Gout
What Is Gout?
Gout is a disorder that causes sudden, severe attacks of intense pain, swelling, redness, and tenderness in joints or soft tissues. In many cases, gout first attacks the joint at the base of the big toe, but it can affect many other joints throughout the body. This painful condition develops when too much uric acid builds up in the bloodstream, forming microscopic needle-like crystals that deposit in joints or soft tissues.
The body reacts to these uric acid crystals as if they were foreign invaders or bacteria. White blood cells and other infection-fighting cells rush to the area, causing intense inflammation. This inflammatory response creates symptoms that can look remarkably similar to an infection—the affected area becomes red, hot, swollen, and extremely tender to even the lightest touch. Acute gout attacks typically last three to ten days. While symptoms slowly improve on their own even without treatment, proper medical intervention can provide much faster relief.
Gout can affect various tissues in the body. Joints are the most commonly affected structures, particularly the big toe joint, though small joints in the fingers and large joints such as the knee, ankle, shoulder, elbow, and hip can also be involved. Bursae (fluid-filled cushioning sacs located throughout the body) can become inflamed with gout crystals, particularly the olecranon bursa at the elbow tip and the prepatellar bursa at the front of the kneecap. Tendon sheaths in the hands and feet can also be affected. Additionally, high uric acid levels may cause kidney stones and sometimes kidney damage, affecting approximately 15 percent of people with gout.
Without proper treatment, gout typically progresses over time. After the first attack, months or years may pass before another occurs. However, people not taking preventive treatment usually experience another attack within two years. Over time, attacks tend to become more frequent, more severe, and may affect multiple joints simultaneously. Repeated gout attacks can cause permanent joint damage in the form of arthritis. If uric acid levels remain elevated for prolonged periods, chalky deposits called tophi can develop around joints and tendons, creating visible lumps under the skin. When properly treated, most cases of gout will not progress to this disabling chronic stage.
Nonsurgical Treatments
The vast majority of gout cases can be effectively managed without surgery. Our doctors offer comprehensive nonsurgical treatments to control acute attacks, prevent future episodes, and protect long-term joint health.
Lifestyle Modifications
Lifestyle changes play a crucial role in managing gout. Maintaining a healthy body weight through balanced diet and regular exercise can significantly reduce gout attacks. Drinking plenty of water helps flush uric acid from the system. Dietary modifications include reducing calorie intake (especially from fats), avoiding sugary drinks and added sugars, eating complex carbohydrates like beans, brown rice, nuts, oatmeal, and starchy vegetables, and getting protein primarily from low-fat dairy products rather than meat and seafood, which are high in purines. Avoiding or significantly limiting alcohol consumption is also important for gout management.
Medications & Injections
For acute attacks, over-the-counter, non-steroidal, anti-inflammatory drugs (such as ibuprofen or naproxen) may provide relief for mild attacks. Prescription-strength NSAIDs like indomethacin may be necessary for more severe symptoms. Colchicine is specifically FDA-approved for gout treatment and works by reducing inflammation during acute attacks. Corticosteroids, available as pills, intravenous medications, or joint injections, can dramatically improve severe inflammation. For long-term management, medications such as allopurinol (which reduces uric acid production), probenecid (which helps kidneys filter out more uric acid), and febuxostat (an alternative for patients who cannot take allopurinol or probenecid) can prevent future attacks by controlling uric acid levels.
Physical & Occupational Therapy
During acute attacks, rest is essential—moving the affected area as little as possible helps reduce pain. Between attacks, maintaining regular physical activity helps preserve joint range of motion and strengthen supporting muscles. Low-impact exercises are particularly beneficial for overall health and weight management without stressing affected joints.
Supportive & Assistive Devices
During acute gout attacks, applying ice to the affected area for about 20 minutes at a time (using an ice pack or wrapping ice in a towel, never applying ice directly to skin) can reduce swelling. Elevating the affected joint frequently above heart level also helps decrease inflammation and pain.
Surgical Treatments
Surgery for gout is rarely needed and is reserved for specific complications that cannot be managed with medication and lifestyle changes. When surgery is necessary, the right approach depends on the specific problem being addressed.
Tophi Removal
Large nodules of uric acid (tophi) that have accumulated around joints, tendons, or bursae may need surgical removal if they remain painfully inflamed, break open and drain, become infected, or significantly interfere with joint function. This procedure involves excising the chalky tophi deposits to relieve symptoms and restore function.
Joint Fusion
If chronic gout has caused permanent joint destruction in smaller joints, fusion surgery may be recommended to eliminate painful motion. This is most commonly performed in the big toe joint, where fusion can provide significant pain relief while maintaining the ability to walk. The procedure stabilizes the joint by surgically joining the bones together.
Joint Replacement
When gout leads to end-stage arthritis in larger joints, particularly the knee, joint replacement surgery may be recommended. This procedure involves removing the damaged joint surfaces and replacing them with artificial components. The goal is to provide substantial pain relief while restoring joint movement and function, allowing patients to return to daily activities with improved quality of life.
Infection Management
On rare occasions, an acute gout attack may be accompanied by a bacterial infection in the joint. This requires urgent surgical intervention to wash out the bacteria from the joint through either an open procedure or arthroscopic surgery, depending on the joint involved. Prompt treatment of joint infections is critical to prevent permanent joint damage.