Your joints hurt, and someone you know said it might be gout. But how do you know if that’s really the problem? Gout can be hard to diagnose. That’s because some of the signs are like those for other conditions.
Gout is a type of inflammatory arthritis caused by too much uric acid in the blood. It can form tiny crystals that settle in your joints. An attack often starts with pain in the big toe, but it can spread or involve other joints. It may happen after an illness or injury.
Gout usually affects just one joint at a time. But if it isn’t treated, other joints may hurt too. Occasional attacks may become more frequent and over time, the pain can become constant.
In the U.S., about 1 in 50 people get gout. It’s more common in men than in women and children. And it tends to run in families. You have a higher risk of gout if you:
- Are overweight
- Eat foods high in purines (anchovies, asparagus, dried beans, liver, sardines, gravy, beer, and animal organs)
- Drink too much alcohol
- Take certain medicines
How to Test for Gout
A gout attack usually goes away in about 3-10 days. But you can feel better sooner if you treat it. To be sure that you have gout, see your doctor. They’ll examine you, and they might do some tests.
These tests help your doctor know if you have gout or something else with similar symptoms:
Joint fluid test. Fluid is taken from the painful joint with a needle. The fluid is studied under a microscope to see if the crystals are there.
Blood test. A blood test can check the level of uric acid. A high level of uric acid doesn’t always mean gout.
X-ray. Images of the joints will help rule out other problems.
Ultrasound. This painless test uses sound waves to look for areas of uric acid deposits.
Is It Gout or Another Condition?
The pain and redness of gout can look like an infection or other conditions. Here are some conditions that may be mistaken for gout.
Gout vs. pseudogout
Do you have gout or pseudogout, also known as calcium pyrophosphate deposition (CPPD)? Pseudogout (SUE-doh-gout) is another form of arthritis. The crystals formed in this condition are made of calcium pyrophosphate, not uric acid as with gout. But like regular gout, the attack comes on all of a sudden. Normally, pseudogout will show up in your knees. Gout usually flares up in your big toe.
With both conditions, your joints become swollen, warm, painful, and stiff. The best way to figure out which one you have is to have a doctor take fluid from your affected joint and test it. They’ll be able to see what type of crystals are present.
Other ways that pseudogout is different from gout include:
- Pseudogout is not related to your diet. But gout attacks can be triggered by eating foods high in purines (organ meat, some seafood) or drinking beer or some alcohol.
- Pseudogout affects men and women equally. But gout tends to be more common in men than in women.
- Pseudogout happens because of pneumonia, heart attacks and strokes, after a surgery, or in people with thyroid problems, and those with high calcium and iron. Gout is linked to obesity, insulin resistance, high cholesterol, heart disease, and/or kidney disease.
Gout vs. psoriatic arthritis
Psoriatic arthritis (PsA) can look like gout, but it is an autoimmune condition. It happens when your body’s immune system attacks healthy tissue by mistake. PsA most often affects your skin and your joints, which can become swollen, stiff, and painful.
Because PsA is a systemic disease, it can affect your entire body, increasing your risk for heart disease, diabetes, and depression. Up to 30% of people with psoriasis develop PsA within 5-10 years of being diagnosed.
Symptoms you may have with PsA include:
- Red patches or plaques on your skin
- Swollen fingers and toes
- Nail changes (pitting, ridging, or thickening) on your fingers and toes
- Heel and foot pain
- Chronic fatigue
Gout vs. rheumatoid arthritis
Gout and rheumatoid arthritis (RA) are alike because they involve inflammation and swelling of joints. But they are different in how they are caused. RA happens when your immune system attacks the tissue that lines your joints. Gout happens when uric acid crystals build up in your joints. If you have RA, besides pain and stiffness in your joints, you may have symptoms such as:
- Weight loss
- Fatigue or weakness
- Systemic problems that may affect your heart, lungs, and eyes
Gout vs. reactive arthritis
Gout and reactive arthritis are both inflammatory conditions. But reactive arthritis is a reaction to an infection that has signs similar to those of gout, with pain or stiffness in your joints. Some of the most common infections that can cause reactive arthritis are those in your gastrointestinal or genitourinary tract. It usually happens right after the infection, and usually goes away within six months.
Other symptoms of reactive arthritis include:
- Swelling in your knees, ankles, or heels
- Back pain
- Swelling of your toes or fingers
- Rashes on your feet or palms of your hands
- Red or itchy eyes
How Is Gout Treated?
Gout can be controlled with medicine. To manage the pain, apply ice, raise the affected area, rest, and take a pain reliever such as ibuprofen. These steps can help prevent another gout attack:
- Exercise and eat a balanced diet to control your weight.
- Drinking lots of water may help prevent uric acid stones.
- Stay away from sugary drinks.
- Avoid alcohol.
- Eat less meat and seafood. Get protein from things such as low-fat dairy products (yogurt, cheese, milk).
- Take medicines to lower uric acid levels.
People with gout usually do quite well once they learn to manage an attack and prevent future attacks. The first step is to see your doctor to make sure that gout is the real cause of those red, painful, swollen joints.
What are the medical treatments for gout attacks?
There are several meds to treat gout attacks and to help prevent them from happening in the future. They include:
NSAIDS. Besides over-the-counter meds such as ibuprofen or naproxen, your doctor may prescribe more powerful nonsteroidal anti-inflammatory drugs (NSAIDs). They include celecoxib (Celebrex) and indomethacin. These types of meds can cause excessive bleeding, stomach pain, and possible ulcers.
Colchicine. Colchicine (Colcrys, Mitigare) may also be prescribed by your doctor to get rid of the pain from gout. Be careful of possible nausea and vomiting side effects from this drug.
Corticosteroids. Your doctor may give you what’s called prednisone, in either a pill or a shot. It will also help with gout pain.
What medications prevent future gout attacks?
After you have gotten your current flare under control, your doctor may want you to ward off future gout attacks. These meds will limit the amount of uric acid your body makes:
- Allopurinol (Aloprim, Lopurin, Zyloprim). This medication will help keep your uric acid levels low or keep uric acid crystals from forming in your joints. It’s usually the most commonly prescribed drug for gout.
- Febuxostat (Uloric). This medication also helps keep your uric acid levels low. Your doctor may use this if allopurinol isn’t working for you. But it carries potential risks of heart-related problems.
Meds that will help your body get rid of excess uric acid include:
Lesinurad (Zurampic). This med works to get rid of excess uric acid from your body via your kidneys. It is used when drugs like allopurinol aren't working alone. If that happens, your doctor may use a combination of lesinurad and allopurinol to help lower your uric acid levels.
Pegloticase (Krystexxa). This is an IV injection that works by stopping your body from turning purines into uric acid. This is usually only used when other commonly used meds don’t work. It is not used for a gout attack that has already started.
Probenecid (Probalan). This drug also works to prevent future attacks by reducing uric acid in your body. It works with your kidneys to get rid of more uric acid in your pee.
Takeaways
Gout is triggered by excess uric acid in your blood, forming crystals in joints that cause sudden pain, swelling, and redness — often starting in your big toe.
Gout is treatable and preventable with lifestyle changes and meds. If you have an acute attack, it can be managed with NSAIDs, colchicine, or corticosteroids. Long-term drugs to prevent future flares include meds such as allopurinol, febuxostat, or probenecid.
You can also make lifestyle changes to prevent gout, such as:
- Reducing alcohol
- Limiting purine-rich foods (organ meat and some seafood such as scallops, mussels, and herring)
- Staying hydrated
- Managing your weight
Gout FAQs
What is the main drug for gout?
Allopurinol is the most commonly used drug for gout. If your body doesn’t tolerate allopurinol, your doctor may prescribe febuxostat
Can I test for gout at home?
There are home kits to test for high uric acid. However, the best way to find out if you have gout is to have a doctor either do a joint fluid test, blood test, X-ray, or ultrasound.
Which tablet is best for uric acid?
Allopurinol is well-tolerated, inexpensive, and commonly used to lower your uric acid. Note: If you are a Black person, of Asian descent, or have kidney disease, you may have a reaction to this drug.
