Gout
Also known as: Gouty Arthritis
Inflammatory arthritis caused by uric acid crystal deposition. Diagnosed with ultrasound and joint aspiration. Treated with medications to control flares and lower uric acid.
Key Facts
- Affects approximately 4% of American adults — over 9 million people
- Men are 3 times more likely to develop gout than women
- The big toe is involved in about 50% of first gout attacks
- Untreated gout can lead to permanent joint damage and kidney stones
- Target uric acid level is below 6 mg/dL for most patients
What is gout?
Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate crystals in joints and soft tissues. It results from chronically elevated uric acid levels in the blood (hyperuricemia). Gout typically presents as sudden, severe attacks of joint pain — classically in the big toe — but can affect any joint.
Left unmanaged, gout can become chronic, causing joint damage, tophi (visible urate deposits under the skin), and kidney stones.
Symptoms
- Sudden onset of severe joint pain, often at night
- Intense swelling, redness, and warmth in the affected joint
- Most commonly affects the big toe (podagra), but also ankles, knees, wrists, and fingers
- Attacks typically peak within 12–24 hours and resolve over days to weeks
- Between flares, patients may feel completely normal
- Chronic gout: persistent joint pain, tophi, and progressive joint damage
How we diagnose it
- Clinical history — Characteristic flare pattern and risk factors
- Musculoskeletal ultrasound — Dr. Fellows can identify the "double contour sign" (urate crystal deposition on cartilage) and tophi using in-office ultrasound, often confirming the diagnosis without joint aspiration
- Joint aspiration — When performed, examination of synovial fluid under polarized microscopy for monosodium urate crystals is the gold standard
- Blood tests — Serum uric acid level (note: can be normal during an acute flare)
- Dual-energy CT — In complex cases, to map crystal deposition
How we treat it
- Acute flare — Colchicine/NSAIDs/steroids — Colchicine, NSAIDs, or corticosteroids depending on the patient's other medical conditions
- Acute flare — Ultrasound-guided injection — Corticosteroid injection for isolated joint flares
- Long-term — Allopurinol or febuxostat — Xanthine oxidase inhibitors to lower uric acid production
- Treat-to-target approach — We monitor uric acid levels and adjust dosing to reach a target below 6 mg/dL (or lower if tophi are present)
- Krystexxa (pegloticase) — IV infusion therapy for severe, refractory gout; administered in our on-site infusion center
- Dietary counseling — Guidance on triggers (alcohol, high-purine foods), though medication is the primary driver of urate control
At Synergy Rheumatology
In-office ultrasound allows us to diagnose gout and monitor crystal burden without always needing joint aspiration. For patients with severe or refractory gout, Krystexxa infusions are available on-site. We manage gout with a treat-to-target approach — regular monitoring and dose adjustment until uric acid is controlled.
Have questions about gout?
Schedule an appointment to discuss your symptoms, diagnosis, or treatment options with Dr. Fellows.