What is gout?
Uric acid is produced in the body during the breakdown of purines, substances that the body creates itself and also takes in through food. The excess is excreted via the kidneys. When uric acid is produced in larger quantities or is not excreted sufficiently, its level in the blood rises (hyperuricaemia). Above a certain limit, it separates in the form of tiny, needle-like crystals that deposit in and around the joint. The immune system recognises the crystals as a foreign body and triggers inflammation – this is a gout attack.
High uric acid does not automatically mean gout. Most people with elevated levels never experience an attack, but the risk is greater the higher the level and the longer it lasts.
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First symptoms of gout – what does an attack look like?
Where does gout most commonly occur?
- toe joint
- ankle and top of the foot
- knee
- wrist and finger joints
- lakat
Tophi most commonly appear on the pinna, elbows, fingers of the hands and feet, and around the Achilles tendon.
Why does gout occur and who is at risk?
Uric acid levels are affected by genetics, kidney function, diet and other conditions. Gout is more common in:
- men, particularly after the age of 40, and women after the menopause;
- person who is overweight, with high blood pressure, diabetes and high blood lipid levels;
- person with chronic kidney disease;
- person with psoriasis;
- people who regularly drink beer, spirits and sweetened juices;
- people who take certain water tablets and some blood pressure medications.
An attack is often triggered by a heavy meal with plenty of meat, alcohol, insufficient fluid intake, starvation and rapid weight loss, joint injury or an acute illness.
How is gout diagnosed?
Rheumatologist diagnoses based on a conversation, joint examination and blood tests: uric acid, kidney function parameters and inflammation markers. During the attack itself, uric acid may be normal, so the measurement is repeated once the attack has subsided.
The most reliable evidence is uric acid crystals in the fluid from the inflamed joint. Joint ultrasound is of great importance, especially in the early stage and when fluid cannot be obtained from the joint: it shows crystal deposits on the cartilage. The examination also rules out conditions that resemble gout, such as joint infection, pseudogout and psoriatic arthritis.
How is gout treated?
Treatment has two aims: to calm the attack as soon as possible and to prevent new attacks.
The attack is treated with anti-inflammatory drugs, and the type of drug and dose are chosen by the doctor according to other diseases and medications the patient is taking. Treatment is most successful when it begins within the first 24 hours of the onset of pain.
When attacks are frequent or tophi, joint damage or kidney stones are present, uric acid-lowering medications are introduced. The aim is a value below 360 µmol/L, and even lower in the case of tophi, so that existing crystals gradually dissolve. This therapy is taken for a long time and is not interrupted during a new attack. In the first months, the doctor usually also prescribes protection against attacks, because a sudden drop in uric acid can trigger a new attack.
Gout diet
Diet alone does not cure gout, but it reduces the number of attacks and aids treatment.
Restrict: offal, red meat and processed meats, seafood and small fish (sardines, anchovies), beer and spirits, sweetened juices.
Recommended: at least two litres of water a day, unless a doctor advises otherwise; low-fat dairy products, which promote the excretion of uric acid; vegetables, fruit and whole grains; gradual weight loss, without starvation.
Wine in moderation has less effect on uric acid than beer, but alcohol should be avoided during an attack.
How to help yourself during an attack?
Rest the joint, elevate the foot and apply cold compresses wrapped in a cloth for 15 to 20 minutes at a time. Drink plenty of water. Do not start or stop uric acid medication on your own – a doctor will decide on that.
Frequently asked questions about gout
Does gout go away on its own?
The attack passes by itself in a few days to two weeks, but the disease does not go away. Without treatment, attacks become more frequent and the crystals damage the joint.
How long does a gout attack last?
Usually 3 to 10 days. The pain is most intense on the first day, and with timely initiated therapy, the attack subsides more quickly.
What is the normal uric acid level?
Reference ranges depend on the laboratory, roughly up to about 420 µmol/L in men and up to about 360 µmol/L in women. In individuals with gout, the treatment target is a value below 360 µmol/L.
Does high uric acid always mean gout?
No. Most people with raised uric acid levels never develop gout. Whether treatment is necessary is assessed by a doctor based on the levels, other medical conditions, and kidney function.
Can gout occur in the knee or hand?
Yes. After the big toe, the ankle, knee, wrist and fingers of the hand are most commonly affected.
When should you see a doctor?
Immediately upon the first sudden pain, swelling and redness of the joint, especially if accompanied by a temperature, because a joint infection can also look like this and requires urgent treatment. Read more about the examination on the page rheumatologist should also be consulted.
