Gout: Symptoms, Risks, Diagnosis, and Treatment Guide
by Princeton Orthopaedic Associates
Gout: Symptoms, Risks, Testing, and Treatment
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.
