Gout Treatment for Travelers
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Guide for
Gout Treatment
By Medical Editor:
Dr. Francesco-Maria Serino, MD, PhD
September, 2024
Summary
Gout is a type of arthritis caused by a buildup of uric acid crystals in the joints, leading to sudden, intense pain and swelling. It often affects the big toe but can also impact other joints like the knees, wrists, and ankles.
A gout flare-up causes sharp joint pain, redness, warmth, and swelling, with even light pressure causing discomfort. Doctors typically diagnose gout through a physical exam, blood tests for uric acid, or joint fluid analysis.
To treat a gout flare-up, medications like colchicine, indomethacin, or prednisone are often prescribed. If you’re on holiday and far from your doctor, make sure to have your gout medicine with you. Over-the-counter pain relievers, like ibuprofen, and ice packs can help reduce pain and swelling. Resting the affected joint is also important.
Diet plays a big role in managing gout. Avoid high-purine foods like red meat, seafood, and alcohol, especially beer, as they can trigger flare-ups. Drink plenty of water to help flush out uric acid and lower your risk of attacks.
When traveling, pack your medications and be mindful of your diet to prevent and manage flare-ups if you’re far from medical care.
What is gout?
Gout is a type of arthritis, called gout arthritis or gouty arthritis, that happens when uric acid crystals build up in the joints. This occurs because the body either makes too much urate—a substance formed when the body breaks down purines found in certain foods— or doesn’t get rid of it properly. When urate levels in the blood become too high, gout crystals start to form in and around the joints.
Over time, these crystals can lead to tophaceous gout, where lumps called tophi develop under the skin, often near joints or tendons. These tophi can cause permanent joint damage if not treated. The condition usually begins with sudden, intense pain in one joint, but it can become long-term, leading to chronic gouty arthritis, which results in ongoing joint damage.a substance formed when the body breaks down purines found in certain foods
Types of gout
Gout progresses through three main stages:
- Gout attack (or acute gout flare): This is when sudden, severe pain and swelling occur in a joint, often the big toe. The pain can last for days to weeks and may go away on its own.
- Intercritical gout: This is the time between flares when there are no symptoms. Without treatment, flares can become more frequent and severe.
- Chronic gouty arthritis and tophaceous gout: After repeated flares, gout can lead to ongoing joint inflammation and the formation of tophi—hard lumps of urate crystals under the skin and around joints.
What causes gout?
Gout is caused by high levels of urate in the blood, which leads to the formation of uric acid crystals. Urate comes from the breakdown of purines, which are natural substances found in our cells. The body processes urate into uric acid, which is normally eliminated through urine. However, if the body produces too much uric acid or doesn’t get rid of it properly, the excess uric acid builds up in the blood.
When uric acid levels become too high, it can form sharp, needle-like crystals in the joints. These uric acid crystals trigger gout by settling in the soft tissues and joints, where the immune system mistakenly attacks them, thinking they are harmful invaders. This immune response causes the painful swelling and inflammation that characterize gout.
If the buildup of uric acid continues, the crystals can accumulate into larger lumps called tophi, which can cause permanent damage to the joints.
Foods that cause gout
Gout can be triggered by certain foods that raise urate levels in the blood, which leads to the formation of uric acid crystals. These foods are typically high in purines, natural substances that are broken down into uric acid by the body. When the body can’t eliminate uric acid effectively, it builds up, leading to gout.
Some of the main food types that increase the risk of gout include:
Red meat and organ meats: Foods like beef, pork, and liver are rich in purines.
Seafood: Certain fish and shellfish, such as anchovies, sardines, and shrimp, are high in purines.
Alcohol: Alcohol, especially beer, is a common trigger as it affects how the body processes uric acid.
Sugary drinks: Beverages sweetened with high-fructose corn syrup can also raise uric acid levels.
These foods don’t directly cause gout in everyone, but in people who are already prone to high urate levels, consuming them can increase the likelihood of a gout flare-up.
Gout symptoms
Gout often starts in the feet, with early stage gout symptoms most commonly affecting the big toe joint, a condition called podagra. This sudden pain is due to uric acid symptoms, where urate crystals build up in the joints, causing inflammation and severe discomfort.
Symptoms of gout in feet
Gout in the feet is caused by uric acid crystals forming in the joints. These sharp crystals trigger the immune system, leading to painful inflammation. Over time, this can cause permanent joint damage if not treated.
Top of foot pain
Gout can cause intense pain on the top of the foot due to inflammation spreading from the affected joint. This pain is usually sharp and comes on suddenly.
Big toe joint pain
Pain in the big toe joint, known as podagra, is the most common early symptom of gout. This pain is often excruciating, especially at night or early in the morning, and the joint may appear red and swollen.
Pain under big toe pad
Gout can also cause pain under the big toe pad, where pressure from walking makes the symptoms worse. This type of pain often makes standing or walking difficult.
Gout in knee
Gout can affect the knee, leading to swelling, redness, and severe pain. The uric acid crystals settle in the knee joint, making movement difficult and painful, particularly during flare-ups.
Gout in hands
Though less common, gout can impact the hands. Urate crystals can form in the finger joints, causing them to swell, stiffen, and become painful. Over time, the joints may become permanently damaged without treatment.
Gout in ankle
Gout in the ankle leads to difficulty walking due to pain and swelling. The joint may become red and hot to the touch, and symptoms often worsen with physical activity.
Gout in finger
In some cases, gout can affect the smaller joints, including the fingers. The pain and swelling can be similar to that in the toes, with sharp uric acid symptoms making movement painful.
Gout in wrist
Gout in the wrist can cause sudden, intense pain that makes it hard to use the hand. The joint may become swollen and warm, similar to gout in other parts of the body.
Gout in elbow
The elbow is another joint that can be affected by gout. Pain and swelling in the elbow joint are common during gout attacks, and the condition can restrict arm movement.
Gout in shoulder
Although rare, gout can occur in the shoulder. When urate crystals form in this area, it causes pain and stiffness, making shoulder movement difficult.
Gout attack
A gout flare-up feels intensely painful, often beginning suddenly, typically reaching its peak severity within 12 to 24 hours. During a gout attack, the affected joint may become swollen, red, and extremely tender, making it difficult to move. Most commonly, this pain is experienced in a single joint, like the big toe or knee, but it can affect other joints as well. The pain from a gout flare-up is usually described as throbbing, crushing, or even excruciating.
This pain occurs because of the buildup of uric acid crystals in the joints, which triggers an inflammatory response, causing the joint to swell and become warm to the touch. The flare typically resolves within a few days to a few weeks, but without treatment, repeated flares can cause more severe and frequent gout attacks.
Gout diagnosis
To diagnose a gout flare-up, doctors typically rely on several methods. The most definitive way is to analyze fluid from the affected joint. This procedure, called arthrocentesis, involves drawing out joint fluid and examining it under a microscope to detect urate crystals, which confirm a gout attack. Other tests include blood work to check urate levels, though uric acid can sometimes be normal during a flare. Imaging techniques like ultrasound or dual-energy CT (DECT) can also help by showing urate crystal deposits in the joints .
Can an online doctor treat gout?
An online doctor can help evaluate a gout flare-up by asking about your symptoms. They’ll look for things like sudden, sharp joint pain, swelling, redness, and warmth, which usually come on quickly, often affecting areas like your big toe, ankle, or knee. These are key signs of a gout attack. The doctor might also ask how long the pain lasts, if it gets worse at night, and if you’ve had similar problems before.
If you’ve had gout in the past, that makes it easier to diagnose. The doctor will consider your medical history, including previous symptoms, family history, or other factors like high uric acid levels. Based on this, they might suspect a gout attack even without doing tests like joint fluid analysis.
Although diagnosing gout definitively usually involves looking at uric acid crystals in the joint, your history and symptoms alone can give a pretty clear idea, allowing the doctor to start treatment remotely
What doctor to see for gout
If you are experiencing a gout flare, the first doctor you should see is a primary care physician (PCP). They are well-equipped to diagnose and manage gout, especially in the early stages or during an acute flare. A PCP can prescribe medications like NSAIDs, colchicine, or corticosteroids to quickly reduce pain and inflammation. They may also advise on lifestyle changes, such as making mindful dietary adjustments while trying new cuisines abroad, to help prevent future flare-ups. Primary care doctors are trained to manage most cases of gout, and in many instances, they are your best point of contact for immediate relief and long-term management.
However, if your gout becomes more severe or recurrent, your primary care doctor may refer you to a rheumatologist. A rheumatologist is a specialist in arthritis and other joint-related diseases, and they have more extensive experience in managing complex or chronic cases of gout. If you develop tophi (hardened uric acid deposits) or experience frequent and severe flares, a rheumatologist can offer advanced treatments, such as urate-lowering therapies like allopurinol or febuxostat, and more closely monitor your condition.
In some cases, particularly if gout has caused joint damage or other complications, you may be referred to an orthopedic specialist. Orthopedists are skilled in treating joint problems and may be necessary if surgery or other invasive treatments are required due to joint damage from long-term gout.
While most cases of gout can be managed by your primary care doctor, seeing the appropriate specialist can make a difference in more complex situations. If your gout is not responding to standard treatment, it’s important to consult a rheumatologist for more specialized care.
Gout treatment
Gout treatment focuses on two main areas: relieving the immediate pain of a gout flare and managing uric acid levels to prevent future attacks.
Common gout medications
Allopurinol
tablets
Indomethacin
capsules
Several gout medicines are used to manage the condition. Allopurinol is one of the most common long-term medications, and it helps lower uric acid levels in the body, reducing the risk of future flare-ups. Another option is febuxostat, which works similarly to allopurinol. These medications fall under uric acid treatment, as they focus on preventing the buildup of uric acid over time.
For flare-ups, other medications are used to manage the pain and inflammation. Colchicine is a gout-specific medication that helps reduce the severity of a gout attack if taken early. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin are also effective in reducing pain and swelling during an attack. In more severe cases, doctors may prescribe prednisone, a corticosteroid that can rapidly reduce inflammation and pain.
Immediate gout pain relief
When a gout attack occurs, the first goal is to manage the pain and inflammation quickly. One of the fastest ways to get immediate gout pain relief is by taking NSAIDs like indomethacin. These medications help reduce inflammation and can significantly lessen pain if taken early in the attack.
Another option for quick relief is colchicine. It works best when taken as soon as symptoms start and can shorten the duration of a gout flare if used correctly. Prednisone may be prescribed for patients who cannot take NSAIDs or who need a stronger anti-inflammatory treatment. This steroid works quickly to reduce swelling and pain but is typically used for short periods to avoid side effects.
Alongside medications, applying gout ice packs to the affected joint can help reduce pain and swelling. Ice numbs the area and brings down inflammation, providing extra relief. Elevating the joint can also help, as this reduces blood flow to the area, limiting swelling.
Treating a gout flare
A gout flare treatment plan typically combines medication and lifestyle adjustments. When a gout flare strikes, starting treatment as soon as possible is critical. As mentioned, NSAIDs like indomethacin or colchicine are commonly used at the onset of a flare. Taking these within the first 24 hours can significantly reduce the duration and severity of the attack. If the pain persists, prednisone may be added for stronger relief.
In addition to medicines that manage the immediate symptoms, it’s important to continue uric acid treatment to prevent future flares. Medications like allopurinol should be taken regularly to keep uric acid levels under control, even during a flare-up. This prevents the formation of new uric acid crystals, reducing the chances of another attack. It’s crucial not to stop taking uric acid-lowering medications during a flare-up, as this can make future flares more likely.
For long-term management, lifestyle changes are also important. Staying hydrated, avoiding alcohol, and limiting foods high in purines (which are substances that break down into uric acid) can help prevent uric acid buildup. Regular exercise and maintaining a healthy weight also contribute to keeping gout under control.
Gout diet
Certain foods can act as gout triggers by raising uric acid levels in the blood, leading to the formation of sharp crystals in the joints that cause painful flare-ups. One of the most common categories of food that causes gout includes those high in purines, which are substances that break down into uric acid. When the body produces more uric acid than it can eliminate, it increases the risk of gout flares. Some of the main uric acid food that causes gout includes red meat, such as beef, lamb, and pork, as well as organ meats like liver and kidney. These foods are particularly high in purines and are best avoided by individuals prone to gout.
Seafood is another gout trigger, particularly shellfish like shrimp, crab, and lobster, and certain fish like sardines, anchovies, and mackerel. These are also rich in purines and can lead to increased uric acid production.
Alcohol, particularly beer, spirits, and wine, is another significant gout trigger. Alcohol interferes with the body’s ability to eliminate uric acid, which can cause levels to spike. Sugary drinks and beverages sweetened with high-fructose corn syrup, such as sodas and sweetened fruit juices, are also considered food that causes gout, as they can increase uric acid production in the body.
By reducing or eliminating these foods, people with gout can lower their risk of painful flare-ups. A balanced diet, avoiding purine-rich foods, and staying well-hydrated are key strategies in managing uric acid levels and preventing future gout episodes
References
- Bajpai, R., Muller, S., Mallen, C., et al. “Onset of Comorbidities and Flare Patterns within Pre-existing Morbidity Clusters in People with Gout: 5-year Primary Care Cohort Study.” Rheumatology (Oxford) 2021; 61:407.
- Shiozawa, A., Szabo, S. M., Bolzani, A., et al. “Serum Uric Acid and the Risk of Incident and Recurrent Gout: A Systematic Review.” J Rheumatol 2017; 44:388.
- Dalbeth, N., Pool, B., Gamble, G. D., et al. “Cellular Characterization of the Gouty Tophus: A Quantitative Analysis.” Arthritis Rheum 2010; 62:1549.
- Janssens, H. J., Lucassen, P. L., Van de Laar, F. A., et al. “Systemic Corticosteroids for Acute Gout.” Cochrane Database Syst Rev 2008;
- Rainer, T. H., Cheng, C. H., Janssens, H. J., et al. “Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial.” Ann Intern Med 2016; 164:464.
- Sutaria, S., Katbamna, R., Underwood, M. “Effectiveness of Interventions for the Treatment of Acute and Prevention of Recurrent Gout—A Systematic Review.” Rheumatology (Oxford) 2006; 45:1422.
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Answer a few questions
Just answer a few questions about your gout symptoms and choose a convenient time for your online session. It’s simple and hassle-free, with no need to sign up.
Select and connect
Doctors respond in minutes. Select your preferred one and start your virtual consultation right from your web browser.
7-day free follow-up chat
Reach out to your doctor with any questions you might have, at no extra cost for 7 days following your consultation.
How does it work?
99% of our users solve their issue within 1 hour. No waiting, no language barriers, no insurance needed.
Answer a few questions
Just answer a few questions about your gout symptoms and choose a convenient time for your online session. It’s simple and hassle-free, with no need to sign up.
Select and connect
Doctors respond in minutes. Select your preferred one and start your virtual consultation right from your web browser.
7-day free follow-up chat
Reach out to your doctor with any questions you might have, at no extra cost for 7 days following your consultation.
Your questions answered
What specialist treats gout?
A rheumatologist is the specialist who treats gout. However, a general practitioner can also manage gout in many cases.
How to stop a gout attack when it starts?
Take anti-inflammatory medications like indomethacin or colchicine and apply ice to reduce swelling.
Does drinking a lot of water help with gout?
Yes, staying hydrated helps flush excess uric acid from the body.
Should I walk with gout?
Rest the affected joint during a flare-up to prevent further irritation.
What not to do during a gout flare-up?
Avoid alcohol, red meat, and putting stress on the affected joint.
What aggravates gout the most?
Foods high in purines (red meat, seafood), alcohol, heat and dehydration.
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Open the intake form and choose one of the following options:
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How do I get a prescription from an online doctor?
Following the consultation, the doctor will either email the e-prescription to you or send it via WhatsApp. You can then either print it out or show it directly to the pharmacist when purchasing the medication.
It’s important to understand that doctors must responsibly evaluate each case individually. They can’t simply prescribe medication solely based on a patient’s request or a recommendation from another doctor without confirming that it’s suitable for the patient’s specific condition.
How much does it cost?
The total cost may differ based on the providers. Each one competes for your request, offering a fair price tailored to your needs. On average, an online doctor visit costs 25 Euros. Prices for in-person appointments, specialists, and lab work vary by city. You can send a request to learn more—there’s no commitment to book, and you can select your provider.
Please note that the visit fee doesn’t cover medication expenses, but common antibiotics are quite affordable in Europe. The cost of antibiotic treatment typically ranges from 5 to 15 euros approximately.
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