Gout

What is gout?

Uric acid (also called urate) is a normal waste product. Your body makes it when it breaks down purines, which are found in your own cells and in many foods. Usually your kidneys remove it in urine. When your body makes too much or removes too little, uric acid builds up in the blood and can form sharp, needle-shaped crystals in and around a joint¹.

Gout often moves through stages¹:

• High uric acid with no symptoms yet
• Flares, with sudden pain and swelling
• Quiet periods between flares
• Tophi, which are lumps of crystals under the skin that can damage joints over time

Not everyone with high uric acid gets gout¹.

Symptoms of gout

• Sudden, intense pain in one joint, often starting at night¹
• A joint that is swollen, red, and warm¹
• The big toe is the most common spot, but gout can also affect the knees, ankles, feet, hands, wrists, and elbows^1,6
• Flares that get better in 1 to 2 weeks, with no symptoms in between¹
• Hard lumps under the skin (tophi), usually after years of high uric acid¹

Without treatment, flares can come more often and last longer^1,4.

Causes and risk factors

Gout is more common in men and usually starts in middle age. In women, it rarely starts before menopause¹. Other things that raise your chance of gout or a flare include^1,3,4:

• Drinking alcohol, especially beer
• Sugary drinks, such as soda
• Red meat, organ meats, and some seafood, such as shellfish, sardines, and anchovies
• Some water pills (diuretics)
• Obesity
• Kidney disease, high blood pressure, heart failure, or diabetes
• A family member with gout

An injury, an illness, or certain medicines can also set off a flare¹.

How gout is diagnosed

Several conditions can look like gout, including a joint infection, so testing matters². A rheumatologist may:

• Ask about your flares, foods, drinks, and medicines²
• Examine the joint²
• Order a blood test for uric acid. A high level supports gout, but levels can be normal during a flare^2,3
• Use a thin needle to take a small amount of fluid from the joint and look for crystals under a microscope^2,3
• Order an ultrasound or a special CT scan to look for crystal buildup²

Treatment options

Gout treatment has two parts: calming a flare, and lowering uric acid over time so flares stop coming back^2,3.

To ease a flare²:

• Anti-inflammatory medicines (NSAIDs)
• Colchicine, which works best when started early in a flare
• Steroids, as pills or a shot into the joint

To prevent flares and tophi²:

• Medicines that lower how much uric acid your body makes (xanthine oxidase inhibitors)
• Medicines that help your kidneys remove uric acid (uricosurics)
• An infused medicine that breaks down uric acid, for gout that hasn’t responded to other treatment

If you have frequent flares or tophi, diet changes alone are usually not enough, and taking uric-acid-lowering medicine every day is the main way to prevent flares². Some people have more flares in the first months on these medicines, so a clinician may add a medicine to prevent them⁶.

Living with gout and when to get care

With treatment and lifestyle changes, gout is one of the most controllable types of arthritis¹. Habits that can lower uric acid and support heart health include^2,4:

• Drinking less alcohol, including beer
• Choosing water over sugary drinks
• Eating less red meat, organ meat, and shellfish
• Staying active and keeping a healthy weight

Talk with your clinician before changing your diet or medicines². Request an appointment or call 646-389-0001 if you’ve had a first flare, flares are coming more often, or you have lumps near a joint.

When to go to the emergency room

Call 911 or go to the nearest emergency room if you have a fever and a joint that is hot, swollen, and very painful. This can be a sign of a joint infection, which needs care right away⁵.

How Madison Medical Care helps

Kevin Yip, MD, is board-certified in internal medicine and rheumatology by the American Board of Internal Medicine. He completed his rheumatology fellowship at Hospital for Special Surgery and NewYork-Presbyterian/Weill Cornell, and his residency at NYU.

• Request an appointment online or call 646-389-0001. Our Patient Support Team aims to contact you within 2 business days.
• We request your prior records, including past uric acid results and any joint fluid tests, so Dr. Yip has the full picture.
• At your 30-minute first visit, in person at 30 E 23rd St, Floor 7, Dr. Yip goes over your flares and results and makes a plan with you for flares and for prevention. Follow-ups are 15 minutes.
• When you ask, we send a visit summary to your primary care clinician.

Madison Medical Care is self-pay and does not bill insurance, and we can’t see patients with Medicare or Medicaid. Your blood tests, imaging, and prescriptions go through your insurance.