Gout: symptoms of an attack and what to do

What gout is and why it happens

Your body makes uric acid every day as it breaks down purines, and gets rid of it mostly through the kidneys. If the kidneys clear it slowly or the body makes too much, the level in the blood rises. Some of the uric acid then forms crystals that settle in and around the joints. The immune system reacts to these crystals, and the joint becomes inflamed.

Gout is more common in men; women usually get it after menopause. The risk is higher if you are overweight, have high blood pressure or kidney disease, or have relatives with gout.

How a gout attack starts

The pain often wakes you at night or in the early morning. At first the joint aches, then within a few hours the pain becomes severe and peaks within the first day. The joint swells, the skin over it turns red, shiny and hot, and it can hurt so much that even the weight of a blanket is too much.

Besides the base of the big toe, gout often affects the midfoot, ankle and knee, and less often the wrist, fingers or elbow.

Common triggers of an attack:

• alcohol, especially beer and spirits;
• heavy meals with a lot of meat, organ meats or seafood;
• sugary drinks containing fructose;
• dehydration, when you drink too little or sweat a lot;
• a joint injury or an illness with a high fever;
• some medicines, including certain diuretics (water pills).

Don’t stop any medicine you’ve been prescribed on your own. If you think an attack is linked to a medicine, tell your doctor.

When an attack is over, the crystals stay in the joint. Without treatment, attacks usually come back, become more frequent and spread to new joints. Over the years, tophi, hard lumps of crystals, can appear under the skin on the fingers, elbows or ears, and stones can form in the kidneys.

What to do during a gout attack

Before you see a doctor:

• rest the joint and put as little weight on the painful foot as you can;
• raise your leg on a pillow;
• apply something cold: ice or a bag of frozen vegetables wrapped in a cloth, for up to 20 minutes at a time;
• drink plenty of water and avoid alcohol;
• don’t massage, rub or warm the joint.

Only take a painkiller your doctor has recommended. Not every medicine is suitable for gout, and if you have kidney, stomach or heart problems, the choice is narrower still. If you already take medicine to lower uric acid, keep taking it during the attack unless your doctor tells you otherwise. Treatment for an attack works better the sooner it starts, so see a doctor as soon as you can after a first attack.

See a doctor the same day if the joint is red, hot and swollen and you also have a fever, chills or nausea. Septic arthritis, an infection inside the joint, can look exactly like this, and you can’t tell it apart from gout by eye, even if you’ve had gout attacks before. An infection damages the joint quickly, so it’s treated in hospital. If you have a high fever, feel very unwell or become confused, call an ambulance on 103.

How a doctor confirms gout

The doctor asks how the attack started and whether you’ve had similar ones, examines the joint and orders tests:

• a blood test for uric acid: a high level supports the diagnosis, but it can be normal during an attack, so if gout is strongly suspected, the test is repeated at least 2 weeks after the attack has settled;
• a complete blood count, inflammation markers, kidney function, glucose and cholesterol, because gout often goes together with high blood pressure, kidney disease and heart disease;
• a joint ultrasound, which shows fluid and inflammation and often crystal deposits on the cartilage;
• joint aspiration, the most accurate method: the doctor uses a needle to draw a little fluid from the joint, which is checked under a microscope for crystals and signs of infection.

At Viva Clinic, joint ultrasound is done at the polyclinic at 27a Sobornosti St. A complete blood count, glucose, cholesterol and kidney function tests are done at the Diagnost-Lab laboratory at 32 Sobornosti St, 4th floor. Ask when booking whether you can have a uric acid test and inflammation markers there as well. Joint aspiration is done in a hospital or specialized center, and the rheumatologist will tell you where to go. An X-ray shows little early in the disease, and the clinic has no X-ray, so if you need one, the doctor will tell you where to have it.

How gout is treated between attacks

Medicines for an attack calm the inflammation, but they don’t lower uric acid. If attacks keep coming back, or you have tophi, damaged joints, kidney stones or kidney disease, your doctor will usually suggest a medicine that lowers uric acid long term. It’s worth discussing this treatment after your first attack.

The dose is increased gradually, guided by blood tests. Doctors usually aim to keep uric acid below 360 µmol/L (6 mg/dL), and below 300 µmol/L (5 mg/dL) if you have tophi or frequent attacks. At that level new crystals stop forming and existing ones slowly dissolve. In the first months of treatment, attacks can become more frequent, so the doctor often adds a medicine to prevent them. Treatment usually lasts for years, often for life, and stopping it on your own once the attacks have gone isn’t a good idea: uric acid will rise again.

There’s no convincing evidence that any particular diet prevents attacks or lowers uric acid. So doctors recommend a normal balanced diet with a few limits:

• less alcohol, especially beer and spirits;
• organ meats and large portions of meat and seafood less often;
• no sugary fizzy drinks;
• enough water through the day;
• low-fat dairy products can stay in your diet.

Being overweight and drinking too much alcohol can make attacks worse, so if you need to lose weight, do it gradually.

Your treatment plan is drawn up by a Viva Clinic rheumatologist in Slavuta. Bring your test results, a list of your medicines and, if you can, a photo of the joint during an attack: by the time of your visit the swelling may have gone down. You can book by phone or on Viber.