Table Of Contents
What is Gout?
Gout is a common condition that causes severe and crippling pain. Gout attacks occur suddenly overnight, producing intense pain in a joint. Around half of gout cases affect the big toe but gout can affect any joint, including fingers, elbows, knees, and ankles.  Joint pain is most severe between the first four to twelve hours after an attack. However, lingering pain and discomfort can last for weeks.
Gout attacks may occur once and not happen again after treatment with medications like Zyloprim (allopurinol). However, other patients may suffer from recurrent gout several times a year.
b. How Does Gout Occur?
Purines are natural substances in the body but are also found in foods and drinks. Alcohol, red meat, and seafood are particularly high in purines. The body creates uric acid by breaking down purines. Gout is caused by a build-up of uric acid in the blood.
Uric acid usually dissolves in the blood and then passes out of the body through urine. However, when uric acid builds up, it creates sharp needle-like urate crystals. These sharp crystals trigger an inflammatory response from the body’s immune system. Gout attacks typically occur overnight because patients’ body temperatures lower during the night, which helps urate crystals to form. This is also why gout is more common in the fingers and toes, as these extremities of the body are often colder than other body parts.
c. What Causes Gout?
There are several factors that can increase the risk of gout. Gout is partially genetic and patients are more likely to develop gout if they have a close relative with the condition. Genes that result in gout often affect how uric acid is transported and absorbed in the bloodstream. 
Diet is a key factor that affects gout. Bodies produce uric acid by breaking down purines. Therefore, people that eat a lot of foods high in purines may be more at risk of this condition. Gout was historically known as ‘the disease of kings’ because it was common amongst the wealthy who could afford excessive amounts of meat and alcohol.
Bodyweight also plays a role in developing gout. Uric acid is naturally removed by the kidneys through urinating. People that are overweight or obese may have less efficient kidneys. This can limit the amount of uric acid removed from the body, increasing the risk of gout. The stomach produces a lot of the chemicals that can cause inflammation. People with more ‘belly fat’ may also be more likely to develop gout than people with body fat in other places. Obesity can also cause gout to develop earlier than it may have otherwise. Patients that are obese usually develop gout ten years before patients that are a healthy weight. 
Other health conditions can also increase the risk of gout. These include untreated high blood pressure, kidney disease, heart disease, and diabetes. 
Gout is usually diagnosed by reviewing the patient’s medical history and a physical exam. Physical tests can include joint examination, x-rays, or taking fluid samples to test for uric acid. Once gout has been diagnosed, medications are available to reduce pain and prevent future occurrences.
a. Gout Prevention Medications
Gout prevention medications are used for patients who have recurrent gout or patients that are at risk of complications such as kidney stones.
Long-term gout medications are recommended if:
- Gout attacks occur frequently.
- Uric acid has caused kidney stones.
- Joint damage is visible in x-rays.
- Tophi have already formed. 
Common medications prescribed to prevent future attacks of gout include Zyloprim (allopurinol) and Uloric (febuxostat). Allopurinol is the most commonly prescribed medication to lower levels of uric acid. Febuxostat is often prescribed if allopurinol is not successful.  These medications work by treating the cause of gout – uric acid. Febuxostat and allopurinol work by reducing the amount of uric acid that the body produces.  
b. Pain-Relief Medications
Many patients do not have recurring gout or may have mild gout that can be managed by diet. These patients may be prescribed specific pain-relief medication. These medications do not prevent future cases of gout but can relieve the pain caused by acute gout attacks. A common pain-relief medication for gout is Colcrys (colchicine). Colchicine works to treat gout by decreasing swelling and lessening the build-up of uric acid in the joints. 
Colchicine is prescribed to treat pain caused by gout and familial Mediterranean fever (FMF). However, for patients with gout pain, doctors may also prescribe other more generic pain relief medications, including nonsteroidal anti-inflammatory drugs (NSAID) such as celecoxib or corticosteroids, including prednisone.
c. Lifestyle Changes
Lifestyle changes can also help to treat and prevent gout. For patients that have mild gout, lifestyle changes can occasionally be sufficient without prescription medications.
One of the most effective ways to treat gout is for patients to alter their diets. It is important to limit or avoid foods and drinks that are high in purines. These foods include alcohol, sugar, and red meat.
As well as consuming fewer purines, overweight or obese gout patients should also try to lose weight by exercising and eating a healthy diet. Achieving a healthy body weight is another lifestyle change that can help prevent gout.
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