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Gout

Arthritis urica (podagra) · Dna (arthritis urica)

What it is

Uric acid crystals precipitate in a joint — the most painful common arthritis.

Symptoms & signs

  • Sudden severe big-toe pain
  • red hot swollen joint
  • often at night
  • tophi in chronic disease

🚩 Get help if…

  • call 112 / 911 now Blistering rash or mouth sores after starting allopurinol
  • see a doctor soon Hot, swollen joint with fever and shivering
  • see a doctor soon Pain in the side with blood in the urine (kidney stone)
  • see a doctor soon Several joints hot and swollen at once

Where it strikes

Medical treatment

  • NSAIDs, colchicine or steroids for the attack trials support
  • Allopurinol to target urate — the treatment that actually ends gout, and it is under-used; rare severe skin reactions (test for HLA-B*58:01 in people of Han Chinese, Korean or Thai descent) trials support
  • Pegloticase for tophaceous gout mixed evidence
  • Canakinumab (IL-1 blocker) for attacks when NSAIDs and colchicine cannot be used — approved (EMA 2013, FDA 2023)

Natural & lifestyle

  • Reduce beer, spirits and fructose
  • cherries and cherry juice
  • coffee
  • weight loss
  • hydration
  • low-fat dairy
  • vitamin C

Emerging & experimental

  • Urate transporter inhibitors
  • selective URAT1 agents

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Vitamin C 500 mg — lowers urate a little; did not prevent attacks in trials mixed evidence
  • Celery-seed extract — traditional; small studies early / small studies
  • Baking soda to alkalise — untested for gout, and a heavy salt load anecdotal / traditional

ICD codes