Guide to Gout: What to Know About the Painful Condition

The pain is so bad that many patients end up in the emergency room.

“Patients go from zero to 10-out-of-10 pain quickly,” Chu says. “The lightest touch or movement makes it worse. People describe that even having a bed sheet on it is uncomfortable.”

To diagnose gout, a doctor will do bloodwork to check your uric acid levels or take a fluid sample from the painful joint and look for urate crystals.

Gout attacks, called flares, usually last several days to a week. Anti-inflammatories, steroids or a medication called colchicine can ease pain during that time.

How to prevent gout attacks

After the first attack, some patients may not experience a second one for five to 15 years, Singh says. But the third one will usually happen faster, within six months to a year. Over time, the attacks become more and more frequent.

Without treatment, gout attacks can cause stiffness, disabling joint pain, nodules that form under the skin called tophi, and eventually, permanent bone or joint damage.

Lifestyle changes such as losing weight, giving up alcohol and switching to a healthy diet may help prevent gout attacks. Drinking low-fat milk and eating low-fat cheese can reduce uric acid levels. And your doctor may recommend avoiding beer, seafood, sugar-sweetened juices and red meat (especially organ meats) because they are high in purines, a chemical that can incite a flare.

Lifestyle changes alone are unlikely to combat or reverse gout, however. For most patients, the best way to prevent future gout attacks is to take a uric-acid-lowering medication such as allopurinol or febuxostat, Singh says.

The American College of Rheumatology (ACR) recommends the medication for patients who have had at least two flares in a year, or who have had one flare but also have high uric acid levels, certain kidney issues, tophi nodules or evidence of joint damage.

Making medication available to more people

Many patients who could benefit from gout medications aren’t taking them, Chu and Singh say. One study published in Arthritis & Rheumatology found that only about a third of gout patients are on uric-acid-lowering therapy. Another published in BMC Medicine found that only half of those with frequent flares take the medication.

Research shows many patients stop taking gout medication because they don’t believe they need it. Others, particularly those who see a primary care physician for their gout, may never get a prescription to begin with.

“One issue we see is that primary care doctors only treat the flares but don’t start the uric-acid-lowering treatment,” Chu says. “So the flares are addressed but the underlying disease process is not being controlled.”

Primary care doctors follow gout guidelines published by the American College of Physicians (ACP) that differ from those of the rheumatology group. The ACP guidelines recommend gout medication only for those who have frequent attacks, and even then, with caveats.

Some rheumatologists have expressed frustration about the discrepancy, saying it doesn’t make sense to wait for a patient to suffer from a gout attack to provide treatment. Studies are underway to more convincingly prove the benefits of prescribing uric-acid-lowering medication for all gout patients, Singh says. Early research indicates it could help prevent inflammation of the body and early mortality.

Singh already recommends uric-acid-lowering medication to all of his gout patients, even after one attack, as a way to prevent future flares and to stop the progression of joint damage. Sometimes, he says, it can be a challenge to persuade patients to take a daily medication for a condition they can’t always see or feel.

“Gout is not hard to treat,” Singh says. “The hardest thing is for the patient to be convinced they need to be treated.”