Gout Attack: Symptoms, Causes and Treatments

The gout attack represents one of the most painful and disabling rheumatological emergencies. According to Health Insurance, this condition affects nearly 2% of the French population, with constantly increasing prevalence. This acute joint inflammation, caused by uric acid crystallization in joints, requires rapid and appropriate management to limit patient suffering and prevent complications.

Early symptom recognition and immediate application of appropriate therapeutic measures are the keys to effective emergency management. This guide details clinical manifestations, triggering factors and treatment protocols recommended by health authorities.

Recognizing Gout Attack Symptoms

Intense and Sudden Joint Pain

The cardinal symptom of gout attack is extreme joint pain, often described as "unbearable" by patients. This pain presents several specific characteristics:

• Sudden onset: Pain usually occurs at night or early morning
• Maximum intensity: Reached within hours, often rated 8-10/10 on pain scale
• Hyperesthesia: Inability to tolerate any contact, even sheet weight
• Preferred location: 70% of first attacks affect big toe

Local Inflammatory Signs

The affected joint presents classic acute inflammation signs:

• Swelling (edema) significant and rapid
• Redness intense skin discoloration
• Heat marked locally
• Functional impotence complete joint inability

Systemic Manifestations

A 2023 NIH study demonstrates 40% of patients present general signs:

• Moderate fever (38-38.5°C)
• General malaise
• Occasional chills
• Significant fatigue

Causes and Triggering Factors

Hyperuricemia: The Fundamental Cause

Hyperuricemia, defined by serum uric acid level above 60 mg/L, is the essential prerequisite for gout attack development. HAS recommendations clarify this elevation can result from:

• Uric acid overproduction: enzymatic deficit, tumor lysis syndrome
• Renal under-elimination: kidney failure, certain medications
• Excessive dietary intake: purine-rich foods

Immediate Triggering Factors

Several elements can precipitate an attack in hyperuricemic patients:

Dietary Factors

• Purine-rich meal (organ meats, seafood, game)
• Excessive alcohol consumption, particularly beer
• Prolonged fasting or restrictive diet
• Significant dehydration

Emergency Treatments First-Line

Non-Medication Immediate Measures

Complete joint rest and limb elevation are the first therapeutic measures. Ice application (15-20 minutes hourly) provides several advantages:

• Immediate pain relief effect
• Reduction of local inflammation
• Crystal diffusion limitation

Important: Absolutely avoid heat which worsens inflammation and intensifies pain.

First-Line Medications

NSAIDs are first-line according to VIDAL. Most used molecules:

• Naproxen: 750 mg then 250 mg x3/day
• Diclofenac: 75 mg x2/day
• Ibuprofen: 800 mg x3/day

When to Seek Emergency Care?

Warning Signs Requiring Immediate Consultation

• High fever (>38.5°C) suggesting septic arthritis
• Polyarticular involvement from start
• Skin signs: erysipelas, cellulitis
• High-risk patients: immunosuppression, decompensated diabetes
• Treatment inefficacy after 48-72 hours