Diagnosis of Gout

Gout tends to be relatively straightforward to diagnose. However, a few conditions can mimic gout. To help diagnose gout, your health care provider may: 

  • Ask you to provide your medical history, including:
    • Your symptoms.
    • Any risk factors you have.
    • Any medications you have taken.
  • Examine the affected joints.
  • Order a laboratory test to check urate levels in your blood.
  • Take a sample of fluid from one of your painful joints, a swollen bursae (fluid-filled sac that cushions the joint), or a tophus to look for urate crystals using a special microscope.
  • Order an ultrasound or special CT scan to check for urate crystal buildup in the affected joint as well as to diagnose other conditions that may be causing the symptoms.

Treatment of Gout

Depending on your symptoms and the cause of your gout, treatment plans may differ from person to person. However, the goals for treating gout are the same for each person and include:

  • Reduce the pain from gout flares.
  • Prevent future flares.
  • Prevent and resolve tophi to stop damage to your joints.
  • Care for other conditions or complications that happen with gout, such as heart and kidney diseases.

When you have gout, your doctor may recommend medications to manage the underlying cause of gout and treat active gout flares.

To treat a gout flare, your doctor may recommend medications including:

  • Over-the-counter or prescription anti-inflammatory medications, which can reduce pain and swelling.
  • Colchicine, which helps to relieve gout pain. This medication works best when taken when symptoms first appear.

Corticosteroids, which can help decrease inflammation, provide pain relief, and reduce joint swelling. Corticosteroids may be given by mouth or injected directly into the affected joint. Because they are potent medications, your doctor will prescribe the lowest dose possible to achieve the desired benefit. 

Another key step to treating gout is managing hyperuricemia, which is the underlying cause of gout. There are medications available to lower urate levels, including:

  • Xanthine oxidase inhibitors, which help prevent the production of urate.
  • Uricosuric agents, which help the kidneys flush more urate out of the body.
  • Uricase, which breaks down urate into a form that is easily removed from the body. This medication is recommended for people who have not responded to other medications.

Other treatments may include making diet and lifestyle changes to reduce risk factors you can control.

Who Treats Gout?

Health care providers who may provide treatment for gout include:

  • Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles.
  • Primary care providers (PCPs), such as internists, who specialize in the diagnosis and medical treatment of adults. Most people with gout are managed by their PCPs.
  • Dietitians, who can teach you about how to follow a healthy diet to improve your health.
  • Nurse educators, who specialize in helping people understand their overall condition and set up their treatment plans.
  • Pharmacists, who dispense medications and teach people about the medications, including the importance of taking them as prescribed.

Living With Gout

There are many things you can do to help manage gout. You can make some lifestyle changes to help you have fewer gout flares and manage your symptoms, such as:

  • Losing weight. If you are overweight or obese, losing weight through a reduced calorie diet and increased exercise helps reduce urate levels, which can help stop or lower the number of flares you have.
  • Making diet changes to help reduce blood urate levels and gout flares, such as: 
    • Drinking fewer alcoholic beverages. This includes nonalcoholic beer.
    • Avoiding sugar-sweetened drinks, such as soda.
    • Avoiding red meats and organ meats (liver, kidney, tongue, and sweetbreads) that are higher in purines and may increase the risk for other health conditions.  
    • Avoiding certain seafood, such as shellfish (shrimp and lobster), sardines, and anchovies.
  • Following the Dietary Approaches to Stop Hypertension (DASH) eating plan.  This diet is particularly helpful for the many gout patients who also have high blood pressure. The DASH eating plan can help improve high blood pressure and may help lower blood urate levels. By lowering urate levels, this plan may help prevent gout flares. The DASH eating plan includes:
    • Eating plenty of vegetables, fruits, and whole grains.
    • Eating low-fat or fat-free dairy products, poultry, and oils.
    • Limiting foods high in saturated fats.
    • Limiting sugar-sweetened foods and drinks.
  • When you have a gout flare, you can do the following to help reduce symptoms from the flare:
    • Applying ice to the affected area to help reduce swelling and pain.
    • Elevating the affected limb, if possible, to help reduce swelling.
    • Resting the affected joint.
  • When gout is associated with frequent flares or tophi, lifestyle changes alone are not sufficient to manage gout and medications to lower urate levels in your blood are the mainstay for managing gout. Taking the medications prescribed for this purpose by your doctor regularly is the key to preventing gout flares from occurring and preventing or reducing tophi. Nevertheless, maintaining healthy weight and diets are also important to help lower the risk of cardiovascular complications, which are common among gout patients.

Always talk with your doctor before making any changes to your diet or medications.

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