Gout is uric acid crystals in a joint, and keeping the level down dissolves them.
Uric acid is a waste product the body makes as it breaks down purines, found in our own cells and in some foods. The kidneys pass most of it out in urine. When the level in the blood stays high for years, it can form sharp, needle-like crystals in and around the joints. Gout is the joint’s reaction to those crystals: sudden attacks of severe pain, redness and swelling.
In plain words.
A high uric acid on a report is not the same as gout. Many people have a high level and never get an attack. On its own it usually does not need a uric acid medicine, but it is a good reason to check weight, BP, sugar, cholesterol and the kidneys, which often go with it.
An attack comes on fast, often at night, most often in the big toe, but also the ankle, top of the foot, knee, wrist or fingers. It is at its worst within a day and settles over one to two weeks. Common triggers are a heavy meal of meat or seafood, alcohol (beer above all), sugary drinks, not drinking enough water, a fever or an operation, and water pills. It is treated with rest, ice and early medicine to calm the inflammation, such as colchicine, a painkiller or a steroid, chosen to suit your kidneys, stomach and heart.
Long-term treatment is a daily tablet that lowers uric acid, such as allopurinol or febuxostat. Allopurinol is usually tried first; febuxostat may not suit people with heart disease. It is advised for attacks that keep coming back, chalky lumps under the skin (tophi), joint damage on X-ray, uric acid kidney stones or weak kidneys. It starts at a low dose and is raised step by step, with blood tests, until the level stays below 6 mg/dL. The crystals then dissolve slowly, over months to years, and for most people it is lifelong.
Crystals in the big toe
Above about 6.8 mg/dL, uric acid can no longer stay dissolved in the body’s fluids. Tiny needle-shaped crystals slowly build up in and around a joint, most often the big toe, usually for years without any pain.
Something stirs the crystals up: a heavy meal, alcohol, a fever, not drinking enough, or a change in medicine. White cells attack them, and within hours the joint turns hot, red, swollen and very tender.
A daily tablet that keeps uric acid below 6 lets the crystals dissolve back into the blood, slowly, over months to years. Attacks can still come in the first months, so a preventive medicine is usually taken alongside at first, and the tablet is not stopped during a flare.
Go to hospital now if
- A hot, swollen, very painful joint for the first time, or one that feels different from your usual gout, especially with fever or chills: go to hospital now. An infection inside the joint can look just like gout and can destroy it within days.
- A new rash, peeling or blistering skin, mouth sores, fever or sore eyes after starting allopurinol or febuxostat: stop the tablet and go to hospital now. This is a rare but serious reaction.
- Severe pain in the side or back with vomiting or fever, or passing very little urine: go to hospital now. A stone may be blocking a kidney.
- Severe loose motions or vomiting while taking colchicine: stop it and see a doctor today. If you took more than prescribed, or feel very weak, go to hospital now: too much colchicine is poisonous.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
See a doctor within a week if
- You have had your first attack of gout, to plan how to prevent the next
- Attacks keep coming back
- You notice chalky lumps under the skin of the ears, elbows, fingers or toes
- A report shows high uric acid, to check the kidneys, BP, sugar and cholesterol
- You take a uric acid tablet and still get attacks, or the level has not been checked in the past year
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Serum uric acid | The level to aim below: under 6 mg/dL on treatment, lower if there are chalky lumps. It can read normal during an attack, so it is best checked again once the attack has settled for two weeks or more. |
| Joint fluid test | Fluid drawn from a swollen joint with a needle, in person. Seeing the needle-shaped crystals under a microscope is the surest proof of gout, and it rules out infection. |
| Creatinine (kidney test) | Weak kidneys raise uric acid and change which medicines and doses are safe. |
| Sugar, cholesterol and liver tests | Gout often comes with diabetes, high cholesterol and fatty liver; some gout medicines also need liver checks. |
| CBC, ESR or CRP | Raised during an attack; they help tell gout from an infection or other kinds of arthritis. |
| X-ray or ultrasound of the joint | Show long-standing crystal deposits and any joint damage. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Do not stop allopurinol or febuxostat during an attack: stopping and restarting makes attacks more likely. Take colchicine only in the dose prescribed; more does not work better and can be poisonous. Colchicine can be dangerous with clarithromycin and some antifungal and heart medicines, and allopurinol or febuxostat with azathioprine, so tell the doctor every medicine you take. Painkillers such as diclofenac or nimesulide can harm the kidneys and stomach, so check before using them, especially with kidney disease. Food and drink changes help, but on their own they usually lower uric acid only a little.
A video call can
- Recognise the pattern of gout and check for warning signs
- Plan treatment of an attack that is safe for your kidneys, stomach and heart
- Decide whether and when to start a uric acid tablet, and raise the dose step by step with blood tests
- Review other medicines that raise uric acid
- Advise on food, drink and weight, and follow up
Needs a visit in person
- Examining a swollen joint
- Drawing fluid from the joint, or a steroid injection into it
- X-ray or ultrasound of the joint
- Any sign in the red box: that is an emergency
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759