What Is the Main Cause of Gout?

People can be genetically predisposed to gout or gouty arthritis, but diet is the main culprit in flares.

Gout is a type of inflammatory arthritis that causes pain and swelling in the joints. Gout may develop in some people who have a chronic condition characterized by high levels of a substance called urate (uric acid) in the blood (hyperuricemia), though not everyone with hyperuricemia develops gout.

Recurring bouts of gout can lead to gouty arthritis, which is a worsening form of arthritis.

Gout is not the same as calcium pyrophosphate crystal deposition (CPPD) disease (formerly called "pseudogout"), which is a condition that develops in some people in response to the presence of a type of crystal known as a calcium pyrophosphate (CPP) crystal.

Symptoms of gout can come and go. When gout symptoms worsen it is called gout attack or flare, and remission is a period of no symptoms.  

Symptoms of gout attacks (flares) include: 

• Sudden episodes of severe joint pain
  • Usually involves redness, swelling, heat, and tenderness of the joint
  • Typically affects a single joint, but some people can develop several inflamed joints at the same time
  • Common in the big toe, and also in lesser toe joints, ankle, and knee
  • Tends to occur more often during the night and early morning than during the day, though can occur any time
  • Pain and inflammation are at their worst within 12 to 24 hours and usually go away completely within a few days to several weeks, even if untreated
• May be accompanied by fever 

Flares are usually followed by periods of remission that can last weeks, months, or years where patients have no symptoms. 

Gout is usually caused by too much uric acid in the body (hyperuricemia). When there is excess uric acid in the body, uric acid crystals (monosodium urate) can accumulate in the joints, fluids, and tissues of the body. Hyperuricemia does not always cause gout, and hyperuricemia without gout symptoms does not require treatment.

Risk factors for developing gout include:

• Obesity
• Certain health conditions, including: 
  • Congestive heart failure
  • high blood pressure (hypertension)
  • Insulin resistance
  • Metabolic syndrome
  • Diabetes
  • Chronic kidney disease/poor kidney function
• Overeating or prolonged fasting
• Consuming large amounts of meat or seafood
• Excessive and regular consumption of alcohol (especially beer, vodka, whiskey, gin, or rum) 
• Consuming beverages containing high fructose corn syrup (such as regular sodas)
• Use of medications that affect blood levels of urate, such as diuretics (water pills)
• Being male
• Having a diet high in purines, which the body breaks down into uric acid
  • Purine-rich foods include red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna

In people already diagnosed with gout, risk factors for repeated gout flares include:

• Injury 
• Recent surgery
• Fasting
• Excessive and regular consumption of alcohol 
• Overeating
• Taking medications that induce sudden changes in blood urate levels
• Dehydration

Gout is only able to be diagnosed during a flare when a joint is hot, swollen, and painful, and when the fluid lining the affected joint (synovial fluid) is examined under a microscope to check for urate crystals.

If a synovial fluid analysis is not possible, criteria that may be used to help diagnose gout are:

• Joint pain and inflammation that develops rapidly, initially involving one joint at a time, especially the joint at the base of the large toe
• Complete remission of symptoms between flares
• High levels of urate in the blood 

Treatment of gout flares is aimed at reduction of pain and inflammation, and is usually short-term and limited to the duration of the flare. 

Medications used to treat gout flares include anti-inflammatory medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve, Anaprox)
  • Indomethacin (Indocin)
  • Celecoxib (Celebrex)
• Colchicine (Colcrys)
• Glucocorticoids
  • Prednisone
  • Prednisolone
  • Methylprednisolone

For people who have tophi (clumps of uric acid crystals around a joint) and kidney stones, medications include: 

• Allopurinol (Zyloprim)
• Febuxostat (Uloric, Adenuric)
• Pegloticase (Krystexxa)

Complications of gout include: 

• Kidney stones, due to medications used to treat gout
• Tophi, which are clumps of uric acid crystals that can form under the skin on joints and cartilage
• Joint damage and deformity
• Kidney disease and kidney failure
• Psychological and emotional problems due to constant pain and inability to perform everyday activities

Preventing gout flares includes: 

• Weight loss
• Limiting or avoiding alcohol
• Eating less purine-rich food (like red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna)
• Changing or stopping medications associated with hyperuricemia (like diuretics) 
  • Don’t stop taking any prescribed medication without first talking to your doctor
• Colchicine (Colcrys) as preventive therapy (usually a short-term treatment)