What are the Causes, Treatment, and Medications for Chronic Gout?

Acute and Chronic gout
Medically reviewed by Dr. Mandy Liedeman


Chronic gout is a type of arthritis caused by uric acid crystals in joints, causing discomfort, stiffness, and swelling. Symptoms include joint pain, redness, warmth, and swelling. Treatment includes medication to reduce inflammation and uric acid, as well as lifestyle changes.

What is Chronic Gout?

The accumulation of uric acid crystals in the joints leads to arthritis, known as chronic gout. The big toe is primarily affected, but other joints, including the knees, ankles, and wrists, can also be affected. Chronic gout is a chronic disorder that worsens over time and can cause joint damage, disability, and a worse quality of life. According to the National Center for Biotechnology Information, gout sufferers have a higher death rate from cardiovascular disease and renal failure than the general population. In some countries, the prevalence of gout is as high as 10% in the adult population. Gout is more common in developed countries and has been increasing in recent years. According to PubMed, the prevalence of gout among adults aged 18 years or older increased from 3.9% in (2007-2008) to 4.9% in (2015-2016).

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Types of Gout:

There are several types of gout, including:

Acute Gout: This is the most common type of gout and is characterized by sudden, intense episodes of pain, swelling, redness, and warmth in one or more joints. These episodes can last for several days to a few weeks. Studies have shown that acute gout attacks occur in around 75 to 85% of people with gout.

Chronic Gout: This type of gout occurs when gout attacks frequently happen and over time, leading to joint damage and loss of function. According to a study, the prevalence of chronic gout is around 5 to 10%.

Tophaceous Gout: This severe type of gout is caused by the formation of tophi, which are hard, lumpy masses that develop in the joints and surrounding tissue as a result of the accumulation of uric acid crystals. Tophaceous gout affects around 10 to 15% of people with gout.

Asymptomatic Hyperuricemia: This is when a person has elevated levels of uric acid in the blood but does not have any symptoms of gout. A study found that asymptomatic hyperuricemia affects around 20 to 30% of people with gout.

Symptoms of Gout:

The symptoms of gout typically occur in sudden, severe attacks and can include the following:

Intense Joint Pain:  Gouty joints are frequently swollen, inflamed, and excruciatingly sensitive to the touch. The pain is often described as a burning or stabbing sensation and is most severe in the first 12 to 24 hours of an attack.

Swelling and Inflammation: The joint affected by gout may become swollen and inflamed, and the surrounding skin may be red and warm to the touch.

Stiffness and Limited Range of Motion: During a gout attack, the affected joint may feel stiff and difficult to move, making it difficult to perform everyday activities.

Tenderness and Sensitivity: The affected joint may be very tender and sensitive to the touch, even with the slightest pressure.

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Causes of Gout

The leading causes of gout are the high amount of uric acid in the blood, either due to the body producing too much uric acid or the kidneys being unable to eliminate it effectively. Other causes include:

Genetics: Gout tends to run in families, and some people have a genetic predisposition to the condition. Studies have also shown that certain genetic variations in genes involved in uric acid metabolism, such as the SLC2A9 and ABCG2 genes, are associated with an increased risk of gout. Furthermore, individuals with a family history of gout are more likely to develop the condition themselves and at an earlier age. 

Diet: Consuming a diet that is high in purines, such as organ meats, red meat, and seafood, can increase the risk of gout.

Medications: A few drugs, like diuretics and low-dose aspirin, can make it more likely to have gout.

Alcohol Consumption: Consuming excessive amounts of alcohol can raise the risk of gout by increasing uric acid levels in the blood.

What Causes Gout in Feet?

Gout in the feet is instigated by the buildup of uric acid crystals in the joints, particularly in the big toe. The crystals form when there is an excess of uric acid in the blood, a condition known as hyperuricemia. The leading cause of hyperuricemia and foot gout is an imbalance between the body’s uric acid synthesis and excretion.

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What Makes you Susceptible to Gout?

Specific medical conditions may increase gout risk. In this regard:

Kidney disease: Individuals with chronic kidney disease have a higher risk of developing gout due to the kidneys’ role in removing uric acid from the body. When the kidneys are not functioning correctly, uric acid can build up in the blood and increase the risk of gout. 

Hypertension: High blood pressure can increase the risk of gout by affecting the kidneys’ ability to excrete uric acid.

Diabetes: Individuals with diabetes have an increased risk of gout due to high blood sugar levels, which can affect the body’s ability to excrete uric acid. 

Medications: Certain medications, such as diuretics and low-dose aspirin, can increase the risk of gout by affecting the body’s ability to excrete uric acid.

It is worth mentioning that gout can occur at any age, but it is more common in men and people over 40.

How to Diagnose Chronic Gout?

Chronic gout is diagnosed using a combination of methods, including physical examination, medical history, laboratory tests, and imaging tests. During the examination, the doctor will look for signs of inflammation, such as redness, warmth, and swelling in the affected joint, and may also check for the presence of tophi. The doctor will also take a detailed medical history and order laboratory tests to measure uric acid levels in the blood and joint fluid. Imaging tests like X-rays or MRIs may be used to monitor the progression of the disease and to rule out other conditions.

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Chronic Gout Prevention

Prevention of chronic gout involves a blend of lifestyle changes and medication. Lifestyle variations may include maintaining a healthy weight, eating a diet low in purines, and avoiding alcohol and foods high in fructose. Allopurinol and febuxostat are two drugs that can help decrease uric acid levels and stave off gout attacks.

Chronic Gout Treatment

Treatment for chronic gout typically involves medications to condense inflammation, relieve pain, and lower uric acid levels. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are often used to reduce pain and inflammation. Colchicine is also commonly used to relieve gout attacks. Allopurinol and febuxostat are two drugs that can help decrease uric acid levels and prevent further attacks. In some cases, corticosteroids may be used to control inflammation. In advanced cases, joint replacement surgery may be necessary.

Gout Medication

Several medications can be used to treat chronic gout, defined as gout that occurs frequently or is not responsive to traditional treatment. These medications include:

Uric Acid-Lowering Therapy: To reduce blood levels of uric acid and stop gout attacks, people use drugs, including allopurinol, febuxostat, and probenecid. These medications are usually taken long-term to prevent recurrent gout attacks.

Colchicine: Colchicine is an anti-inflammatory medication that can be used to treat acute gout attacks. It is typically used with uric acid-lowering therapy to manage chronic gout.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs such as ibuprofen and naproxen can reduce inflammation and pain during acute gout attacks. However, these medications should be used cautiously, as they can cause stomach ulcers and bleeding.

Corticosteroids: Injections of corticosteroids, such as triamcinolone or methylprednisolone, can reduce inflammation and pain during acute gout attacks. These medications can be very effective, but they should be used with caution as they can cause side effects such as weight gain and increased risk of infection.

Canakinumab: A human monoclonal antibody that targets interleukin-1β, is an alternative treatment for gout in patients with a history of inadequate response to conventional therapy, contraindications to conventional therapy or intolerance to conventional therapy.

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How to Manage It?

Managing chronic gout involves lifestyle changes, medications, and other treatments. Here are some ways to manage chronic gout:

Lifestyle Modifications:

Maintaining a Healthy Weight: Being overweight or obese can increase the risk of developing gout. Losing weight through diet and exercise can lower the risk of gout and reduce the frequency of gout attacks.

Avoiding Triggers: Certain foods and drinks, such as alcohol, red meat, and seafood, can trigger gout attacks. Avoiding these triggers can help to reduce the frequency and severity of attacks.

Staying Hydrated: Drinking enough water can help to flush out the uric acid from the body and reduce the risk of gout attacks.

Exercise: Regular exercise can help to maintain a healthy weight, reduce stress, and improve overall health, which can help to reduce the risk of gout attacks.

Dietary Changes:

Eat a Healthy Diet: Eating a diet rich in fruits and vegetables, whole grains, and lean protein can help maintain a healthy weight and reduce the risk of gout.

Limit Foods High in Purines: Purines are compounds found in certain foods and drinks and can raise uric acid levels. Foods high in purines include organic meats, red meat, seafood, and alcohol. Limiting these foods can help to reduce the risk of gout attacks.

Eat Low-fat Dairy Products: Eating low-fat dairy products, such as milk, yogurt, and cheese, can help to reduce the risk of gout by lowering the levels of uric acid in the blood.

Drink Coffee: Drinking coffee may lower the risk of gout. This is believed to be due to the presence of caffeine and other compounds in coffee that may help to reduce inflammation and improve kidney function.

Avoid Sugary Drinks: Consuming sugary drinks, such as soda and fruit juice, can lead to weight gain and increase the risk of gout. This is because consuming high amounts of sugar can cause a spike in uric acid levels in the blood, which can lead to the formation of uric acid crystals and gout. Additionally, sugary drinks are often high in calories, which can contribute to weight gain and obesity, which is a risk factor for gout.

Other treatments:

  • Crystallization inhibitors, such as pegloticase, may be used to dissolve tophi (hard lumps of uric acid crystals that form under the skin)
  • Physical therapy, such as ultrasound and therapeutic exercises, may help manage gout.
  • Surgery may be an option in some cases, such as a joint replacement for severe joint damage.
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When to consult a doctor? 

It is important to note that gout is a symptomatic disease that can only be treated with proper medical care and assistance.

The day you start getting symptoms should be the day you will get medical aid.

If gout is at the chronic stage, it needs specific yet longtime treatment.

Your doctors online team has professional medical doctors that can help you to get out of chronic gout symptoms as soon as they can.

Do not let the disorder beat your lifestyle instead, let our doctors beat your disorder!

FAQs about Acute and Chronic Gout Pain Answered by Your Doctors Online Team

How to get rid of gout quickly?

The following are the best ways to get rid of gout quickly:
1. Stay hydrated( drink plenty of water)
2. Consult a doctor
3. Take prescribed gout medications 
4. Avoid uric acid-enriched foods

Is gout life-threatening?

Gout is associated with several medical conditions one of the most prevalent disorders is a risk of cardiovascular events and death. Several studies have shown that increasing gout severity may lead to a higher risk of death, and is reflected in the number of tophi.

What is the main cause of gout?

Following are some most highlighted causes of gout
1. Hyperuricemia
2. Diabetes
3. Kidney dysfunction
4. Metabolic disturbances
5. High intake of uric acid-enriched foods
6. Alcohol intoxication 

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