❓What Is Gout?

When the level of uric acid in your blood stays high, the uric acid slowly turns into tiny crystals inside your joints. When your body treats these crystals as something foreign and attacks them, a sudden and severe joint inflammation called a gout attack (flare) begins.
The most common place is the base of the big toe (the first metatarsophalangeal joint). The pain often starts out of nowhere during the night or early morning, with redness, warmth and swelling. Ankles, knees and hand joints can also be affected.
When a blood test shows a high uric acid level but no attack has happened yet, it is called hyperuricemia. Crystals keep building up quietly even without pain, so a high level found at a health check should not be ignored.
Gout is more common in men, but women also become more likely to develop it after menopause.

⚙️Why Does It Happen?

Uric acid builds up in the body

Uric acid is a waste product made from your own cells and from purines in food. It builds up when your body makes too much or your kidneys pass too little into the urine

The blood uric acid level stays high (hyperuricemia)

At this stage there are almost no symptoms. It is usually found by a blood test at a routine health check

Uric acid forms crystals inside the joint

Uric acid that can no longer stay dissolved turns into fine, needle-like crystals that settle on the lining of the joint

White blood cells attack the crystals and strong inflammation begins

The cells that protect your body gather around the crystals and release powerful inflammatory substances

The joint suddenly turns red, swells and hurts badly (a gout attack)

Drinking alcohol the night before, dehydration, a large meal or hard exercise can act as a trigger

🍺 Beer and other alcohol 🍖 Liver, fish roe, dried fish 🥤 Sugary drinks high in fructose 💧 Dehydration ⚖️ Excess body weight 👨 Middle-aged men 💊 Some diuretic medicines

🔍Watch for These Symptoms

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Sudden, severe pain at the base of the big toe

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Pain that wakes you up at night or in the early morning

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The area is red, swollen and warm to the touch

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It hurts even when only a bedsheet touches it

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Too painful to put on a shoe or to walk

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The pain usually peaks within one or two days and often settles down in one to two weeks even without treatment, but without proper care attacks come back and can spread to the ankle, knee and hand joints

💊Treatment (During an Attack and After It Settles)

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Anti-inflammatory Painkillers (NSAIDs) During an Attack

Loxoprofen and similar drugs calm the inflammation and pain of an attack. They cannot be used if you have a stomach or duodenal ulcer, or if you have ever had an asthma attack triggered by a fever or pain medicine (aspirin-induced asthma). The dose or type is adjusted if your kidney function is reduced

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Colchicine

Sometimes used at the very start of an attack. Diarrhoea, nausea and other digestive symptoms are common, and the dose must be reduced if your kidney or liver function is reduced. Care is needed with some other medicines such as clarithromycin, so please bring your medication record book

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Steroids

For people who cannot easily take NSAIDs or colchicine, oral steroids or an injection into the joint may be chosen to calm the inflammation. Your doctor decides based on other conditions such as diabetes

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Urate-Lowering Drugs (Febuxostat and Others)

Febuxostat (Feburic) and similar drugs are started at a low dose only after an attack has settled, and are usually continued long term. They are not started during an attack. Regular blood tests are needed because side effects such as liver problems can occur. Please do not stop the medicine on your own

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Imaging (X-ray and Ultrasound)

The imaging we can perform at our clinic is X-ray and ultrasound (echo). Ultrasound can show crystal deposits in the joint and helps tell gout apart from pseudogout (calcium pyrophosphate crystal deposition disease, a different crystal condition that more often affects the knee and wrist in older people). If MRI or CT is needed, we arrange it at a partner medical facility

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Lifestyle Changes

Cut back on beer and other alcohol, on purine-rich foods such as liver, fish roe and dried fish, and on sugary drinks high in fructose. Drinking enough water and moving toward a healthy body weight also matter

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Regular Blood Tests

The usual target is to keep the uric acid level at 6.0 mg/dL or below. Treatment starts at a low dose and is adjusted while checking blood tests, along with kidney and liver function

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Adjusting for Other Conditions and Medicines

If you have kidney, liver or heart conditions, or take medicines prescribed elsewhere, the choice and dose of treatment changes. Please always bring your medication record book so we can check for interactions

📈Outlook & Recovery

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Keeping uric acid low aims for a state where attacks are less likely

A gout attack itself often settles within one to two weeks, but that does not mean the condition is gone. The crystals are still in the joint, and if the uric acid level stays high the attacks return. Keeping the level at 6.0 mg/dL or below allows the crystals to dissolve little by little, so attacks become less likely over time. If you stop the medicine on your own, the uric acid level goes back up, and attacks have been reported to return within the following few years in many people. Having no attacks is a sign the medicine is working -- it is not a signal that treatment is finished.

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If you have a fever together with a red, swollen and severely painful joint, see a doctor right away instead of waiting.
A bacterial infection of the joint, called septic arthritis, can start out looking very much like a gout attack, but it is an emergency that can destroy the joint in a short time if left untreated. Gout and infection cannot be told apart by appearance alone, so fluid is drawn from the joint with a needle (joint aspiration) and checked for crystals and for bacteria.
Do not assume it is "just my usual gout." Seek medical care early if you have a fever, if the pain keeps getting worse, or if several joints swell at the same time.

🏠Living with Gout

💡 Five Things to Remember

A urate-lowering drug is not started for the first time while an attack is happening (a sudden change in the uric acid level can make the attack worse)
If you are already taking a urate-lowering drug, do not stop it or change the dose on your own when an attack occurs -- treatment for the attack pain is added instead
The target is a uric acid level of 6.0 mg/dL or below, adjusted while checking regular blood tests
Go easy on beer and other alcohol and on sugary drinks high in fructose, and drink plenty of water
No more attacks is a sign the medicine is working. Please talk with us before you stop it

Gout & High Uric Acid

Keeping uric acid low aims for a state where attacks are less likely

💡 Five Things to Remember

🩻 Gotokuji Orthopedic Clinic