Gout treatment has two parts: settling the painful attack, and lowering uric acid over the long term to make attacks less frequent. Gout is a form of arthritis in which uric acid forms needle-shaped crystals inside a joint, and the body reacts to them with sudden pain and swelling. Dr. Aman Khanna, an orthopaedic surgeon in Surat, assesses and manages gout and uric acid joint pain at his OPD in Mahavir Health Campus, Athwa Gate.
What a gout attack feels like
The pain is usually severe and starts quickly, often at night. The joint becomes swollen, red and warm, and is so tender that even a bedsheet is uncomfortable. The base of the big toe is the classic site, but gout also affects the ankle, the middle of the foot, the knee, the wrist, the fingers and the elbow.
Without treatment an attack generally peaks within a day or so and eases over several days to a couple of weeks. Between attacks the joint may feel normal. If uric acid stays high, attacks can come more often, last longer and involve more joints.
Why uric acid builds up
Uric acid is a waste product of the breakdown of purines, which come from the body's own cells and from some foods. It builds up when the body makes more than the kidneys clear, or when the kidneys clear less than they should. Family history, kidney disease, high blood pressure, being overweight, some water tablets, regular alcohol (beer in particular), sweetened drinks, red meat, organ meat and shellfish all contribute. Being short of fluids can tip it over.
A high uric acid level on a blood report does not always mean gout, and many people with a raised level never have an attack. The reverse happens too: the level can look normal during an attack. The report is read together with the joint, not alone.
How gout is confirmed
The diagnosis starts with the story of the attack and an examination of the joint. A blood uric acid test helps, and it is often most useful when repeated a few weeks after the attack has settled. Kidney function is checked at the same time because it guides which medicines are suitable.
An X-ray can look normal in early gout and shows joint damage only in long-standing disease. Ultrasound can show crystal deposits. When the diagnosis is uncertain, fluid drawn from the joint and examined under a microscope for crystals is the most reliable confirmation. This also helps rule out infection and other types of arthritis.
Treating a gout attack
- Rest the joint and keep it raised; a cold pack wrapped in cloth can ease the pain.
- Medicine started early in the attack: an anti-inflammatory tablet, a colchicine-type medicine or a short steroid course. The choice depends on the kidneys, stomach, heart and other medicines being taken.
- Plenty of fluids, and no alcohol during the attack.
Painkillers should not be picked at random. A joint that is hot and swollen with fever, or one that flares after an injury or a procedure, can be an infection and needs to be seen the same day.
Lowering uric acid over the long term
Dr. Khanna manages both the attack and the long-term treatment himself. Medicine to lower uric acid is discussed from the first attack and is advised more strongly after repeated attacks, when lumps of crystal (tophi) form, with joint damage, or with kidney stones or kidney disease. It is started at a low dose, and the dose is raised step by step with blood tests until uric acid reaches the target the doctor sets, usually below 6 mg/dL. Attacks can flare during the first months, so a second medicine to prevent flares is often given alongside it for about three to six months.
This medicine works only while it is taken. Stopping it once the pain has gone allows the level to climb and the attacks to return, so it should be neither started nor stopped without the doctor's advice. Do not stop it during an attack.
Food, drink and weight
Diet helps the medicines work but cannot replace them. Cutting down on alcohol, especially beer, sweetened drinks and organ meat, drinking enough water, and losing weight gradually all help. Crash diets and prolonged fasting can push uric acid up and should be avoided.
Long-standing gout and the joint
Most people with gout never need an operation. Surgery is considered for tophi that break the skin or press on a tendon or nerve, or for a joint damaged by years of attacks. Gout in the toe or ankle is covered on the foot and ankle page, and gout in the knee on the knee page. Where kidney, heart or blood pressure conditions are involved, the plan is coordinated with your physician.
When to see a doctor
See a doctor for a first attack of sudden joint swelling, for attacks that keep returning, for chalky lumps near joints, or when a high uric acid report comes with joint pain. Bring recent blood reports and the list of medicines you take.
To book an OPD visit, use WhatsApp or the clinic and hours page.