Diagnosis
Healthcare professionals diagnose gout based on symptoms and how the affected joint looks. Tests to help diagnose gout may include:
- Joint fluid test. Your healthcare professional may use a needle to take fluid from your affected joint. Urate crystals may show in the fluid under a microscope.
- Blood test. Your healthcare professional may suggest a blood test to measure the levels of uric acid in your blood. But high levels of uric acid don't always mean gout. And some people who have symptoms of gout don't have high levels of uric acid during an attack.
- X-ray imaging. Joint X-rays can help rule out other causes of joint swelling and irritation. And certain features of gout that affect the joints show up on X-rays.
- Ultrasound. This test uses sound waves to find urate crystals in joint cartilage or in the lumps that may form under the skin, called tophi. Cartilage is the strong tissue that connects and protects the joints and bones.
- Dual-energy computerized tomography (DECT). This test uses X-ray images taken from different angles to show urate crystals in joints.
Treatment
Two types of medicines treat gout. One type helps lessen the swelling, irritation and pain of gout attacks. The other type works to prevent gout complications by lowering uric acid in the blood.
Which type of medicine is right for you depends on how often you get symptoms, how bad they are and other health conditions you have.
Medicines to treat gout attacks
Medicines that treat gout attacks and prevent new attacks include:
- Nonsteroidal anti-inflammatory drugs, also called NSAIDs. NSAIDs include medicines you get without a prescription such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). They also include stronger prescription medicines such as indomethacin (Indocin) and celecoxib (Celebrex, Elyxyb). Too much NSAID use may cause stomach pain, bleeding and ulcers.
- Colchicine. Your healthcare professional may suggest colchicine (Colcrys, Gloperba, others), an anti-inflammatory medicine that lessens gout pain. Colchicine works best when taken within 24 hours of the start of symptoms. Side effects include upset stomach, vomiting and loose stools. Side effects may make it hard to take colchicine.
- Corticosteroids. Steroid medicines, such as prednisone, may control gout irritation, swelling and pain. You take steroids by mouth or get them as a shot into a joint. Side effects include mood changes, high blood sugar levels and high blood pressure.
- Anakinra (Kineret). Although this medicine isn't approved for treating gout, some healthcare professionals may suggest it for a few days to treat an attack. You take it as a daily shot. Side effects include an increased risk of infection. Other side effects are swelling, bruising and itching at the site of the shot.
Medicines to prevent gout complications
These medicines may be for people who have more than two gout attacks each year or for those who have fewer gout attacks that are very painful. Your healthcare professional may prescribe them if your X-rays show joint damage from gout or tophi or if you have a long-term kidney condition or kidney stones. You may need to take these medicines for life.
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Medicines that block the making of uric acid. These include allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric). You get allopurinol as a pill to take by mouth. Side effects of allopurinol include fever, rash, hepatitis and kidney issues.
Febuxostat also is a pill you take by mouth. Side effects include rash, upset stomach and liver issues. Febuxostat also may increase the risk of heart-related death.
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Medicines that help rid the body of uric acid. Medicines such as probenecid (Probalan) help the kidneys remove uric acid from the body. You take probenecid as a pill by mouth. Side effects include rash, stomach pain and kidney stones.
Pegloticase (Krystexxa) given through a vein helps break down uric acid. Healthcare professionals use it for gout that is very bad or resists other treatment. Side effects include a serious allergic reaction called anaphylaxis, upset stomach, vomiting and trouble passing stool, called constipation.
Medicines that lower uric acid levels in the body can cause gout to recur, also called flare, when first taken. So treatment may include NSAIDs, colchicine or low-dose steroids to prevent flares.
Lifestyle and home remedies
These lifestyle choices are vital for people who have gout even if they take medicines:
- Drink healthier. Limit or don't drink alcohol, especially beer. That includes beer without alcohol. Limit or don't drink beverages sweetened with fructose. Limit fruit juice, which is high in fructose, as well. Drink plenty of water.
- Limit foods high in purines. These include red meat and organ meats, such as liver. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna.
- Exercise regularly and keep a healthy weight. Keeping your body at a healthy weight lowers your risk of gout. Low-impact activities such as walking, bicycling and swimming are easier on your joints.
Preparing for your appointment
Make an appointment with your healthcare professional if you have symptoms of gout. Your healthcare professional may send you to a specialist in joint, muscle and bone conditions, called a rheumatologist.
Here's some information to help you get ready for your appointment.
What you can do
Make a list of:
- Your symptoms, including when they started and how often they happen.
- Key medical information, including other conditions you have and any family history of gout.
- All medicines, vitamins and supplements you take, including dosages.
- Questions to ask your healthcare professional.
Take a family member or friend along, if possible, to help you remember all the information you get.
Questions to ask your healthcare professional include:
- What are the possible causes of my symptoms?
- What tests do I need?
- Are there treatments or lifestyle changes that might help my symptoms?
- Should I see a specialist?
Questions to ask a rheumatologist include:
- What are the possible side effects of the drugs you're prescribing?
- How soon after I start treatment should my symptoms improve?
- Do I need to take medicines long-term?
- I have other health conditions. How can I best manage them together?
- How should I change my diet?
- Is it safe for me to drink alcohol?
- Where can I find more information about this condition?
Be sure to ask all the questions you have.
What to expect from your doctor
Questions your healthcare professional may ask include:
- Do your symptoms come and go? How often?
- What seems to set off your symptoms, such as certain foods or stress?
- Have any of your parents, brothers or sisters had gout?
- What do you eat in a day?
- Do you drink alcohol? How much and how often?