Gout: Causes, Symptoms & Treatment

Gout is a crystal-induced inflammatory arthritis caused by deposition of monosodium urate crystals in joints and soft tissues. Elevated serum uric acid (hyperuricemia) leads to crystal formation, triggering an intense inflammatory response. Acute gout attacks cause sudden severe pain, typically affecting the big toe, though any joint can be affected. The condition is characterized by recurrent attacks alternating with symptom-free periods.

Gout is the most common inflammatory arthritis in men and increasingly common in women.

Hyperuricemia results from:

• Increased uric acid production
• Decreased renal excretion (most common, 90%)
• High purine diet (red meat, organ meats, shellfish)
• Alcohol consumption (especially beer)
• Fructose intake
• Dehydration

Risk factors include:

• Male gender
• Age over 40
• Family history
• Obesity
• Hypertension
• Diuretic use
• Renal disease
• Metabolic syndrome

Acute attack symptoms:

• Sudden severe joint pain (often nocturnal)
• Erythema, warmth, swelling
• Tachyphylaxis (rapid onset)
• Associated fever
• Peak severity 24-48 hours
• Resolution over 7-10 days with treatment

Between attacks: asymptomatic periods (initially), chronic tophi with prolonged hyperuricemia.

Diagnosis involves:

• Synovial fluid analysis (polarized light microscopy)
• Serum uric acid level (may be normal during attack)
• Imaging (X-ray shows tophi)
• Assessment of 24-hour urine uric acid

Acute attack treatment:

• NSAIDs (indomethacin, naproxen)
• Colchicine (especially early in attack)
• Corticosteroids (for NSAID/colchicine intolerance)

Chronic management (urate-lowering therapy):

• Allopurinol (reduces uric acid production)
• Febuxostat (alternative)
• Probenecid (enhances uric acid excretion)
• Goal: serum uric acid <6 mg/dL

Prophylaxis during therapy initiation: NSAIDs or colchicine to prevent flares.

Prevention strategies include:

• Weight loss
• Reduced purine intake
• Alcohol moderation
• Hydration (2+ liters daily)
• Avoiding high-fructose foods
• Management of metabolic syndrome
• Review of medications (diuretics)

See a doctor for sudden severe joint pain. Diagnosis confirmation and acute treatment initiation are important. Specialist consultation helps manage chronic hyperuricemia and prevents future attacks.