Gout

Gout is a form of arthritis caused by crystals of uric acid forming in a joint. It usually presents as a sudden, severe, red, hot, swollen joint — most often the big toe — that comes on overnight and is excruciatingly painful. Rising uric acid levels (from diet, alcohol, obesity, some medicines, kidney function) cause crystals to settle in joints and soft tissues.

Acute attack — classic presentation

• Sudden severe pain, usually overnight.
• Big toe (most common), ankle, knee, wrist, fingers.
• Hot, red, swollen; hypersensitive to light touch.
• Fever sometimes.
• Resolves over 3-10 days, treated or not — but treatment speeds it up and prevents damage.

Red flags — rule out infected joint

A single hot, swollen, painful joint can be septic (bacterial) arthritis — a medical emergency — not gout. If you have fever and don't look right, go to the hospital; joint-fluid aspiration distinguishes.

Risk factors

• Male sex, age.
• Obesity, metabolic syndrome.
• Diet — red meat, organ meat, seafood, sugary drinks, fruit juices, high-fructose products.
• Alcohol — especially beer and spirits.
• Kidney disease — reduces uric acid clearance.
• Medicines — thiazide diuretics, some others.
• Genetics, family history.
• Dehydration.

Treatment

• Acute attack — NSAIDs, anti-crystal medicines, or short-course steroids (oral or injected into the joint). Starting early shortens the attack.
• Ice and rest the joint.
• Hydration.
• Between attacks — urate-lowering therapy for frequent attacks, joint damage, tophi (visible nodules), or kidney stones. Take daily, for life in most cases; keeps uric acid below 6 mg/dL.
• Don't stop urate-lowering tablets during attacks — changing levels worsens the attack.

Lifestyle — what helps

• Weight loss (gradual; crash diets can trigger attacks).
• Cut alcohol — especially beer and spirits.
• Cut sugary drinks, fruit juices, high-fructose sweets.
• Moderate meat and seafood portions; limit organ meats.
• More low-fat dairy (protective).
• Cherries, vitamin C, plenty of water.
• Treat high BP, diabetes, fatty liver, kidney disease — often co-exist with gout.