All About Gout

This authoritative guide from the experts at Harvard Medical School will help you quickly find out what causes gout…what triggers lead to an attack…and most importantly, what treatments doctors recommend to help relieve pain and prevent it from coming back. Step-by-step, All About Gout answers your need-to-know questions about this painful arthritis-related condition you wouldn’t wish on anyone. 

All About Gout Cover

If you have ever suffered from a gout attack, you know it’s not something you’ll ever forget…and that you certainly don’t want a repeat performance!

Your toe, ankle or knee is swollen and it feels like it’s on fire. And the pain is so intense, it’s almost impossible to move around.  What can you do?

Turn to All About Gout—the authoritative online guide from the experts at Harvard Medical School. You’ll quickly find out what causes gout…what triggers lead to an attack…and most importantly, what treatments doctors recommend to help relieve pain and prevent it from coming back. 

Step-by-step, All About Gout answers your need-to-know questions about this painful arthritis-related condition you wouldn’t wish on anyone. For example…

“What causes gout?” Uric acid is your enemy. Its needle-shaped crystals are the root cause of the inflammation, redness and pain. In All About Gout, you’ll learn more about this naturally-occurring substance and how you can help keep it within safer levels.  

What role does food play?” Certain foods and alcohol may increase your risk of gout. But there are also foods that may decrease your risk.  See What About Gout for important details. 

 “Are there risk factors I can avoid?” Yes! High blood pressure and certain medications can increase your risk of a gout attack. But there are other factors, too. Be sure to see All About Gout for practical advice you can apply right away.

Are there specific gout triggers?” Watch out for anything that causes changes in uric acid—up or down. Binge-drinking alcohol (especially beer) could set off an attack. All About Gout reveals the other triggers you must know about. 

“Is it gout…or pseudo gout?” Surprisingly, six other types of arthritis have symptoms similar to gout. To be confident about getting the right treatment, see All About Gout to make sure you get the right diagnosis.

Thankfully, there IS help for treating and preventing excruciating gout attacks. 

Prepared by the editors of Harvard Health Publishing in consultation with Robert H. Shmerling, MD
Associate Professor of Medicine, Harvard Medical School, Clinical Chief, Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, Senior Editor, Harvard Health Publishing. (2018)

About Harvard Medical School Guides

Harvard Medical School Guides delivers compact, practical information on important health concerns. These publications are smaller in scope than our Special Health Reports, but they are written in the same clear, easy-to-understand language, and they provide the authoritative health advice you expect from Harvard Health Publishing.

  • Understanding gout
    • What causes gout?
    • What is uric acid?
  • Risk factors
    • The role of diet
    • Gout on the rise
  • Symptoms
    • Gout attack triggers
  • Diagnosis
    • Tests used to diagnose gout
    • Disorders with similar symptoms
  • Treatment
    • Treating gout attacks
    • Preventing gout attacks
    • Making lifestyle changes
  • Resources

Risk factors

It’s not known exactly why people get gout. But certain factors have been found to increase the chances of having high uric acid levels and developing gout. These factors can make gout more likely (largely because they lead to higher uric acid levels), but they don’t cause gout. 

Family history. There is a hereditary component to gout. People with family members who have gout are more likely to get it. They may have inherited a tendency for their kidneys to do a poor job of eliminating uric acid, even if they have otherwise normal kidney function. 

Age and sex. Gout strikes men three times as often as women, and it is more common as people get older. Women rarely have gout before menopause, perhaps because estrogen helps to keep uric acid levels low. After menopause, risk increases for women. Men of any age can have gout, but it tends to be more common after age 40. 

Metabolic syndrome. This is a combination of conditions that increases a person’s risk of heart disease, stroke, and diabetes. The conditions include abdominal obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL cholesterol. People with metabolic syndrome tend to have high uric acid levels and have an increased risk of gout. Several components of metabolic syndrome also have been found to increase risk on their own.

Excess weight. People who are overweight or obese tend to make more uric acid than normal. Overweight is defined as a body mass index (BMI) of 25 to 29.9, and obesity is a BMI of 30 or greater. (BMI is an estimate of body fat based on a person’s height and weight.) Studies have found that the heavier people are, the greater their risk of gout.

High blood pressure. High blood pressure can promote high uric acid levels. People who have high blood pressure are up to twice as likely to have gout as those with normal blood pressure.

Kidney disease. People with kidney disease are at risk because the kidneys
are key players in getting rid of uric acid. Impaired kidney function can lead
to high uric acid levels.

Diuretics. Medications that affect kidney function, including diuretics, can affect uric acid levels. Diuretics are used to treat high blood pressure, heart failure, and other conditions. They help the body get rid of extra fluid and salt by causing the kidneys to make more urine and excrete more salt. They also raise uric acid levels. Commonly used diuretics include hydrochlorothiazide (Microzide) and furosemide (Lasix). The risk of developing gout increases the longer these drugs are used. Risk also goes up with higher doses.

Antirejection drugs. People who have had an organ transplant must take drugs that suppress the immune system, to prevent it from attacking the transplanted organ. Some of these drugs also increase uric acid levels.

Other health problems. Medical conditions in which there is a high turnover of cells can lead to excess production of uric acid. (Uric acid is a byproduct of dying cells.) Conditions that increase cell turnover include psoriasis and leukemia.

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