery, and serious illness can set off a flare in someone prone to gout - and in St. Petersburg's year-round heat, staying well hydrated is an easy first defense.
- Age and sex: Men develop gout earlier, typically between 30 and 50; women are usually affected after menopause.
Symptoms
Gout attacks, called flares, often begin at night and reach peak intensity within hours. Between flares, most people feel entirely normal, which makes it tempting to put off long-term treatment. Typical features include:- Sudden, severe joint pain: The big toe is the classic site, but gout can strike the ankles, knees, elbows, wrists, and fingers.
- Swelling, redness, and warmth: The joint may look shiny and feel so tender that even the weight of a bedsheet hurts.
- Lingering discomfort: After the worst pain eases, soreness can last from a few days to a few weeks.
- Limited motion: As gout progresses, affected joints may become stiff and harder to move.
Diagnosis
Your physician will review your symptoms and may confirm the diagnosis with testing:- Joint fluid analysis: Fluid drawn from the joint is examined under a microscope for urate crystals - the most definitive test.
- Blood tests: A uric acid level supports the diagnosis, although the level can be misleadingly normal during a flare.
- Imaging: Ultrasound or X-rays help detect crystal deposits and rule out other problems, such as osteoarthritis or a joint infection.
Treatment
Treatment has two goals: calming the flare and lowering uric acid long term.- Flare relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, the anti-inflammatory medicine colchicine, and corticosteroids such as prednisone can shorten an attack, especially when started early.
- Urate-lowering therapy: For repeated flares, tophi, or kidney involvement, daily medication such as allopurinol lowers uric acid and helps prevent future attacks. It is continued long term, even when you feel well.
- Lifestyle measures: Staying well hydrated, limiting alcohol and sugary drinks, moderating purine-rich foods, and gradual weight loss all reduce flare frequency.
Complications
Untreated gout can cause tophi (firm lumps of urate crystals under the skin), permanent joint damage, and uric acid kidney stones. Keeping uric acid at goal protects both the joints and the kidneys, and frequent flares are a signal that long-term therapy should be started or adjusted. If gout keeps interrupting your life, effective long-term control is very achievable. The internal-medicine team at Zimmer Medical Group can build a prevention plan and monitor your uric acid over time - schedule a visit to get started.Getting Gout Under Control for Good
Gout is one of the few forms of arthritis that can be switched off, but only by keeping uric acid low every day for years, and the first few months of that treatment are exactly when most people give up.
Allopurinol: start low, raise slowly, aim at a number
Allopurinol is started at a low dose and increased every few weeks until the uric acid level is below 6 mg/dL, lower still when tophi are present; most people need more than the starting dose, and an unchecked level is the usual reason gout continues on treatment. People of Southeast Asian or African ancestry are tested for the HLA-B*5801 gene first, because it predicts a rare but severe skin reaction. Febuxostat is the alternative when allopurinol is not tolerated, with a caution about heart events in people with cardiovascular disease. Once at target, it continues for life; stopping brings flares back within a year or two.
Why flares increase when treatment starts
Falling uric acid loosens crystals from the joints, so flares are more frequent in the first months of allopurinol. Low-dose colchicine taken daily for the first three to six months prevents most of them, and a flare during that period is not a reason to stop allopurinol; it is continued at the same dose while the flare is treated. Colchicine interacts with atorvastatin and other statins and with clarithromycin, so those combinations are reviewed.
Treating a flare when you have other conditions
Naproxen is avoided in chronic kidney disease, heart failure, and anyone on a blood thinner; a short course of prednisone or a steroid injection into the joint is the substitute. Colchicine doses are reduced with kidney impairment. Treatment started within the first day of a flare works far better than on day three, which is why a supply is kept at home.
The medications and habits that raise uric acid
Hydrochlorothiazide and other diuretics raise uric acid, and switching blood pressure treatment to losartan, which lowers it, often helps. In people with diabetes or kidney disease, SGLT2 inhibitors such as empagliflozin lower uric acid as a side benefit. Beer and liquor, sugary drinks, and dehydration in the Florida heat are the everyday triggers, and our hydration in Florida heat guide covers the practical side; diet changes alone rarely reach target. Our gout is rising article explains why it is more common than it was.
A hot joint is not always gout
A single hot, swollen joint with fever is treated as infection until the fluid has been examined, even with known gout, because the two coexist and infection destroys a joint in days. Pseudogout from calcium crystals looks identical and favors the knee and wrist, and cellulitis over a joint mimics both. Gout also travels with metabolic syndrome and kidney stones. Our musculoskeletal team manages long-term treatment. NIAMS and the American College of Rheumatology publish patient guidance on gout treatment.
If you take allopurinol and do not know your last uric acid level, or have had two or more flares in a year, schedule a visit.