Gout is a type of inflammatory arthritis that causes sudden, painful flare-ups in the joints. It can cause swelling, redness, heat and severe pain—most often in the big toe, but gout can affect other joints too.

Gout develops because your body has too much uric acid. Uric acid comes from the breakdown of purines, a substance that’s in many foods. The uric acid, or urate, can form into crystals around the joint. This inflames the joint.

Gout usually happens in flares, and they often start suddenly at night. Gout can affect any joint, but for most people, it happens in one of their big toes.

Gout targets the big toe because:

• Uric acid crystallizes in cool temperatures. Because your big toe is furthest from your heart, it’s cooler than other joints.
• Your big toe has to deal with a lot of joint pressure from walking and standing.

Drinking, eating certain foods and illness can trigger a gout flare. Many people will recover from a flare within a week or so. Some people may have flares more frequently, and they may last longer.

Pseudogout is another type of inflammatory arthritis that causes sudden joint pain and swelling, similar to gout. Pseudogout most often affects larger joints like the knees or wrists, but it can also involve the shoulders, ankles or hips.

It happens when calcium pyrophosphate (CPP) crystals build up in the cartilage that cushions your joints. These crystals irritate the joint lining and trigger painful flares. 

Doctors still aren’t sure why some people make extra CCP. It also isn’t clear what triggers a flare of pseudogout. The flares can last a few days, but are longer for some people.

People with gout can also develop pseudogout.

We diagnose both conditions in many of the same ways. We will:

• Ask about your medical history and past flares
• Examine the joints causing your pain
• Take a fluid sample from the painful joint to look for crystals
• A special CT scan to look for uric acid crystal buildup in the joint

There’s no cure for either gout or pseudogout, but there are ways to relieve symptoms. We treat both conditions in many of the same ways. 

At Carilion, our goal is to:

• Reduce your pain from flares
• Prevent future flares
• Prevent or slow joint damage
• Treat any related conditions, like heart or kidney problems

Medicines

The medicine you take depends on how severe your gout or pseudogout is, and may include: 

• Anti-inflammatories: These medicines can help relieve joint pain by lowering inflammation.
• Corticosteroids: Can also help with pain and inflammation in the short term. These drugs can have side effects, so your doctor will manage your dose carefully.
• Colchicine: Which helps relieve pain from gout and pseudogout.

The main difference between treating gout and pseudogout is that we don’t have a medicine to stop the buildup of CCP. But there is medicine that can help lower urate levels. These include medicines that can:

• Keep your body from making too much urate
• Helps your kidneys flush extra urate
• Break urate down so it’s easier for your body to get rid of