Gout is painful swelling that can occur in some of your joints. Gout is a type of arthritis. This condition is caused by having too much uric acid in your body. Uric acid is a chemical that forms when your body breaks down substances called purines. Purines are important for building body proteins.

When your body has too much uric acid, sharp crystals can form and build up inside your joints. This causes pain and swelling. Gout attacks can happen quickly and be very painful (acute gout). Over time, the attacks can affect more joints and become more frequent (chronic gout). Gout can also cause uric acid to build up under your skin and inside your kidneys.

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    This condition is caused by too much uric acid in your blood. This can occur because:

    • Your kidneys do not remove enough uric acid from your blood. This is the most common cause.
    • Your body makes too much uric acid. This can occur with some cancers and cancer treatments. It can also occur if your body is breaking down too many red blood cells (hemolytic anaemia).
    • You eat too many foods that are high in purines. These foods include organ meats and some seafood. Alcohol, especially beer, is also high in purines.

    A gout attack may be triggered by trauma or stress.

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    This condition is more likely to develop in people who:

    • Have a family history of gout.
    • Are male and middle-aged.
    • Are female and have gone through menopause.
    • Are obese.
    • Frequently drink alcohol, especially beer.
    • Are dehydrated.
    • Lose weight too quickly.
    • Have an organ transplant.
    • Have lead poisoning.
    • Take certain medicines, including aspirin, cyclosporine, diuretics, levodopa, and niacin.
    • Have kidney disease or psoriasis.
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    An attack of acute gout happens quickly. It usually occurs in just one joint. The most common place is the big toe. Attacks often start at night. Other joints that may be affected include joints of the feet, ankle, knee, fingers, wrist, or elbow. Symptoms may include:

    • Severe pain.
    • Warmth.
    • Swelling.
    • Stiffness.
    • The affected joint may be very painful to touch.
    • Shiny, red, or purple skin.
    • Chills and fever.

    Chronic gout may cause symptoms more frequently. More joints may be involved. You may also have white or yellow lumps (tophi) on your hands or feet or in other areas near your joints.

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    This condition is diagnosed based on your symptoms, medical history, and physical exam. You may have tests, such as:

    • Blood tests to measure uric acid levels.
    • Removal of joint fluid with a needle (aspiration) to look for uric acid crystals.
    • X-rays to look for joint damage.
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    Treatment for this condition has two phases: treating an acute attack and preventing future attacks. Acute gout treatment may include medicines to reduce pain and swelling, including:

    • NSAIDs.
    • Steroids. These are strong anti-inflammatory medicines that can be taken by mouth (orally) or injected into a joint.
    • This medicine relieves pain and swelling when it is taken soon after an attack. It can be given orally or through an IV tube.

    Preventive treatment may include: 

    • Daily use of smaller doses of NSAIDs or colchicine.
    • Use of medicine that reduces uric acid levels in your blood.
    • Changes to your diet. You may need to see a specialist about healthy eating (dietitian).

    Follow these instructions at home: 

    During a Gout Attack

    • If directed, apply ice to the affected area:
      • Put ice in a plastic bag.
      • Place a towel between your skin and the bag.
      • Leave the ice on for 20 minutes, 2–3 times a day.
    • Rest the joint as much as possible. If the affected joint is in your leg, you may be given crutches to use.
    • Raise (elevate) the affected joint above the level of your heart as often as possible.
    • Drink enough fluids to keep your urine pale yellow.
    • Take over-the-counter and prescription medicines only as told by your health care provider.
    • Do not drive or operate heavy machinery while taking prescription pain medicine.
    • Follow instructions from your health care provider about eating or drinking restrictions.

    Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

    Avoiding Future Gout Attacks 

    • Follow a low-purine diet as told by your dietitian or health care provider. Avoid foods and drinks that are high in purines, including liver, kidney, anchovies, asparagus, herring, mushrooms, mussels, and beer.
    • Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
    • Maintain a healthy weight or lose weight if you are overweight. If you want to lose weight, talk with your health care provider. It is important that you do not lose weight too quickly.
    • Start or maintain an exercise program as told by your health care provider.
    • Drink enough fluids to keep your urine pale yellow.
    • Take over-the-counter and prescription medicines only as told by your health care provider.
    • Keep all follow-up visits as told by your health care provider. This is important.

    Contact a health care provider if: 

    • You have another gout attack.
    • You continue to have symptoms of a gout attack after10 days of treatment.
    • You have side effects from your medicines.
    • You have chills or a fever.
    • You have burning pain when you urinate.
    • You have pain in your lower back or belly.

    Get help right away if: 

    • You have severe or uncontrolled pain.
    • You cannot urinate.
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