Everyone’s path is a little different, but here is what the diagnosis journey may look like:

1. Noticing symptoms
   A sudden, painful, swollen joint starts to hurt, often in the big toe. Many people think they injured their foot or broke a toe at first.
2. Seeing a doctor
   You may start with your primary care doctor. Some people are later seen by a rheumatologist, a doctor who specializes in arthritis and immune system diseases.
3. Medical history and exam
   Your doctor will ask about your pain, how long it lasts, what joints are involved, what medicines you take, and if you have kidney disease, heart disease, or diabetes. They will examine your joints and skin.
4. Lab tests
   • Blood tests to measure uric acid levels and check your kidneys
   • Tests to look for other causes of joint pain
5. Joint fluid test (if needed)
   For some people, the doctor may gently remove a small amount of fluid from the painful joint with a needle. Under a microscope, they can see the uric acid crystals that confirm gout.
6. Imaging tests
   X rays, ultrasound, or other scans can sometimes show crystals, damage in the joint, or tophi.
7. Follow up and plan
   Once gout is diagnosed, you and your care team can make a plan to lower flares, protect your joints, and watch for other health problems linked to gout, such as kidney disease and heart disease.

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Treatment for gout usually has two main goals:

1. Treat and prevent flares
2. Lower uric acid over time to dissolve crystals and protect joints

Your plan might include:

Treating Flares

During a flare, the focus is on easing pain and swelling.

• Nonsteroidal anti inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
• Colchicine, a medicine that can reduce pain and swelling from gout flares
• Corticosteroids, like prednisone, taken by mouth or injected into the joint to reduce inflammation

Your doctor will choose what is safest for you, based on other conditions like high blood pressure, kidney disease, or heart disease.

Lowering Uric Acid (Long Term Treatment)

To prevent future flares and help crystals dissolve, many people need long term urate lowering therapy:

• Allopurinol or febuxostat
  These medicines help your body make less uric acid. They are often the first choice for long term gout treatment.
• Probenecid and other uricosurics
  These medicines help the kidneys remove more uric acid through urine.
• Pegloticase
  A medicine given through a vein (IV) that breaks down uric acid. It is usually for people with severe, hard to treat gout who did not respond to standard medicines. Studies show that pegloticase can help some patients reach gout remission when used with other medicines.

Newer and future medicines are being studied to help more people reach target uric acid levels and reduce flares.

Lifestyle Changes

Medicines are often needed, but healthy habits can help:

• Drinking more water
• Limiting or avoiding sugary drinks and heavy alcohol use
• Being careful with foods very high in purines, like organ meats and certain shellfish
• Working toward a weight that is healthy for you
• Staying active in safe ways for your joints

You do not cause gout just by what you eat, and you cannot fix gout with diet alone. Gout is a real medical disease and deserves real treatment

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