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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

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Gout
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Additional copies of this booklet are available from

National Institute of Arthritis and Musculoskeletal

and Skin Diseases 

NIAMS/National Institutes of Health

1 AMS Circle

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You can also find this booklet on the NIAMS Web site 

at www.niams.nih.gov/hi/topics/gout/gout.htm.
Table of Contents

What Is Gout? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What Causes Gout? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Who Is Likely To Develop Gout? . . . . . . . . . . . . . . . . . . . . . 5

How Is Gout Diagnosed? . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

How Is Gout Treated? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

What Can People With Gout Do To Stay Healthy? . . . . . 8

What Research Is Being Conducted To Help 

People With Gout? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Where Can People Find More Information 

About Gout? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Gout
Information Box

Signs and Symptoms of Gout . . . . . . . . . . . . . . . . . . . . . . . . 6
This booklet contains general information about gout. It

describes what gout is and how it develops. It also explains

how gout is diagnosed and treated. If you have further

questions after reading this booklet, you may wish to

discuss them with your doctor.

What Is Gout?

Gout is one of the most painful rheumatic diseases. It

results from deposits of needle-like crystals of uric acid in

connective tissue, in the joint space between two bones, or

in both. These deposits lead to inflammatory arthritis,

which causes swelling, redness, heat, pain, and stiffness in

the joints. The term arthritis refers to more than 100 different rheumatic diseases that affect the joints, muscles, and

bones, as well as other tissues and structures. Gout accounts

for approximately 5 percent of all cases of arthritis.

Pseudogout is sometimes confused with gout because it produces similar symptoms of inflammation. However, in this

condition, also called chondrocalcinosis, deposits are made

up of calcium phosphate crystals, not uric acid. Therefore,

pseudogout is treated somewhat differently and is not

reviewed in this booklet.

Uric acid is a substance that results from the breakdown of

purines, which are part of all human tissue and are found in

many foods. Normally, uric acid is dissolved in the blood

and passed through the kidneys into the urine, where it is

eliminated. If the body increases its production of uric acid

or if the kidneys do not eliminate enough uric acid from the

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body, levels of it build up in the blood (a condition called

hyperuricemia). Hyperuricemia also may result when a person eats too many high-purine foods, such as liver, dried

beans and peas, anchovies, and gravies. Hyperuricemia is

not a disease and by itself is not dangerous. However, if

excess uric acid crystals form as a result of hyperuricemia,

gout can develop. The excess crystals build up in the joint

spaces, causing inflammation. Deposits of uric acid, called

tophi (singular: tophus), can appear as lumps under the

skin around the joints and at the rim of the ear. In addition,

uric acid crystals can collect in the kidneys and cause kidney

stones.

For many people, gout initially affects the joints in the big

toe. Sometime during the course of the disease, gout will

affect the big toe in about 75 percent of patients. It also can

affect the instep, ankles, heels, knees, wrists, fingers, and

elbows. The disease can progress through four stages:

• Asymptomatic (without symptoms) hyperuricemia—

In this stage, a person has elevated levels of uric acid

in the blood but no other symptoms. A person in this

stage does not usually require treatment.

• Acute gout, or acute gouty arthritis—In this stage,

hyperuricemia has caused the deposit of uric acid

crystals in joint spaces. This leads to a sudden onset

of intense pain and swelling in the joints, which also

may be warm and very tender. An acute attack commonly occurs at night and can be triggered by stressful events, alcohol or drugs, or the presence of

another illness. Early attacks usually subside within

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3 to 10 days, even without treatment, and the next

attack may not occur for months or even years. Over

time, however, attacks can last longer and occur more

frequently.

• Interval or intercritical gout—This is the period

between acute attacks. In this stage, a person does

not have any symptoms and has normal joint

function.

• Chronic tophaceous gout—This is the most disabling stage of gout and usually develops over a long

period, such as 10 years. In this stage, the disease has

caused permanent damage to the affected joints and

sometimes to the kidneys. With proper treatment,

most people with gout do not progress to this

advanced stage.

What Causes Gout?

A number of risk factors are related to the development of

hyperuricemia and gout:

• Genetics may play a role in determining a person’s

risk since up to 18 percent of people with gout have

a family history of the disease.

• Gender and age are related to the risk of developing

gout; it is more common in men than in women and

more common in adults than in children.

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• Being overweight increases the risk of developing

hyperuricemia and gout because there is more tissue

available for turnover or breakdown, which leads to

excess uric acid production.

• Drinking too much alcohol can lead to hyperuricemia because it interferes with the removal of

uric acid from the body.

• Eating too many foods rich in purines can cause or

aggravate gout in some people.

• An enzyme defect that interferes with the way the

body breaks down purines causes gout in a small

number of people, many of whom have a family

history of gout.

• Exposure to lead in the environment can cause gout.

Some people who take certain medicines or have certain

conditions are at risk for having high levels of uric acid in

their body fluids. For example, the following types of medicines can lead to hyperuricemia because they reduce the

body’s ability to remove uric acid:

• Diuretics, which are taken to eliminate excess fluid

from the body in conditions like hypertension,

edema, and heart disease, and which decrease the

amount of uric acid passed in the urine;

• Salicylates, or anti-inflammatory medicines made

from salicylic acid, such as aspirin;

4
• The vitamin niacin, also called nicotinic acid;

• Cyclosporine, a medicine used to suppress the body’s

immune system (the system that protects the body

from infection and disease) and control the body’s

rejection of transplanted organs; and

• Levodopa, a medicine used to support communication along nerve pathways in the treatment of

Parkinson’s disease.

Who Is Likely To Develop Gout?

Gout occurs in approximately 840 out of every 100,000 people. It is rare in children and young adults. Adult men, particularly those between the ages of 40 and 50, are more likely

to develop gout than women, who rarely develop the disorder before menopause. People who have had an organ

transplant are more susceptible to gout.

How Is Gout Diagnosed?

Gout may be difficult for doctors to diagnose because the

symptoms may be vague, and they often mimic other conditions. Although most people with gout have hyperuricemia

at some time during the course of their disease, it may not be

present during an acute attack. In addition, having hyperuricemia alone does not mean that a person will get gout.

In fact, most people with hyperuricemia do not develop the

disease.

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5
To confirm a diagnosis of gout, a doctor may insert a needle

into an inflamed joint and draw a sample of synovial fluid,

the substance that lubricates a joint. A laboratory technician

places some of the fluid on a slide and looks for monosodium

urate crystals under a microscope. Their absence, however,

does not completely rule out the diagnosis. Chalky, sodium

urate deposits (tophi) around joints also may indicate the

presence of gout. Gout attacks may mimic joint infections,

and a doctor who suspects a joint infection (rather than

gout) may check for the presence of bacteria.

How Is Gout Treated?

With proper treatment, most people with gout are able to

control their symptoms and live productive lives. Gout can

be treated with one or a combination of therapies. The goals

of treatment are to ease the pain associated with acute

6

Signs and Symptoms of Gout

■ Hyperuricemia

■ Presence of uric acid crystals in joint fluid

■ More than one attack of acute arthritis

■ Arthritis that develops in 1 day, producing a swollen,

red, and warm joint

■ Attack of arthritis in only one joint, usually the toe,

ankle, or knee
attacks, to prevent future attacks, and to avoid the formation

of tophi and kidney stones. Successful treatment can reduce

both the discomfort caused by the symptoms of gout and

long-term damage to the affected joints. Treatment will help

prevent disability due to gout.

The most common treatments for an acute attack of gout

are high doses of nonsteroidal anti-inflammatory drugs

(NSAIDs) taken orally (by mouth) or corticosteroids, which

are taken orally or injected into the affected joint. NSAIDs

reduce the inflammation caused by deposits of uric acid

crystals but have no effect on the amount of uric acid in

the body. The NSAIDs most commonly prescribed for

gout are indomethacin (Indocin*) and naproxen (Anaprox,

Naprosyn), which are taken orally every day. Corticosteroids

are strong anti-inflammatory hormones. The most commonly prescribed corticosteroid is prednisone. Patients often

begin to improve within a few hours of treatment with a corticosteroid, and the attack usually goes away completely

within a week or so.

When NSAIDs or corticosteroids do not control symptoms,

the doctor may consider using colchicine. This drug is most

effective when taken within the first 12 hours of an acute

attack. Doctors may ask patients to take oral colchicine as

often as every hour until joint symptoms begin to improve

or side effects such as nausea, vomiting, abdominal cramps,

or diarrhea make it uncomfortable to continue the drug.

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7

* Brand names included in this booklet are provided as examples only, and their

inclusion does not mean that these products are endorsed by the National Institutes

of Health or any other Government agency. Also, if a particular brand name is not

mentioned, this does not mean or imply that the product is unsatisfactory.
For some patients, the doctor may prescribe either NSAIDs

or oral colchicine in small daily doses to prevent future

attacks. The doctor also may consider prescribing medicine

such as allopurinol (Zyloprim) or probenecid (Benemid) to

treat hyperuricemia and reduce the frequency of sudden

attacks and the development of tophi.

What Can People With Gout Do To Stay Healthy?

• To help prevent future attacks, take the medicines

your doctor prescribes. Carefully follow instructions

about how much medicine to take and when to take

it. Acute gout is best treated when symptoms first

occur.

• Tell your doctor about all the medicines and vitamins

you take. He or she can tell you if any of them

increase your risk of hyperuricemia.

• Plan followup visits with your doctor to evaluate your

progress.

• Maintain a healthy, balanced diet; avoid foods that

are high in purines; and drink plenty of fluids, especially water. Fluids help remove uric acid from the

body.

• Exercise regularly and maintain a healthy body

weight. Lose weight if you are overweight, but do

not go on diets designed for quick or extreme loss

of weight because they increase uric acid levels in

the blood.

8
What Research Is Being Conducted To Help People

With Gout?

Scientists are studying which NSAIDs are the most effective

gout treatments, and they are analyzing new compounds to

develop safe, effective medicines to lower the level of uric

acid in the blood and to treat symptoms. They also are

studying the structure of the enzymes that break down

purines in the body to achieve a better understanding of

the enzyme defects that can cause gout.

Scientists are studying the effect of crystal deposits on cartilage cells for clues to treatment. They also are looking at the

role of calcium deposits in pseudogout in the hope of developing new treatments. The role genetics and environmental

factors play in hyperuricemia also is being investigated.

Where Can People Find More Information

About Gout?

■ National Institute of Arthritis and Musculoskeletal

and Skin Diseases (NIAMS)

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892–3675

Phone: 301–495–4484 or 

877–22–NIAMS (226–4267) (free of charge)

TTY: 301–565–2966

Fax: 301–718–6366

E-mail: NIAMSInfo@mail.nih.gov

www.niams.nih.gov

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NIAMS provides information about various forms of

arthritis and rheumatic diseases and bone, muscle, joint,

and skin diseases. It distributes patient and professional

education materials and also refers people to other

sources of information. Additional information and

updates can be found on the NIAMS Web site.

■ American College of Rheumatology/Association

of Rheumatology Health Professionals

1800 Century Place, Suite 250

Atlanta, GA 30345–4300

Phone: 404–633–3777

Fax: 404–633–1870

www.rheumatology.org

This association provides referrals to rheumatologists.

The organization also provides educational materials

and guidelines about many different rheumatic diseases.

■ Arthritis Foundation

1330 West Peachtree Street

Atlanta, GA 30309

Phone: 404–872–7100 or 800–283–7800 (free of charge)

or call your local chapter (listed in the phone directory)

www.arthritis.org

This is the main voluntary organization devoted to

arthritis. The foundation publishes free pamphlets on

many types of arthritis and a monthly magazine for

members that provides up-to-date information on arthritis. The foundation also provides clinic referrals.

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Acknowledgments

The NIAMS gratefully acknowledges the assistance of N. Lawrence Edwards, M.D.,

University of Florida in Gainesville; John H. Klippel, M.D., Arthritis Foundation,

Washington, DC; Barbara Mittleman, M.D., NIAMS, NIH; Roland W. Moskowitz,

M.D., University Hospitals of Cleveland, OH; Lawrence Ryan, M.D., Medical

College of Wisconsin in Milwaukee; and Bernadette Tyree, Ph.D., NIAMS, NIH,

in the preparation of this and previous versions of this booklet.

The mission of the National Institute of Arthritis and

Musculoskeletal and Skin Diseases (NIAMS), a part of the

National Institutes of Health (NIH), is to support research

into the causes, treatment, and prevention of arthritis and

musculoskeletal and skin diseases, the training of basic and

clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases.

The National Institute of Arthritis and Musculoskeletal and

Skin Diseases Information Clearinghouse is a public service

sponsored by the NIAMS that provides health information

and information sources. Additional information can be

found on the NIAMS Web site at www.niams.nih.gov.
U.S. Department of Health and Human Services

Public Health Service

National Institutes of Health

National Institute of Arthritis and 

Musculoskeletal and Skin Diseases

NIH Publication No. 02–5027

April 2002