7 Things to Know About Chronic Gout

Doctor William C Lloyd Healthgrades Medical Reviewer
Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Nancy LeBrun on September 18, 2022
  • determined-senior-woman
    What You Should Know About Chronic Gout
    Gout is a form of arthritis that causes sharp pain and swelling in your joints. You can develop gout if you have high uric acid levels. Uric acid forms as your body breaks down chemicals called purines, which are found in foods and also produced by your body. If you have too much uric acid, it can form crystals that lodge in the fluid in your joints and trigger inflammation. When gout attacks recur, it’s considered to be chronic. Here’s what you need to know.
  • Little blue pill
    1. Chronic gout may need different treatment than occasional gout.
    Some people only have one gout attack in their lifetime, but many people have recurring flares of this painful form of arthritis. If you have periodic attacks and don’t get treatment, you are at higher risk for developing chronic gout, in which the pain and inflammation don’t go away and there’s a risk of damage to the joints and kidneys. Chronic gout may need different medication than that used for less severe cases.
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    2. Doctors divide gout into four stages; chronic gout is the most advanced.
    In stage one, your uric acid levels may be high, which is the cause of gout, but you don’t have symptoms like pain or swelling. Stage two is defined by acute gout attacks in your joints that tend to develop at night. Stage three is the “intercritical” phase, when you are pain-free between attacks. Stage four is considered chronic gout, in which the inflammation and discomfort do not go away. Doctors treat the stages differently, but the goal is always to lower the level of uric acid in your body while addressing your symptoms.
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    3. Chronic gout can lead to complications if it’s not treated.
    It’s important to get help for your chronic gout, and not just because it’s painful. Chronic gout can damage your joints and affect your mobility and quality of life. People with chronic gout may develop “tophi,” which are deposits of uric acid crystals that form large bumps under your skin. If left untreated or uncontrolled, chronic gout can lead to kidney stones or kidney disease, if the excess uric acid crystallizes in your urinary tract. It can also increase the risk of a heart attack.
  • Middle-aged woman taking pills
    4. It’s important to continue your gout medication, even if you feel fine.
    Gout medication is often very effective, but only if you take it. As many as 80% of the people who are given allopurinol (Zyloprim, Aloprim), the most commonly prescribed uric acid reducer, don’t continue it when the pain goes away. If you start and stop your uric acid lowering medication, however, you can set off another attack. If you do get a flare, you have to wait till it’s over to start the uric acid reducer again, or it could worsen the symptoms.
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    5. Doctors have different treatment options for people with chronic gout.
    All people with gout need to lower their uric acid levels. Some people, however, don’t respond to or can’t tolerate the most commonly prescribed drug, allopurinol. In that case, there are other options for you to try, including probenecid (Benemid) or lesinurad (Zurampic). If those medications don’t work either, and your gout is chronic, there is an injectable biologic medicine called pegloticase (Krystexxa) that can lower your uric acid levels rapidly and dissolve gout crystals. This medication may also shrink tophi more effectively than other drugs. In some patients, the tophi disappear and you no longer have gout attacks.
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    6. You can help manage your chronic gout with diet and lifestyle choices.
    If you have gout, you can make diet and lifestyle changes that reduce the chance of your gout getting worse. Avoid foods such as beef, seafood and alcohol, especially beer. Exercise is important, as is staying at a healthy weight. There is evidence that cherries can lower uric acid, and coffee and vitamin C may also help. Talk to your doctor before starting any supplements or changing your diet. If you do have a gout attack, don’t try to push through it; it’s better to rest the affected joint.
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    7. Gout, even chronic gout, is one of the most treatable forms of arthritis.
    Gout is the only form of arthritis that can be “cured,” meaning you have no crystals, pain or inflammation. Even if that doesn’t happen for you, almost all cases can be managed successfully. In fact, gout is more easily controlled than many other forms of arthritis, if you stick with your medication and lead a healthy lifestyle. If you have chronic gout, your healthcare provider can help you treat it to minimize pain and swelling, so you can get on with your daily life.
Chronic Gout | Gout
  1. Gout: Risk Factors, Diagnosis and Treatment. Hospital for Special Surgery. https://www.hss.edu/conditions_gout-risk-factors-diagnosis-treatment.asp
  2. Treatments for Chronic Gout. Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/gout/articles/chronic-gout.php
  3. Symptoms and Diagnosis of Gout. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/arthritis-info/gout/clinical-presentation-of-gout/
  4. Chronic gout: epidemiology, disease progression, treatment and disease burden. National Institutes of Health. https://www.ncbi.nlm.nih.gov/pubmed/21050059
  5. Current treatment options for acute and chronic gout. Drug Review. https://onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1238
  6. Symptoms and Stages. Gout and Uric Acid. http://gouteducation.org/patient/what-is-gout/gout-symptoms-stages/
  7. All About Gout. Harvard Health Publishing. https://www.health.harvard.edu/newsletter_article/all-about-gout
  8. Gout. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gout/diagnosis-treatment/drc-20372903
  9. Gout: why is this curable disease so seldom cured? National Institutes of Health. https://www.ncbi.nlm.nih.gov/pubmed/22863577
  10. Medication Guide. Krystexxa. U.S. Food and Drug Administration. https://www.fda.gov/downloads/Drugs/DrugSafety/UCM227568.pdf
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Last Review Date: 2022 Sep 18
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