Gout is a form of arthritis caused by crystals that form in the joints from too much uric acid in your blood. When uric acid builds up in the fluid around your joints, it can form tiny crystals called urate crystals. Urate crystals can cause pain and swelling in these joints. These attacks often happen in the big toe but can also affect joints like your elbows, knees, hands, or ankles. Flares, or sudden gout attacks, can come on quickly and be very painful. Some people develop tophi, which are firm lumps of uric acid crystals that can develop under the skin after years of uncontrolled gout.
There are two types of gout, and knowing the difference can help you manage your symptoms.
Kidney disease can increase your risk for gout, and having gout may affect your kidneys. Gout happens when there is too much uric acid in your blood. Uric acid is a waste product. Healthy kidneys remove uric acid from your blood in your urine (pee). Sometimes uric acid gets too high. This can happen when your body makes too much uric acid. It can also happen when your kidneys do not remove enough uric acid. If you have gout or high uric acid, ask your doctor to test for kidney disease.
People with gout have a higher risk of developing chronic kidney disease (CKD), and people with CKD are more likely to develop gout because the kidneys cannot remove uric acid as effectively. Uric acid can build up and form urate crystals as your blood is filtered through your kidneys. As the urate crystals pass through your kidneys, they can be painful and damage your kidneys by causing damage and scarring, especially if your gout is left untreated. Researchers continue to study exactly how gout and kidney disease influence one another. Treating gout and managing uric acid levels may help reduce complications.
About 1 in 10 people with chronic kidney disease (CKD) also have gout, and about 1 in 4 people with gout have CKD.
Learn the truth about gout and kidney disease. Download your free booklet about gout.
Gout attacks, also called flares or flare ups, come on suddenly and can become extremely painful.
These attacks can last from a few hours to several days and are more likely to happen in the morning or at night. You may even have a gout attack while you are sleeping. Gout symptoms can vary depending on the type of gout you have, but it often begins with pain in one joint, usually the big toe.
Early signs of a gout flare may include:
Symptoms of a gout flare often include:
Gout flares also commonly affect the knees, ankles, elbows, wrists and fingers.
These attacks can last from a few hours to several days and may go away on their own, but gout can become more frequent and severe if left untreated.
Use this guide will help you track your gout flares as well as important tests related to gout and kidney disease. Bring this guide with you to your doctor visits so you can work together to figure out a gout treatment that makes sense for you.
Gout can affect anyone, even people who don't have a family history of gout. Some groups are more likely to develop gout due to a combination of biological and lifestyle factors. Biological risk factors are physical or genetic traits that can make you more likely to develop a disease. Gout can cause sudden and severe joint pain, especially in the knees and feet.
Demographics at higher risk include:
Having certain health conditions can also increase your risk of gout, including:
Certain factors can also trigger a gout flare, including:
Understanding risk factors is the first step to protecting your kidney health. Learn how other conditions like high blood pressure and diabetes can increase your chances of developing kidney disease. Learn more.
Certain medicines can increase uric acid or damage kidneys, including:
Frequent or long-term use of NSAIDs may increase the risk of kidney injury, especially in people who already have kidney disease. Talk to your doctor about how to manage your use of NSAIDs.
Gout is more common in the Hmong community than in other groups. Download our guide to learn more.
If you think you might have gout, it's important to get diagnosed by a doctor so that you can get the treatment you need. The tests can include:
Synovial fluid test
The synovial fluid test is the most accurate test for gout. Synovial fluid is a liquid found in your joints. This test examines the fluid for urate crystals that indicate that you have gout.
A synovial fluid test only takes a few minutes. You may first be given anesthesia, a medicine to numb the area, through a shot using a small needle.
Uric acid test
Doctors use blood and urine tests to check uric acid levels, which can help diagnose gout. A normal range without any symptoms is 3.5–7.2 mg/dL in blood and 250–750 mg in urine (collected over 24 hours).
Neither the uric acid blood nor the urine test should be used alone when diagnosing gout. Doctors use the results together with other tests to confirm.
Imaging tests
To confirm that your joint pain isn't due to injury, your doctor may use imaging tests, like an X-ray or ultrasound, to diagnose gout.
If you don’t have a gout specialist, use this “Find a Gout Specialist” tool to identify healthcare professionals who are experienced treating chronic gout.
Gout is a long-term condition that can be managed. While there is no cure for gout, treatment and lifestyle habits can help reduce swelling, manage pain, shorten how long a flare lasts and prevent future attacks.
Your doctor may recommend a medicine called allopurinol (Zyloprim) to help lower uric acid levels and lower risk of future gout flares. The American College of Rheumatology Guideline recommends starting with a low dose and working with your doctor to slowly increase as needed while monitoring your kidney function and uric acid levels.
Most people taking urate-lowering medicine have a treatment goal of lowering their blood uric acid level to below 6mg/dL. Your doctor may recommend a different goal depending on your condition.
Medicines used for gout may also include:
If your gout is severe or difficult to control with other uric-lowering medicines, your doctor may prescribe a medicine called pegloticase (Krystexxa®), which is given by IV (through a vein) to help your body remove uric acid more quickly.
Some medicines like ibuprofen or high-dose aspirin may not be safe if you have kidney disease and gout. Ask your doctor if you need to stop taking these medicines.
Other ways to help during a flare:
Do not stop taking a uric acid-lowering medicine during a gout flare unless your doctor tells you to.
If you have a hard time paying for your prescription medicines or treatments, help may be available. Learn more on how you can find financial assistance through prescription assistance programs (PAPs) and resources that may help lower your medicine costs.
People on dialysis have a higher risk of developing gout because their kidneys are unable to remove uric acid effectively from the body. Although dialysis removes some uric acid from the blood, it may not completely prevent gout flares.
Treatment decisions should be individualized because some gout medicines require dose adjustments or may not be appropriate while receiving dialysis. If you are on dialysis, talk with your doctor and members of your care team about your treatment and medicines. You may need to start, stop, or adjust your medicines. Your care team can help you choose the safest treatment options to manage gout while on dialysis.
Gout can happen after a kidney transplant because some anti-rejection medicines can increase uric acid levels and affect how your body removes it. If you have a kidney transplant, tell your care team if you develop any gout symptoms so they can monitor uric acid levels and kidney function with regular follow-up visits and blood tests.
Some anti-rejection medicines, such as cyclosporine (Sandimmune®, Neoral®, Gengraf®) and tacrolimus (Prograf®), can increase uric acid levels, making gout more common after transplantation.
Don’t stop taking your anti-rejection medicines unless instructed by your doctor.
In addition to taking medicine, healthy habits and lifestyle changes can help lower how often you have gout flares and support your overall health:
For people with gout, limiting foods high in purines may help manage gout flares. Purines are chemicals in your body and food that can create uric acid.
Foods high in purines include:
Some seafood (shellfish, anchovies, mussels, trout)
Foods and drinks with high-fructose corn syrup (sodas, processed foods, baked goods, etc.)
Remember to take urate lowering medicine exactly as prescribed, even when you are not having a gout flare.
Most doctors now offer health visits by video or phone instead of in person at their office. This is called a telehealth visit or a virtual doctor's visit. Your doctor will let you know if you can have a virtual visit or if you need to come to the office.
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