Gout

Diagnosis

Doctors usually diagnose gout based on your symptoms and the appearance of the affected joint. Tests to help diagnose gout may include:

• Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope.
• Blood test. Your doctor may recommend a blood test to measure the levels of uric acid in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.
• X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation.
• Ultrasound. This test uses sound waves to detect urate crystals in joints or in tophi.
• Dual-energy computerized tomography (DECT). This test combines X-ray images taken from many different angles to visualize urate crystals in joints.

Treatment

Gout medications are available in two types and focus on two different problems. The first type helps reduce the inflammation and pain associated with gout attacks. The second type works to prevent gout complications by lowering the amount of uric acid in your blood.

Which type of medication is right for you depends on the frequency and severity of your symptoms, along with any other health problems you may have.

Medications to treat gout attacks

Drugs used to treat gout flares and prevent future attacks include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin, Tivorbex) or celecoxib (Celebrex). NSAIDs carry risks of stomach pain, bleeding and ulcers.
• Colchicine. Your doctor may recommend colchicine (Colcrys, Gloperba, Mitigare), an anti-inflammatory drug that effectively reduces gout pain. The drug's effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea.
• Corticosteroids. Corticosteroid medications, such as prednisone, may control gout inflammation and pain. Corticosteroids may be in pill form, or they can be injected into your joint. Side effects of corticosteroids may include mood changes, increased blood sugar levels and elevated blood pressure.

Medications to prevent gout complications

If you experience several gout attacks each year, or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications. If you already have evidence of damage from gout on joint X-rays, or you have tophi, chronic kidney disease or kidney stones, medications to lower your body's level of uric acid may be recommended.

• Medications that block uric acid production. Drugs such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) help limit the amount of uric acid your body makes. Side effects of allopurinol include fever, rash, hepatitis and kidney problems. Febuxostat side effects include rash, nausea and reduced liver function. Febuxostat also may increase the risk of heart-related death.
• Medications that improve uric acid removal. Drugs such as probenecid (Probalan) help improve your kidneys' ability to remove uric acid from your body. Side effects include a rash, stomach pain and kidney stones.

Lifestyle and home remedies

Medications are often the most effective way to treat gout attacks and prevent recurrent symptom flares. However, lifestyle choices also are important, and you may want to:

• Choose healthier beverages. Limit alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, drink plenty of nonalcoholic beverages, especially water.
• Avoid foods high in purines. Red meat and organ meats, such as liver, are especially high in purines. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna. Low-fat dairy products may be a better source of protein for people prone to gout.
• Exercise regularly and lose weight. Keeping your body at a healthy weight reduces your risk of gout. Choose low-impact activities such as walking, bicycling and swimming — which are easier on your joints.

Preparing for your appointment

Make an appointment with your doctor if you have symptoms that are common to gout. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down your symptoms, including when they started and how often they occur.
• Note important personal information, such as any recent changes or major stressors in your life.
• Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking. Your doctor will also want to know if you have any family history of gout.
• Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Questions to ask the doctor at the initial appointment include:

• What are the possible causes of my symptoms or condition?
• What tests do you recommend?
• Are there any treatments or lifestyle changes that might help my symptoms now?
• Should I see a specialist?

Questions to ask if you're referred to a rheumatologist include:

• What are the possible side effects of the drugs you're prescribing?
• How soon after beginning treatment should my symptoms start to improve?
• Do I need to take medications long term?
• I have these other health conditions. How can I best manage them together?
• Do you recommend any changes to my diet?
• Is it safe for me to drink alcohol?
• Are there any handouts or websites that you'd recommend for me to learn more about my condition?

If any additional questions occur to you during your medical appointments, don't hesitate to ask.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

• What are your symptoms?
• When did you first experience these symptoms?
• Do your symptoms come and go? How often?
• Does anything in particular seem to trigger your symptoms, such as certain foods or physical or emotional stress?
• Are you being treated for any other medical conditions?
• What medications are you currently taking, including over-the-counter and prescription drugs as well as vitamins and supplements?
• Do any of your first-degree relatives — such as a parent or sibling — have a history of gout?
• What do you eat in a typical day?
• Do you drink alcohol? If so, how much and how often?