Gout is a common and painful form of arthritis that arises from the accumulation of uric acid crystals within the joints. These sharp crystals trigger sudden, severe episodes of pain, swelling, and redness, often affecting the big toe but capable of impacting other joints. While gout can be debilitating, effective management approaches are available to control symptoms and prevent long-term complications.
Your First Stop for Gout Care
When experiencing symptoms suggestive of gout, a primary care physician (PCP) is typically the first healthcare professional to consult. They play an initial role in assessing symptoms, taking a medical history, and conducting a physical examination of the affected joints. This initial evaluation helps them determine the likelihood of gout and rule out other conditions.
For diagnosis, a PCP may order blood tests to measure uric acid levels, although high levels do not always confirm gout, and normal levels can occur during an acute attack. In some cases, they might recommend imaging tests like X-rays, ultrasound, or dual-energy CT scans to look for crystal deposits or joint changes. A more definitive diagnosis involves a joint aspiration, where fluid is drawn from the affected joint and examined for uric acid crystals.
During an acute gout attack, a PCP can prescribe medications to reduce pain and inflammation. These may include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, colchicine, or corticosteroids, which can be given orally or injected directly into the joint. Your doctor will also offer advice on lifestyle adjustments, such as dietary modifications to limit purine-rich foods, maintaining good hydration, and managing body weight. They decide when a referral to a specialist is appropriate based on the severity and complexity of the condition.
When to See a Gout Specialist
For chronic or complex cases of gout, rheumatologists are the primary specialists for diagnosing and treating inflammatory joint conditions, including gout. They manage complicated cases and offer advanced therapies to control inflammation and lower uric acid levels.
A referral to a rheumatologist is often made if gout attacks are frequent or severe, if chronic gout has developed, or if there are visible uric acid deposits called tophi. They also become involved if the diagnosis is uncertain, if kidney stones are present, or if initial treatments have not adequately controlled uric acid levels. Rheumatologists utilize urate-lowering therapies (ULTs) such as allopurinol or febuxostat to achieve a target serum uric acid level.
Other specialists may also collaborate in gout management, especially when co-existing health conditions are present. Nephrologists specialize in kidney health and are consulted if gout is complicated by kidney disease or the formation of kidney stones, as the kidneys are responsible for excreting uric acid. High uric acid levels can contribute to kidney stone formation and impair kidney function.
Cardiologists may become involved because gout is linked to an increased risk of cardiovascular diseases, including hypertension and heart failure. Uric acid and the inflammation associated with gout can contribute to these heart-related issues. Finally, registered dietitians or nutritionists provide tailored dietary advice, focusing on limiting purine-rich foods, sugary drinks, and alcohol, while promoting a balanced diet and weight management. Diet is an important part of a comprehensive management plan.