Gout is a common type of inflammatory arthritis that causes sudden, intense joint pain and swelling. In this guide, you will learn what gout is, why it happens, who is at higher risk, how we diagnose it, and the treatments that help you feel better and prevent future flares.
What Is Gout?
Gout happens when uric acid builds up in the blood and forms needle-like crystals inside a joint. Your immune system reacts to those crystals, which triggers sudden pain, redness, heat, and swelling. The big toe is the classic spot, but gout can affect the midfoot, ankle, knee, wrist, fingers, and elbow.
How Gout Feels
Sudden, severe pain that often starts at night.
Redness, warmth, and swelling at one joint.
Extreme tenderness where even a bedsheet can hurt.
Stiffness and limited motion during and after a flare.
With long-standing gout, firm bumps under the skin called tophi can develop.
Why Gout Happens
Uric acid forms when your body breaks down purines, which are found naturally in your tissues and in certain foods. When production is high or your kidneys don’t clear enough uric acid, crystals can deposit in joints and surrounding tissues. Cold areas like the big toe are common sites for crystal formation.
Who Is at Higher Risk?
Age and sex: more common in men and after menopause in women
Family history of gout or high uric acid
Chronic kidney disease or reduced kidney function
Metabolic conditions: obesity, insulin resistance, high blood pressure, high triglycerides
Medications: diuretics for blood pressure, low-dose aspirin, cyclosporine, tacrolimus
Dietary factors: frequent alcohol use, especially beer and spirits, red and organ meats, certain seafoods like anchovies and shellfish, and sugar-sweetened beverages with fructose
When to Seek Care
If you notice a new hot, swollen joint or have repeated gout flares, seek care promptly from a clinician or urgent care provider. Early evaluation helps confirm that gout is the cause, guides fast pain relief, prevents infection or other problems, and protects the joint from lasting damage. A clinician will review your health history and medicines to choose safe, effective treatment and avoid drug interactions.
Severe joint pain with redness and warmth
Fever or feeling unwell along with a hot, swollen joint can signal a joint infection (septic arthritis). Seek urgent same-day medical evaluation to rule out infection before receiving steroid injections or NSAID-only treatment.
Recurrent attacks in the same or different joints
Hard nodules near joints or the ear rim that may be tophi
How We Diagnose Gout
During your visit, a clinician will look at the painful joint and review your overall health, symptoms, and medicines. The best way to confirm gout is to take a tiny sample of joint fluid and check it under a microscope for uric acid crystals. This test helps rule out infection and other problems that can look like gout.
Joint aspiration and crystal analysis when possible
Blood tests, including uric acid level, kidney function, and markers of inflammation
Imaging when needed: ultrasound can show a double contour sign, X-rays reveal long-term changes, and specialized CT may identify crystal deposits
Treating an Acute Gout Flare
Flares respond best when treatment starts early. The main goal is to ease pain quickly, reduce swelling, and lower inflammation while protecting the affected joint from more harm. Your doctor will tailor medicines to your health history and current medicines to ensure safety and effectiveness and help you return to daily activities.
Anti-inflammatory medicines such as NSAIDs, if safe for you
Colchicine, especially when started soon after symptoms begin
Corticosteroids by mouth or a targeted joint injection
Rest, elevation, and ice for comfort
Do not stop your long-term urate-lowering medicine during a flare unless your doctor advises it. Let us know at the first sign of a flare so we can tailor treatment to your health history and medications.
Preventing Future Attacks
If you have repeated flares, tophi, kidney stones from uric acid, or moderate to advanced chronic kidney disease, you may benefit from urate-lowering therapy. The aim is to keep your blood uric acid below target so crystals dissolve and flares fade over time.
Topic
Key Points
Who Should Start Urate-Lowering Therapy
2 or more flares per year, tophi, uric acid kidney stones, or chronic kidney disease stage 3 or higher
First-Line Medicine
Allopurinol is typically first choice. Start low and increase gradually. Febuxostat is another option if needed. In patients with established cardiovascular disease, febuxostat carries an FDA boxed warning for increased risk of cardiovascular death. Use only after shared decision-making, and consider allopurinol first. Allopurinol can rarely cause severe cutaneous adverse reactions. Consider HLA-B*58:01 testing in high-risk groups (e.g., Han Chinese, Thai, Korean patients with CKD, and African American patients) before starting therapy.
Other Options
Probenecid may help if kidney function is adequate. Pegloticase is reserved for severe, refractory cases. Less effective with moderate-to-severe CKD; avoid or use cautiously in patients with a history of uric acid kidney stones; review for drug–drug interactions.
Target Uric Acid
Under 6 mg/dL is the usual goal. Under 5 mg/dL may be used if tophi are present.
Flare Prevention When Starting Therapy
Low-dose colchicine or an NSAID is often used for several months to reduce flare risk during dose adjustments.
Daily Steps That Help
Maintain a healthy weight and stay active within comfort
Limit alcohol, especially beer and spirits
Moderate high-purine foods like red and organ meats and certain seafoods
Cut back on sugar-sweetened drinks, especially those with fructose
Drink water regularly and review medications with your doctor
Possible Complications If Gout Is Not Treated
Tophi that can erode bone and limit joint motion
Progressive joint damage and arthritis
Uric acid kidney stones
How Princeton Orthopaedic Associates Can Help
Our team evaluates the painful joint, confirms the diagnosis, and builds a treatment plan that eases pain fast and prevents future attacks. When appropriate, we can perform joint aspiration or an image-guided injection and coordinate long-term urate-lowering therapy with your broader care team.
If you think you're having a gout flare or you've had recurrent attacks, schedule an evaluation. Getting ahead of flares now helps protect your joints for the long term.
This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.
Torn Meniscus: What It Is, How It Happens, and How We Treat It
Understand what a meniscus tear is, the symptoms to watch for, how it’s diagnosed, and available treatment options. Learn when it’s best to see a specialist and what recovery typically involves so you can make informed decisions about your knee health.
A torn meniscus is a common knee injury that affects the cartilage pads that cushion your thigh bone and shin bone. You may get one from twisting your knee during sports or from gradual wear as you get older. Symptoms and treatments vary, and we walk through what you can expect at each step.
Quick Facts You Should Know
Your menisci are C shaped cartilage pads that help absorb shock and stabilize the knee.
Tears can occur suddenly with a twist or develop slowly from degeneration.
Common symptoms include pain, swelling, catching or locking, and difficulty fully straightening the knee.
Treatment ranges from rest and physical therapy to arthroscopic surgery depending on the tear and your goals.
Young people often have traumatic tears from sports.
Older adults may have degenerative tears that happen with everyday activities.
Some tears can heal with nonoperative care; others need repair or trimming.
We focus on restoring function so you can return to the activities you enjoy.
The menisci are rubbery wedges of cartilage that sit between your femur and tibia. They help spread load across the knee joint, absorb shock, and add stability when you twist or change direction.
When a meniscus tears, the knee loses some of that cushioning. That can cause pain with activity, swelling, and catching sensations. Over time, untreated problems can change how the joint wears, which may increase the risk of arthritis for some people.
What a Meniscus Tear May Feel Like
Pain along the joint line, often on the inside or outside of the knee.
Swelling that can appear right away or develop over 24 to 48 hours.
A catching, locking, or a sense that the knee gives way.
Tenderness when pressing along the joint line.
Limited ability to fully straighten the knee.
Pain that increases with twisting or squatting motions.
Common Ways Meniscus Tears Occur
Tears usually come from one of two patterns. Younger people often tear their meniscus during a forceful twist, pivot, or tackle. Older adults may develop a tear from gradual wear as the cartilage weakens with age.
Traumatic injury during sports or a fall.
Twisting the knee while the foot is planted.
Degenerative changes that make the meniscus fragile over time.
Repetitive squatting or kneeling that stresses the cartilage.
How We Diagnose a Meniscus Tear
We start with a focused history and knee exam. Certain exam maneuvers help us identify likely meniscal problems, and we check for swelling, range of motion, and mechanical symptoms.
If we need to confirm the diagnosis or plan treatment, imaging such as MRI is often helpful because it shows soft tissue details. X rays can rule out arthritis or bone issues.
Treatment Options: What to Expect
Treatment depends on your symptoms, the tear type and location, your age, and your activity goals. We focus on relieving pain, restoring function, and protecting long term joint health.
Nonoperative Care
Rest, ice, compression, and elevation to control pain and swelling.
Anti inflammatory medication if appropriate and recommended by your provider.
Physical therapy to strengthen muscles around the knee and improve movement patterns.
Activity modification to avoid motions that make symptoms worse while you recover.
Procedures and Surgery
If symptoms persist or there is a mechanical block in the knee, we may recommend arthroscopic surgery. Two common approaches are meniscal repair and partial meniscectomy.
Meniscal repair aims to sew the torn pieces back together when healing potential is good. It preserves meniscus tissue and helps protect the joint long term.
Partial meniscectomy trims the damaged portion when repair is not possible. This often reduces symptoms quickly but removes some cushioning.
Typical Recovery Timelines
Recovery varies based on the treatment chosen and the tear itself. Below are common timelines to help set expectations.
Treatment
Usual Recovery
Notes
Conservative care
Several weeks to a few months
Many people improve with therapy and activity changes.
Partial meniscectomy
4 to 8 weeks for many daily activities
Return to sports may be faster but depends on rehab and surgeon guidance.
Meniscal repair
3 to 6 months
Requires protected rehab to allow healing of the repaired tissue.
When You Should See a Specialist
If your knee locks or you can not fully straighten it.
If swelling or pain does not improve with a few weeks of rest and therapy.
If you have persistent instability or can not return to your normal activities.
Who to see at Princeton Orthopaedic Associates
Specialty
When to Choose
Role
Sports Medicine
Acute injuries and nonoperative care
Diagnosis, rehab planning, and nonsurgical management
Orthopedic Surgeon (Knee)
Persistent symptoms or mechanical problems
Discuss surgical options and perform arthroscopy when needed
Physical Therapy
Recovery after injury or surgery
Hands on care and guided strengthening to restore function
Simple Steps to Reduce Your Risk
Keep leg muscles strong, especially your quadriceps and hamstrings.
Practice balance and agility drills to reduce awkward twists.
Use proper footwear and replace shoes when they wear out.
Warm up before activity and avoid sudden increases in activity level.
If you want help protecting your knee or recovering from a meniscus tear, schedule an exam with one of our specialists. We personalize care so you can get back to your life with confidence.
This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.
