Evidence-based Physiotherapy for Gouty Arthritis

Gout is a kind of arthritis that causes painful and stiff joints. Gout is caused by the build up of crystals made of a substance called uric acid in your joints. It often starts in the big toe and can also cause lumps under the skin and kidney stones.

Who Gets Gout?

Millions of people have gout at some time in their lives. Usually, people who get gout get it when they are middle aged or older, but children and young adults occasionally get it. Men, especially those between ages 40 and 50, are more likely to develop gout than women. Women rarely develop gout before menopause.

You are more likely to get gout if you:

  • Have a family history of gout.
  • Have had an organ transplant.
  • Are a man.
  • Are an adult.
  • Are overweight.
  • Drink alcohol.
  • Eat a lot of foods rich in purines.
  • Have been exposed to lead.

Some other health problems can make it more likely for you to have too much uric acid in the blood. These include:

  • Renal insufficiency, a condition in which your kidneys don’t get rid of enough waste.
  • High blood pressure.
  • Hypothyroidism, or an underactive thyroid gland.
  • Conditions that make your cells reproduce and shed more quickly than usual, such as psoriasis, hemolytic anemia, and some cancers.
  • Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome, two rare conditions in which your body doesn’t have enough of the enzyme that helps control uric acid levels.

Some medications make you more likely to develop gout, including:

  • Diuretics, which are taken to rid the body of excess fluid in condition like hypertension, edema, and heart disease. Diuretics reduce the amount of uric acid passed in the urine.
  • Drugs with salicylate, such as aspirin.
  • Niacin, a vitamin also known as nicotinic acid.
  • Cyclosporine, a medication that blocks the body’s immune system to treat some autoimmune diseases and to prevent the body from rejecting transplanted organs.
  • Levodopa, a medicine used to treat Parkinson’s disease.

What Are The Symptoms of Gout?

Gout causes pain in your joints, often in the big toe. Many people get their first attack of gout in one of their big toes, but it can also affect other joints in your feet, arms, and legs. In addition to pain, your joint may feel swollen, red, warm, and stiff.

In the early stages of gout, you may have attacks that start at night and come on suddenly. Intense pain and swelling may be bad enough to wake you up. Gout attacks are often triggered by stressful events, alcohol, drugs, or another illness.

Usually, a gout attack will get better in three to 10 days, even without treatment. After that, you may not have another attack for months or even years. Over time, however, your attacks may last longer and happen more often.

After a long period of time, such as 10 years or so, gout can sometimes advance and cause permanent damage to your joints and kidneys. With proper treatment, however, most people with gout do not have permanent damage.

What Causes Gout?

Your body has substances called purines in its tissues. Purines are also found in many foods, including liver, dried beans and peas, and anchovies. When purines break down, they become uric acid.

Normally, uric acid dissolves in your blood and passes out of your body when you pee. When you have too much uric acid in your blood, it can start to form crystals in your joints and under your skin, causing gout.

Things that can cause uric acid to build up in the blood include:

  • Your body increasing the amount of uric acid it makes.
  • Your kidneys not getting rid of enough uric acid.
  • Eating too many foods high in purines.

Is There a Test For Gout?

Your doctor can test your blood to see if you have high levels of uric acid. They may also draw a sample of fluid from one of your painful joints to look for crystals of uric acid.

How Is Gout Treated?

Proper treatment can reduce the pain from gout attacks, help prevent future attacks, and prevent damage to your joints.

Your doctor may recommend medications to treat your pain. These may include:

  • Anti-inflammatory drugs (NSAIDs), which can reduce pain and swelling.
  • Corticosteroids, such as prednisone, which are strong anti-inflammatory hormones.
  • Colchicine, which works best when taken within the first 12 hours of a gout attack.
  • Other medications to reduce symptoms or reduce the build up of uric acid in your blood.

Your doctor may also recommend diet and lifestyle changes, such as losing weight, if you are overweight, and eating fewer foods that are high in purines.

Physical Therapy Management (current best evidence)

Physical therapy management of gout falls under preferred practice pattern:

1.       Impaired joint mobility

2.       Motor function

3.       Muscle performance

4.       Range of motion associated with localized inflammation.

The physical therapist should be aware that any patient with a history of gout, hyperuricemia, and/or a septic joint presentation should be referred for medical evaluation prior to treatment.

During acute exacerbations the physical therapist should focus on reinforcement of management program and splinting, orthotics, or other assistive devices to protect the affected joint(s).

A 2002 study in the Journal of Rheumatology found that the use of cryrotherapy to alleviate the pain associated with acute bouts of gout may be effective.

During intercritical phases physical therapists may offer assistance with maintenance of ROM, strength, and function. The physical therapist can also assist the patient in the creation of a suitable exercise routine and keeping thier weight under control.

There is a Randomized Clinical Trial which suggests that Electro-acupuncture in combination with blood letting puncture and cupping has relatively good results as a treatment for Gout. The treatment is effective mostly because the blood uric acid decreased significantly after the treatment was given to the patients.

There is another study about Electro-acupuncture combined with local blocking therapy on acute gouty arthritis that shows an improvement in health status of the patients. This treatment is positive and it also decreases blood uric acid levels.

Differential Diagnosis

Pseudogout - a form of arthritis that occurs 1/8th as often as gout. Symptoms are very similar to gout; however, the knee joint is primarily affected. Diagnosis is made by aspiration of synovial fluid. Other differential diagnosis include RA, neoplasm, septic arthritis, infectious arthritis, acute rheumatic fever, juvenile RA, acute fracture, and palindromic rheumatism.

Acute gouty arthritis typically presents with rapid development of severe joint pain, swelling, and tenderness that reaches its maximum within just 6-12 h, especially with overlying erythema, most classically in the first metatarsophalangeal joint. Demonstrating the presence of monosodium urate (MSU) crystals in the joint fluid or tophus has been the gold standard for the diagnosis of gout.

Living With Gout

In addition to taking medications recommended by your doctor, you can make some changes to your diet to help you have fewer gout attacks. As always, talk with your doctor before making any changes to your diet or medications.

Your doctor may recommend that you lose weight, if you are overweight, or drink less alcohol. You can also avoid eating foods with lots of purines, since they can increase your uric acid levels. Foods that are high in purines include:

  • Anchovies.
  • Asparagus.
  • Beef kidneys.
  • Brains.
  • Dried beans and peas.
  • Game meats.
  • Gravy.
  • Herring.
  • Liver.
  • Mackerel.
  • Mushrooms.
  • Sardines.
  • Scallops.
  • Sweetbreads.

Other Medical Problems Related To Gout

If gout goes untreated for a long period of time, such as 10 years, it can permanently damage your joints and kidneys. This is called chronic tophaceous gout. With proper treatment, however, most people with gout do not have this problem.


  1. GOUT in the Primary Care Setting — A Free CPD/CE Activity with Patient Videos from The Americand.com/a-to-z-guides/gout-topic-overview