Gout is the most common form of inflammatory arthritis in the United States, affecting more than 9 million Americans. Despite being one of the most treatable forms of arthritis, gout is frequently undertreated — leading to recurrent painful attacks, joint damage, and kidney complications. Dr. Adam Elisha, DO, is a board-certified rheumatologist in Duluth, MN who provides expert diagnosis and long-term gout management.
What Is Gout?
Gout is caused by hyperuricemia — an elevated level of uric acid in the blood. When uric acid accumulates, it can form sharp, needle-like crystals (monosodium urate crystals) that deposit in joints and surrounding tissue. These crystals trigger intense inflammatory reactions, resulting in sudden and severe attacks of joint pain, swelling, and redness.
Symptoms of Gout
- Acute gout attacks: Sudden onset of intense joint pain — often beginning at night — that reaches its worst within 12–24 hours. The big toe (podagra) is the classic site, but gout can affect the ankle, knee, wrist, elbow, and finger joints.
- Redness and warmth: The affected joint becomes visibly red, swollen, and warm to the touch.
- Tophi: In chronic, undertreated gout, urate crystals accumulate under the skin as firm, chalky deposits called tophi, most commonly around the elbows, fingers, and Achilles tendon.
- Kidney stones: Uric acid can also crystallize in the kidneys, causing uric acid kidney stones.
Diagnosing Gout
The gold standard for diagnosing gout is joint aspiration — withdrawing fluid from the affected joint and examining it under a polarized light microscope to identify urate crystals. Blood tests showing elevated uric acid support the diagnosis, though uric acid can sometimes be normal during an acute attack. Ultrasound has become an increasingly useful non-invasive tool for detecting urate crystal deposits.
Treating Gout
Managing Acute Attacks
Acute gout attacks are treated with anti-inflammatory medications to reduce pain and swelling as quickly as possible. Options include NSAIDs (such as indomethacin or naproxen), colchicine, and corticosteroids — chosen based on the patient’s kidney function, other medical conditions, and medication tolerances.
Long-Term Urate-Lowering Therapy
The cornerstone of gout prevention is lowering serum uric acid to below 6 mg/dL (below 5 mg/dL in patients with tophi). Allopurinol is the most commonly used urate-lowering medication and is highly effective when dosed appropriately. Febuxostat and probenecid are alternatives. Many patients require long-term therapy — stopping medication when you “feel fine” is one of the most common reasons gout keeps coming back.
Dietary and Lifestyle Measures
Diet plays a supportive role in gout management. Limiting high-purine foods (red meat, organ meats, shellfish), avoiding alcohol (especially beer), staying well-hydrated, and losing weight if overweight can help reduce uric acid levels. However, diet alone rarely controls gout — medications are usually necessary for adequate uric acid reduction.
When to See a Rheumatologist About Gout
See a rheumatologist if you have more than one or two gout attacks a year, attacks in several joints, visible lumps under the skin (tophi), a history of uric acid kidney stones, or uric acid that stays high despite treatment. A specialist can dose urate-lowering therapy correctly and prevent the joint damage and kidney problems that come from years of undertreated gout.
Frequently Asked Questions About Gout
What triggers a gout attack?
Common triggers include alcohol (especially beer), high-purine foods such as red meat, organ meats, and shellfish, dehydration, certain water pills, and illness or surgery. Even starting urate-lowering therapy can briefly trigger an attack, which is why preventive medication is often added at first.
Is gout curable?
Gout is not curable, but it is highly controllable. Lowering uric acid below the target level prevents attacks and slowly dissolves existing crystals, and many patients become completely attack-free over time.
Can I stop allopurinol once the attacks stop?
Usually no. Urate-lowering therapy is long-term. Stopping it lets uric acid rise again, the crystals reform, and the attacks return. Feeling well means the treatment is working.
What uric acid level should I aim for?
The goal is below 6 mg/dL for most people, and below 5 mg/dL for those with tophi. Reaching and staying at target is what prevents future attacks, so the dose is adjusted until your level is in range.
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Gout Care in Duluth, MN
If you’re having recurrent gout attacks, or if your uric acid levels have been difficult to control, a consultation with a rheumatologist can make a significant difference. Dr. Adam Elisha at St. Luke’s Rheumatology Associates in Duluth provides comprehensive gout evaluation and tailored urate-lowering therapy. Call (218) 249-6960 to schedule an appointment.