Gout Explained: What Causes Flare-Ups and How to Manage Them

Causes of Gout

Gout occurs when uric acid (urate) builds up in the body and forms needle-shaped crystals in a joint. Uric acid forms when the body breaks down purines, which are found naturally in the body and in many foods.

Normally, uric acid is filtered by the kidneys and removed in urine. When the body makes too much or the kidneys do not remove enough, uric acid levels rise and crystals can form.

Factors that may contribute to gout include:

• A diet high in purine-rich foods (certain meats and seafood)
• A family history of gout
• Chronic kidney disease
• Drinking alcohol
• High blood pressure
• Higher urate levels
• Increasing age
• Being overweight or having obesity
• Sugar-sweetened beverages
• Certain medications, such as diuretics

Metabolic syndrome, which includes conditions such as high blood pressure, insulin resistance, high triglycerides, and abdominal obesity can also contribute to a gout flare. These conditions often occur together and can raise uric acid levels.

How is Gout Diagnosed?

Gout can resemble other joint conditions, so diagnosis begins with a review of symptoms, medical history, and a physical exam. Your physician may ask when the pain started, how often flares occur, and whether you have conditions or take medications that increase the risk. Diagnostic tools may include:

• A physical exam
• A blood test to check urate levels (Uric acid can be normal during a flare, so this test alone cannot confirm or rule out gout.)
• Joint fluid analysis to look for urate crystals
• Imaging tests such as an ultrasound or a dual-energy CT scan, when needed

“Joint pain can have many causes, so it is important to take the time to understand what is behind your symptoms,” said Dr. Anand. “We look closely at what you are feeling, your health history and, when needed, lab work or imaging so we can make the right diagnosis and help you feel better.”

Complications of Gout

Left untreated, gout can lead to long-term problems, including:

• Tophi (hard uric acid crystal deposits that form under the skin)
• Joint damage or deformity
• Persistent inflammation
• Kidney stones
• Worsening kidney function, especially in people with existing kidney disease

Gout Treatment

Gout treatment focuses on reducing pain during a flare and preventing future flares by lowering uric acid levels. Common treatments include:

• Anti-inflammatory medicine — Over-the-counter or prescription
• Colchicine — This medicine can help relieve gout pain and works best when taken early in a flare.
• Corticosteroids — Taken orally or by injection
• Urate-lowering therapy (ULT) — Considered for patients with recurrent flares, tophi, joint damage, or persistently high uric acid levels. Some medications reduce uric acid production; others help the body eliminate more of it.

“We want to do more than treat the pain you feel today,” added Dr. Anand. “Our goal is to help you get relief during a flare, lower the chance of future attacks and protect your joints over time.”

Lifestyle Changes

Medication is often essential, but daily habits also play a key role. Helpful changes include:

• Losing weight if needed
• Avoiding alcohol
• Limiting sugary drinks, such as soda
• Reducing red meat, organ meats and certain seafood
• Eating more fruits, vegetables, whole grains and low-fat dairy
• Drinking plenty of water
• Following a healthy eating plan, such as the DASH diet
• Resting, icing and elevating the joint during a flare

For some people, lifestyle changes may not be enough. If flares are frequent or tophi are present, long-term medication may be recommended.

If you have sudden joint pain, swelling or redness, do not ignore it. A Catholic Health physician can help determine whether gout or another condition is causing your symptoms and recommend the right treatment.

Our team can help you manage flares, lower your risk of complications and build a plan to help prevent future attacks.