Gouty Arthritis: What It Is, Causes, and Signs of Joint Involvement

Gouty arthritis is joint inflammation caused by uric acid crystals. An attack begins suddenly, often at night, and may resolve on its own within a couple of weeks; there are usually no symptoms between attacks, but attacks can recur. Below is what is known about the causes, signs, and diagnosis of gout.

What gouty arthritis is

Gout is a systemic chronic metabolic disease: crystals of urates, sodium monourate, or uric acid are deposited in various tissues. It manifests as recurrent acute arthritis and gouty nodules called tophi, and one of its main manifestations is kidney damage.

Gout is also described as a common type of inflammatory arthritis: pain, swelling, and redness in one or more joints. Hyperuricemia is detected in 4–12% of the population; in the US and Europe, about 2% of residents have gout, and among men aged 55–65 it is 4–6%. Men are affected more often: the ratio to women ranges from 7:1 to 19:1; the peak in men is at 40–50 years, and in women at 60 years and older.

Why joints become inflamed in gout

Uric acid is a breakdown product of purines, which are present in body tissues and in food. The kidneys excrete it in urine. When too much acid is produced or too little is excreted, its level in the blood rises — this is hyperuricemia. By itself it causes no problems, but in some people needle-shaped crystals form; in a joint they cause inflammation and pain, and they can also lead to kidney stones.

The likelihood of gout is higher in men, in middle age, with obesity, heart failure, hypertension, metabolic syndrome, chronic kidney disease, accelerated cell breakdown (psoriasis, certain tumors), hereditary diseases, and a family history. Contributing factors include excess purines in food (red meat, organ meats, certain seafood), alcohol, fructose, diuretics, low-dose aspirin, certain immunosuppressants, high doses of niacin, as well as menopause, elevated cholesterol, osteoarthritis, diabetes, surgery, and injuries.

An attack is often triggered by a high fever during illness, excess alcohol or a very heavy meal, dehydration, joint injury, or taking certain medications.

Signs of gouty arthritis

The typical picture is sudden severe pain in a joint, usually the big toe; other toes, the foot, ankle, knee, hands, wrist, and elbow may also be affected. The skin over the joint is hot, swollen, and red, although redness is harder to notice on dark skin. An attack often starts at night, and the pain can be so severe that it wakes the person. Without treatment it lasts 1–2 weeks, and subsequent attacks may last longer; there are usually no symptoms between them.

• severe joint pain, often at night;
• swelling and heat around the joint;
• redness of the skin over the joint;
• symptom-free intervals between attacks.

Gout and gouty polyarthritis: what the difference is

Gout is the name of the disease, a metabolic disorder; gouty arthritis is its joint manifestation. The word "polyarthritis" refers to inflammation of several joints at once, and this is not the typical picture for gout: an attack more often affects one joint. If the disease is left untreated for a long time, attacks become more frequent and tophi appear — dense deposits under the skin, usually on the ears, fingers, or elbows; they can be painful, change the shape of joints, and damage bones and soft tissues.

How gout is diagnosed

The doctor asks about symptoms, diet, and alcohol, examines the joints, and may order a blood test for uric acid. If the picture is unclear, the patient is referred to a rheumatologist: fluid is taken from the joint with a thin needle and examined under a microscope to look for urate crystals; a urine test, ultrasound, or a special computed tomography scan is performed. Similar symptoms occur in pseudogout, which is sometimes confused with gout.

Complications and when to see a doctor

Without treatment, repeated attacks lead to joint damage, tophi, kidney stones, and in rare cases chronic arthritis. A doctor should be seen at the first symptoms of gout and when the usual treatment has stopped helping.

Gout by itself is not a reason to call an ambulance. If, against a background of sudden joint pain and swelling, the pain intensifies, a very high fever develops, chills, nausea, or inability to eat appear — this may be an infection inside the joint, and emergency medical care is needed; 103/112 — for a sharp deterioration in condition.

This material is for reference: it explains how the disease works but does not replace a doctor's consultation — tests and treatment should be discussed with a specialist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer