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Gout

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Gout

Gout affecting the big toe

Image by StoryMD

About

3D medical animation still showing gout infected foot.

Image by Scientific Animations, Inc.

What Is Gout?

Gout is a type of inflammatory arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then resolve. Gout flares often begin in your big toe or a lower limb. Gout happens when high levels of urate build up in your body over a long period of time, which can then form needle-shaped crystals in and around the joint. This leads to inflammation and arthritis of the joint. When the body makes too much urate, or removes too little, urate levels build up in the body. However, many people with high levels of serum urate will not develop gout.

Areas of the body that can be affected by gout include:

Joints.
Bursae, cushion-like sacs between bones and other soft tissues.
Tendon sheaths, membranes that surround tendons.
Kidneys, because the high uric acid levels can lead to stones.

Gout is a disease that can move through several stages:

Hyperuricemia, when you have elevated levels of urate in your blood over a long period of time and even crystals in the joint, but you do not have symptoms.
Gout flares, when you have periodic attacks of intense pain and swelling in your joints.
Interval or intercritical gout, which is the time between gout attacks when you do not have any symptoms.
Tophi, a late stage of gout when crystals build up in the skin or other areas of the body. Depending on their location, tophi can permanently damage your joints and other internal organs such as the kidneys. Proper treatment can prevent the development of tophi.

With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis. Many people avoid gout flares and can decrease the severity of their symptoms, and can even become gout free.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Additional Materials (15)

1:51

Preventing Gout with a Healthy Diet

Lee Health/YouTube

4:36

Gout and Pseudogout, Joint Pain- Everything You Need To Know- Dr. Nabil Ebraheim

nabil ebraheim/YouTube

2:02

Gout - Mayo Clinic

Mayo Clinic/YouTube

5:54

Gout pathophysiology | Muscular-skeletal diseases | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

6:12

Gout - causes, symptoms, diagnosis, treatment, pathology

Osmosis/YouTube

8:14

Gout and pseudogout | Muscular-skeletal diseases | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

1:34

What Happens During a Gout Attack | WebMD

WebMD/YouTube

2:24

Gout Diagnosis & Treatment

Everyday Health/YouTube

3:01

Gout and MTP Joint Arthrocentesis

Larry Mellick/YouTube

1:37:16

Gout Update | Dr. William Martin - UCLA Health

UCLA Health/YouTube

7:19

Gout: Visual Explanation for Students

Zero To Finals/YouTube

1:01

Gout - an Osmosis Preview

Osmosis/YouTube

3:06

Arthritis | What Are The Types Of Arthritis? | StreamingWell.com

streamingwell/YouTube

2:19

Psuedogout - Everything You Need To Know - Dr. Nabil Ebraheim

nabil ebraheim/YouTube

4:26

Big Toe Pain - Everything You Need To Know - Dr. Nabil Ebraheim

nabil ebraheim/YouTube

What Is Gout?

The Gout by James Gillray. Published May 14th 1799.

Image by James Gillray (1756–1815)/Wikimedia

What Is Gout?

Gout is a type of arthritis, which is a group of related disorders caused by episodes of abnormal inflammation in the joints. People with gout have high levels of a substance called urate in the blood (hyperuricemia). Gout develops when hyperuricemia leads to the formation of urate crystals in joints, triggering an inflammatory response from the immune system.

In people with gout, the first episode of inflammation (called a flare) usually affects the big toe or other joints in the foot or ankle. If urate levels remain high, flares can recur, affecting additional joints throughout the body. The time between flares varies among affected individuals; however, most people who experience multiple flares have their second one within a year of their first.

Flares usually begin at night and can last several days. It is unclear what causes a flare to stop; the body likely turns off the inflammation response after a certain period of time. During a flare, individuals can experience throbbing or burning pain, swelling, warmth, redness, and difficulty moving the affected joint. Fevers may occur, after which the skin over the affected joint can begin to peel. Without treatment, people with gout can experience frequent flares and joint pain and damage, which can limit mobility and decrease quality of life.

In about 15 percent of people with gout, urate accumulates in the kidneys and forms kidney stones. As the condition worsens, urate crystals can also be deposited under the skin or in other soft tissue, forming a nodule called a tophus (plural: tophi). These tophi often form in the hands, elbows, or feet. Tophi do not typically cause pain, but they can become inflamed, infected, or ooze fluid. Depending on their location, tophi can interfere with movements such as walking or gripping objects.

Many people with gout also have other health conditions. Most affected individuals have high blood pressure (hypertension), chronic kidney disease, or obesity. Some also have diabetes, heart disease, or a history of stroke. It is unclear whether gout is the cause of a person's increased risk for these conditions, or whether the conditions cause the development of gout, or whether both of these situations occur to influence disease.

Source: MedlinePlus Genetics

Additional Materials (1)

3:01

Gout and MTP Joint Arthrocentesis

Larry Mellick/YouTube

Risk Factors

Uric Acid: Obesity and Gout

Image by TheVisualMD

Who Gets Gout?

Many people develop gout. It is more common in men than in women. Gout usually develops in middle age. Women usually do not develop gout before menopause, which is why women tend to develop the disease at a later age than men. Less frequently, younger people develop the disease; however, if they do, the disease tends to be more severe.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Additional Materials (2)

4:36

Gout and Pseudogout, Joint Pain- Everything You Need To Know- Dr. Nabil Ebraheim

nabil ebraheim/YouTube

Dual Energy CT images with gout tophi shown in green

BMJ Publishing Group Limited

Causes

Histopathology of gout - A slide showing gouti tophi. Photo micrograph under polarized light. Date

Image by James Heilman

What Causes Gout?

Gout happens when urate, a substance in your body, builds up and forms needle-shaped crystals in your joints. This leads to pain, swelling, redness, and changes in the movement and use of the affected joint. However, not everyone with high urate levels develops gout.

Urate comes from purines, which are found in your body’s tissues and many foods. When purines break down, they become urate. Normally, urate passes out of your body in urine. However, when too much is made or too little is removed, urate builds up in your blood and needle-shaped crystals form in your joints, causing inflammation that is experienced as gout flares that cause pain and swelling.

Researchers continue to study how genes and environmental factors contribute to a buildup of urate in your blood. However, certain factors may increase your chances of developing gout, including:

Having high urate levels.
Having a family history of gout.
Being male.
Having menopause.
Increasing age.
Drinking alcohol.
Drinking sugar-sweetened beverages, such as soda.
Having an unhealthy diet and eating foods that are rich in purines (usually from animal sources), a substance that breaks down into urate.

Some health conditions may increase your risk of developing gout, such as:

Overweight or obesity.
Metabolic syndrome, a name for a group of conditions that include high blood pressure, high blood sugar, abnormal cholesterol levels, and excess body fat around the waist.
Chronic kidney disease, a condition that develops when your kidneys are damaged and cannot filter blood the way they should.
High blood pressure.
Conditions that cause your cells to turn over rapidly, such as psoriasis or some cancers.
Rare genetic conditions (Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome) that lead to increased urate.

Some medications can increase your risk of developing gout, such as:

Diuretics, which help your body eliminate excess fluid.
Low-dose aspirin.
Niacin, a vitamin, when taken in large amounts.
Cyclosporine, which is an immunosuppressant for people who have organ transplants and treats some autoimmune diseases.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Additional Materials (3)

1:34

What Happens During a Gout Attack | WebMD

WebMD/YouTube

7:19

Gout: Visual Explanation for Students

Zero To Finals/YouTube

5:54

Gout pathophysiology | Muscular-skeletal diseases | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

ABCG2 Gene

Ideogram of human chromosome 4

Image by Office of Biological and Environmental Research of the U.S. Department of Energy Office of Science, the Biological and Environmental Research Information System, Oak Ridge National Laboratory.

ABCG2 Gene: ATP Binding Cassette Subfamily G Member 2 (Junior Blood Group)

Normal Function

The ABCG2 gene belongs to a group of genes called the ATP-binding cassette family; genes in this family provide instructions for making proteins that transport molecules across cell membranes. In the intestines, the ABCG2 protein helps release (secrete) a substance called urate into the urine. Urate is a byproduct of certain normal biochemical reactions in the body. In the bloodstream it acts as an antioxidant, protecting cells from the damaging effects of unstable molecules called free radicals. Urate levels are regulated by the kidneys and, to a lesser extent, by the intestines.

The ABCG2 protein also transports certain drugs out of cells. For example, this protein clears some chemotherapy drugs from organs and tissues. Transport of these drugs allows them to have their intended effects and be eliminated from the body.

Health Conditions Related to Genetic Changes

Gout

Genetic changes in the ABCG2 gene are associated with a condition called gout, which is a form of arthritis that causes painful joint inflammation.

ABCG2 gene changes associated with gout decrease the protein's ability to release urate. One variant replaces the protein building block (amino acid) glutamine with the amino acid lysine at position 141 in the protein (written as Gln141Lys or Q141K). This change reduces the protein's ability to secrete urate by half. Another variant creates a premature stop signal in the instructions for making the ABCG2 protein (written as Gln126Ter or Q126X), which results in no functional ABCG2 protein. Variants in the ABCG2 gene reduce the removal of urate from the blood, which causes the blood level of urate to rise. The excess urate can accumulate in the body's joints in the form of crystals, triggering an inflammatory response from the immune system and leading to gout.

While changes in the ABCG2 gene can alter urate levels in the body, they are not enough to cause gout by themselves. A combination of dietary, genetic, and other environmental factors play a part in determining the risk of developing this complex disorder.

Other Names for This Gene

ABC15
ABCP
ATP-binding cassette transporter G2
ATP-binding cassette, sub-family G (WHITE), member 2 (Junior blood group)
BCRP
BCRP1
BMDP
breast cancer resistance protein
CD338
CDw338
EST157481
mitoxantrone resistance-associated protein
MRX
multi drug resistance efflux transport ATP-binding cassette sub-family G (WHITE) member 2
MXR
MXR-1
MXR1
placenta specific MDR protein
placenta-specific ATP-binding cassette transporter
UAQTL1

Genomic Location

The ABCG2 gene is found on chromosome 4.

Source: MedlinePlus Genetics

SLC2A9 Gene

Ideogram of human chromosome 4

Image by Office of Biological and Environmental Research of the U.S. Department of Energy Office of Science, the Biological and Environmental Research Information System, Oak Ridge National Laboratory.

SLC2A9 Gene: Solute Carrier Family 2 Member 9

Normal Function

The SLC2A9 gene provides instructions for making a protein called glucose transporter 9 (GLUT9). This protein is found mainly in the kidneys, specifically in structures called proximal tubules. These structures help to reabsorb needed nutrients, water, and other materials into the blood and excrete unneeded substances into the urine. Within the proximal tubules, the GLUT9 protein helps reabsorb or excrete a substance called urate. Urate is a byproduct of certain normal biochemical reactions in the body. In the bloodstream it acts as an antioxidant, protecting cells from the damaging effects of unstable molecules called free radicals. When more urate is needed in the body, the GLUT9 protein helps reabsorb it into the bloodstream. Most urate that is filtered through the kidneys is reabsorbed into the bloodstream; about 10 percent is released into urine.

The GLUT9 protein also plays a role in reabsorbing and excreting the simple sugar glucose.

Health Conditions Related to Genetic Changes

Renal hypouricemia

At least 17 mutations in the SLC2A9 gene have been found to cause renal hypouricemia. This condition results in a reduced amount of urate in the blood. Renal hypouricemia often does not cause any health problems but can lead to kidney stones, blood in the urine (hematuria), or pain and nausea after exercise. Most of the mutations that cause renal hypouricemia replace single protein building blocks (amino acids) in the GLUT9 protein and severely reduce or eliminate the protein's ability to reabsorb urate into the bloodstream. As a result, an excessive amount of urate is lost through the urine. While it is not clear how these changes in urate levels lead to the signs and symptoms of renal hypouricemia, it is likely that the loss of urate's antioxidant properties in combination with the increase in urate passing through the kidneys to be released in the urine contribute to the characteristic features of this condition.

Gout

Genetic changes in the SLC2A9 gene are associated with a condition called gout, which is a form of arthritis. Gout develops when elevated urate levels in the blood (hyperuricemia) lead to the formation of urate crystals in joints, triggering an inflammatory response from the immune system.

SLC2A9 gene changes associated with gout likely increase the production of a form of the GLUT9 protein that is 28 amino acids shorter than the full-length version. This shorter version of GLUT9 reabsorbs urate into the bloodstream more readily than the full length version. An increase in the short GLUT9 protein raises the levels of urate in the blood and reduces its release into the urine. As a result, urate can accumulate in the body's joints in the form of crystals, leading to painful arthritis.

While changes in the SLC2A9 gene can alter urate levels in the body, they are likely not enough to cause gout by themselves. A combination of dietary, genetic, and other environmental factors play a part in determining the risk of developing this complex disorder.

Other Names for This Gene

glucose transporter type 9
GLUT-9
GLUT9
GLUTX
human glucose transporter-like protein-9
solute carrier family 2 (facilitated glucose transporter), member 9
solute carrier family 2, facilitated glucose transporter member 9
UAQTL2
urate voltage-driven efflux transporter 1
URATv1

Genomic Location

The SLC2A9 gene is found on chromosome 4.

Source: MedlinePlus Genetics

Symptoms

Gout in hands

Image by Δρ. Χαράλαμπος Γκούβας (Dr. Harry Gouvas, Harrygouvas)

What Are the Symptoms of Gout?

The most common symptom of gout is pain in the affected joint. Many people have their first flare of gout in one of their big toes, but it can also affect other joints in your body. Gout flares often start suddenly at night, and the intense pain may be bad enough to wake you up. In addition, your joint may feel swollen, red, and warm.

Gout flares usually occur in one joint and can be triggered by certain foods, alcohol, certain medications, physical trauma, or certain illnesses. Flares typically get better over a week or two, and in between, you usually don’t have symptoms. Some people may have frequent flares, while others may not have another flare for years. However, over time, if left untreated, your flares may happen more often and last longer.

If gout is untreated over long periods of time, tophi can develop. A tophus is the buildup of needle-shaped crystals that cause hard lumps to form under the skin, in and around the joints and other organs. Tophi start out as painless; however, over time, they can become painful and can cause bone and soft tissue damage and misshapen joints.

Some people with gout may be more likely to have or develop other conditions or complications, especially with the heart and kidneys. Common conditions include:

Hypertension (high blood pressure).
Chronic kidney disease.
Obesity.
Diabetes.
Nephrolithiasis (kidney stones).
Myocardial Infarction (heart attack).
Congestive heart failure.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Additional Materials (2)

11:33

Gout Signs and Symptoms (& Why They Occur)

JJ Medicine/YouTube

2:02

Gout - Mayo Clinic

Mayo Clinic/YouTube

HLA-B27 Antigen Test

HLA-B27 Antigen Test

Also called: HLA-B27 Test, Human Leukocyte Antigen B27

HLA-B27 antigen test is a genetic test that identifies the presence of the HLA-B27 antigen on the surface of white blood cells. The test is used to diagnose certain autoimmune disorders, particularly those involving the joints and spine.

HLA-B27 Antigen Test

Also called: HLA-B27 Test, Human Leukocyte Antigen B27

HLA-B27 antigen test is a genetic test that identifies the presence of the HLA-B27 antigen on the surface of white blood cells. The test is used to diagnose certain autoimmune disorders, particularly those involving the joints and spine.

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Use the slider below to see how your results affect your health.
1
Your result is Negative.
A negative HLA-B27 antigen test indicates the absence of the HLA-B27 protein. It suggests that the pain and inflammation may have a different root cause.
Related conditions
1. HLA-B27 antigen: MedlinePlus Medical Encyclopedia [accessed on Dec 26, 2023]
2. HLA-B27 Antigen | Ulta Lab Tests [accessed on Dec 26, 2023]

Additional Materials (3)

18:40

Ankylosing Spondylitis | HLA-B27, Pathophysiology, Signs & Symptoms, Diagnosis, Treatment

JJ Medicine/YouTube

9:21

Human Leukocytic Antigen (HLA)

Medicosis Perfectionalis/YouTube

Mapping of HLA Loci based on Human genome physical map of chromosome 6

Pdeitiker

Rheumatoid Factor (RF) Test

Rheumatoid Factor (RF) Test

Also called: RF Test, RF Blood Test, Rheumatoid Factor, Rheumatoid Arthritis Factor

This test measures the amount of rheumatoid factor in a sample of your blood. Rheumatoid factors are proteins produced by your immune system that can attack healthy tissue. High levels may be a sign of rheumatoid arthritis or another autoimmune disease.

Rheumatoid Factor (RF) Test

Also called: RF Test, RF Blood Test, Rheumatoid Factor, Rheumatoid Arthritis Factor

This test measures the amount of rheumatoid factor in a sample of your blood. Rheumatoid factors are proteins produced by your immune system that can attack healthy tissue. High levels may be a sign of rheumatoid arthritis or another autoimmune disease.

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Use the slider below to see how your results affect your health.
(i.U.)/mL
14
Your result is Negative.
A low number or a negative result means that you have little or no rheumatoid factor in your blood. But that doesn't rule out rheumatoid arthritis or another health problem. Many people with rheumatoid arthritis have little or no rheumatoid factor. Further testing may be necessary to confirm a diagnosis.
Related conditions
You may need an RF test if you have symptoms of rheumatoid arthritis. Symptoms often begin in the wrists, hands, and feet. They usually affect the same joints on both sides of the body and tend to come and go.
Symptoms of rheumatoid arthritis may include:
- Joint pain
- Tenderness, swelling, and warmth of the joint
- Joint stiffness that lasts longer than 30 minutes
- Fatigue
- Occasional low fevers
- Loss of appetite
- Problems outside of the joints that may include dry eyes or mouth, firm lumps under the skin, or anemia
You may also need an RF test if you're having tests to diagnose another condition that can cause high levels of rheumatoid factor, such as:
- Other autoimmune disorders, including:
  Sjögren syndrome
  Lupus
  Scleroderma
  Juvenile idiopathic arthritis in children and teens
- Chronic infections, including:
  Hepatitis C (liver)
  Tuberculosis (mostly affects the lungs)
  Endocarditis (heart)
- Certain types of cancer, including leukemia
An RF test alone cannot diagnose any conditions. To make a diagnosis, your provider will look at the results of other tests along with your symptoms and medical history.
A negative (normal) result means that you have little or no rheumatoid factor in your blood. But that doesn't rule out rheumatoid arthritis or another health problem. Many people with rheumatoid arthritis have little or no rheumatoid factor. If you have symptoms of rheumatoid arthritis, but your RF test results are normal, your provider may order more tests to make a diagnosis.
A positive (abnormal) result means that a higher level of rheumatoid factor was found in your blood. This doesn't always mean that rheumatoid factors are causing your symptoms. But the higher your RF test results, the more likely it is that you have a condition linked to rheumatoid factors. Your provider may do more tests to find out if you have:
- Rheumatoid arthritis or another autoimmune disease
- A chronic infection
- Certain cancers
1. Rheumatoid Factor (RF) Test: MedlinePlus Medical Test [accessed on Jan 29, 2024]
2. Rheumatoid factor (RF): MedlinePlus Medical Encyclopedia [accessed on Jan 29, 2024]
3. Rheumatoid Factor (RF) Test - Testing.com. Dec 6, 2022 [accessed on Jan 29, 2024]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (17)

Rheumatoid Arthritis, Pain

Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation, pain, stiffness and eventual deterioration of the joints, especially in hands and wrists, but also in shoulders, neck, hips, knees, and feet. More than 1.3 million people in the U.S. have rheumatoid arthritis. There is no cure, but early diagnosis and treatment can slow the progression of the disease, minimize symptoms, and help preserve joint function; getting exercise and rest can also help.

Image by TheVisualMD

What Is Rheumatoid Arthritis?

Rheumatoid Arthritis B-Cell Breakthrough : A new discovery has shed light on the mechanism by which joints are damaged by rheumatoid arthritis, scientists announced this week. Rheumatoid Arthritis x-rayWriting in this week's edition of the journal PLoS Medicine Barts and the London Medical school researcher Constantino Pitzalis and his colleagues collected samples from the inflamed joints of patients affected by the disease, which affects about 1% of the adult population and occurs when the immune system mistakes healthy joints for hostile tissue and attacks them.

Image by Bernd Bragelmann Braegel Mit freundlicher Genehmigung von Dr. Martin Steinhoff

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation, pain, stiffness and eventual deterioration of the joints, especially in hands and wrists, but also in shoulders, neck, hips, knees, and feet. While a diagnosis of RA ultimately depends on clinical symptoms, the presence of antibodies such as rheumatoid factor (RF) and cyclic citrullinated peptide antibody (CCP) are usually good indicators that the disease is present. The CCP test may detect the presence of antibodies before symptoms appear.

Image by TheVisualMD

What Happens in Rheumatoid Arthritis?

A hand affected by rheumatoid arthritis

Image by James Heilman, MD

Collecting Skin Microbiome Samples

Heidi H. Kong, M.D., M.H.Sc., performs a non-invasive collection of skin samples with the assistance of Sheila Phang, R.N., a research nurse. These types of samples are processed and sequenced for microbiome studies. The skin microbiome is the collection of bacteria and other microorganisms that inhabits the skin. Dr. Kong’s research is part of efforts to understand the skin microbiome and its role in health and disease. The photograph was taken in an Outpatient Clinic in the NIH Clinical Center. NOTE: When this photo was taken, Dr. Kong was with the Dermatology Branch of the National Cancer Institute (NCI). The branch became part of NIAMS in 2017.

Image by NIAMS/Photographer: Rhoda Baer

Rheumatoid Arthritis - Mayo Clinic

Video by Mayo Clinic/YouTube

Rheumatoid Arthritis of the hand - Everything You Need To Know - Dr. Nabil Ebraheim

Video by nabil ebraheim/YouTube

Rheumatoid Arthritis

Video by Focus Medica/YouTube

Rheumatoid Arthritis Overview

Video by AnswersTV/YouTube

Rheumatoid Factor Test Positive - what does it mean? | Comprehensive Guide to Autoimmune Disorders

Video by Dr. Diana Girnita - Rheumatologist OnCall /YouTube

Juvenile Rheumatoid Arthritis - JRA

Video by drmdk/YouTube

5 Things you need to know about your positive Rheumatoid Factor

Video by Connected Rheumatology/YouTube

Symptoms and Treatment for Rheumatoid Arthritis patients.

Video by CNN/YouTube

Osteoarthritis and rheumatoid arthritis

Video by Khan Academy/YouTube

The Pain, Swelling And Stiffness of Rheumatoid Arthritis

Video by Mayo Clinic/YouTube

Novel Treatments for Rheumatoid Arthritis

Video by Mechanisms in Medicine/YouTube

Hip Joint

The hip is a ball-and-socket joint located where the femur (thigh bone) meets the pelvic cone. Its ball-and-socket construction permits the hip joint a large range of motion, second only to that of the shoulder. (This large range of motion is restricted somewhat by the soft tissues of the hip joint.) The hip joint supports much of your weight when you are standing, walking, or running. When you sit, the load is largely transferred to the ischial tuberosities (sit bones). The femoral ball-the ball-shaped head of the femur-is the moving part of the hip joint. It fits into a hollow socket in the hip called the acetabulum. The acetabulum holds about half of the femoral ball. The femoral ball is attached to the femur by a thin neck region. This is the part of the hip joint that most often fractures in the elderly. The femoral ball and the inner surface of the acetabulum are covered in articular cartilage, providing a smooth contact surface. The acetabulum has a rim made of fibrocartilage called the labrum, which acts as a kind of gasket. The labrum helps to hold the femoral ball in place. The hip joint capsule, a thick, fibrous sheath of connective tissue, surrounds the entire hip joint and helps to hold it firmly together.

Image by TheVisualMD

Rheumatoid Arthritis, Pain

TheVisualMD

What Is Rheumatoid Arthritis?

Bernd Bragelmann Braegel Mit freundlicher Genehmigung von Dr. Martin Steinhoff

Rheumatoid Arthritis

TheVisualMD

What Happens in Rheumatoid Arthritis?

James Heilman, MD

Collecting Skin Microbiome Samples

NIAMS/Photographer: Rhoda Baer

2:09

Rheumatoid Arthritis - Mayo Clinic

Mayo Clinic/YouTube

5:50

Rheumatoid Arthritis of the hand - Everything You Need To Know - Dr. Nabil Ebraheim

nabil ebraheim/YouTube

0:42

Rheumatoid Arthritis

Focus Medica/YouTube

8:09

Rheumatoid Arthritis Overview

AnswersTV/YouTube

7:31

Rheumatoid Factor Test Positive - what does it mean? | Comprehensive Guide to Autoimmune Disorders

Dr. Diana Girnita - Rheumatologist OnCall /YouTube

4:28

Juvenile Rheumatoid Arthritis - JRA

drmdk/YouTube

7:38

5 Things you need to know about your positive Rheumatoid Factor

Connected Rheumatology/YouTube

3:10

Symptoms and Treatment for Rheumatoid Arthritis patients.

CNN/YouTube

11:16

Osteoarthritis and rheumatoid arthritis

Khan Academy/YouTube

1:47

The Pain, Swelling And Stiffness of Rheumatoid Arthritis

Mayo Clinic/YouTube

3:28

Novel Treatments for Rheumatoid Arthritis

Mechanisms in Medicine/YouTube

Hip Joint

TheVisualMD

C-Reactive Protein Test

C-Reactive Protein Test

Also called: CRP

A c-reactive protein test checks for inflammation in the body. Inflammation can be caused by infection, injury, or chronic disease.

C-Reactive Protein Test

Also called: CRP

A c-reactive protein test checks for inflammation in the body. Inflammation can be caused by infection, injury, or chronic disease.

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Use the slider below to see how your results affect your health.
mg/L
10
Your result is Normal.
Test results may vary depending on your age, gender, health history, the lab and the method used for the test.
Related conditions
A CRP test may be used to find or monitor conditions that cause inflammation. These include:
- Bacterial infections, such as sepsis, a severe and sometimes life-threatening condition
- A fungal infection
- Inflammatory bowel disease, a disorder that causes swelling and bleeding in the intestines
- An autoimmune disorder such as lupus or rheumatoid arthritis
- An infection of the bone called osteomyelitis
You may need this test if you have symptoms of a serious bacterial infection. Symptoms include:
- Fever
- Chills
- Rapid breathing
- Rapid heart rate
- Nausea and vomiting
If you've already been diagnosed with an infection or have a chronic disease, this test may be used to monitor your treatment. CRP levels rise and fall depending on how much inflammation you have. If your CRP levels go down, it's a sign that your treatment for inflammation is working.

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (20)

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Cardiovascular Inflammation

Heart disease is the number one killer of men and women in the U.S. The most common cause of heart attack, stroke, and cardiovascular death is atherosclerosis. Atherosclerosis is a chronic inflammatory response in the walls of arteries that leads to the hardening of arterial walls and the buildup of fatty deposits called plaques, or atheromas. Although the process of inflammation can be beneficial in other parts of the body, chronic inflammation within arterial walls is problematic as it seems to promote this underlying growth of plaque. The combination of arterial inflammation and the growth of plaque can lead to the rupture of the plaque, and result in a blood clot. Blood clots can lead to dangerous conditions such as heart attack or stroke.

Video by TheVisualMD

C-Reactive Protein (CRP) Molecule

C-reactive protein (CRP) is a substance made by the liver; infection and inflammation can trigger the release of CRP within hours. Elevated CRP levels are also seen after a heart attack or surgery. Levels can jump 1000-fold in response to acute inflammation, often rising before the appearance of pain, fever or other clinical symptoms. The high sensitivity version of the test (hs-CRP) measures the same molecule, but in very small amounts, and is used to assess the risk of heart disease in otherwise healthy people. The C-reactive protein (CRP) test is a general test for inflammation in the body; it can indicate that inflammation is present, but cannot determine the location or cause. The test is sometimes used to monitor flare-ups of inflammatory diseases such as rheumatoid arthritis or lupus. A version of the test called high-sensitivity C-reactive protein (hs-CRP) is used to evaluate a person's risk for heart disease.

Image by TheVisualMD

C Reactive Protein: Liver and Heart

C-Reactive protein is synthesized by the liver in response to either signals from fat cells (adipocytes) or when there is inflammation throughout the body.

Image by TheVisualMD

Lipoprotein (a) or Lp(a), Heart Attack

LDL, HDL and total cholesterol have become standard biomarkers for heart disease. And yet half of all people who suffer heart attacks have normal cholesterol levels. For that reason, researchers have looked for other biomarkers that might help identify people at risk for cardiovascular disease. Lp(a) is a lipoprotein that closely resembles LDL, and like LDL, elevated levels of Lp(a) are associated with a higher risk of heart disease. Unlike LDL, however, Lp(a) levels are believed to be largely genetic.

Image by TheVisualMD

NBC Nightly News and C-Reactive Protein

Video by SAVI Health/YouTube

CRP Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing

Video by NURSINGcom/YouTube

CRP And Homocysteine Inflammation Markers, How Do They Relate To Coronary Artery Disease? - Dr. Lyel

Video by EmpowHER/YouTube

CRP High Sensitivity Cardiac Risk Assessment from Walk-in Lab

Video by Walk-In Lab LLC/YouTube

What Can Give False Readings on an hs-CRP Test? : Health Tips

Video by ehowhealth/YouTube

CRP Indicates Heart Disease Risk Video - Brigham and Women's Hospital

Video by Brigham And Women's Hospital/YouTube

C Reactive Protein: Fat cells

Researchers have found that fat cells trigger the production of C-reactive protein (CRP), which is why individuals who are overweight or obese tend to have chronically higher levels of CRP. High levels of CRP are sometimes treated with aspirin or statins.

Image by TheVisualMD

C-reactive Protein, Atherosclerosis and Heart Disease

C-reactive protein (CRP) is a substance made by the liver that is released into the bloodstream by inflammation. CRP levels also seem to be associated with an increased risk of heart disease and atherosclerosis, in which fatty deposits called plaque build up inside the arteries. For this reason, a high sensitivity C-reactive protein test (hs-CRP) is increasingly ordered along with other tests as part of a cardiovascular risk profile (other components of the profile include cholesterol, triglycerides, blood pressure, glucose levels, lifestyle and family history).

Image by TheVisualMD

C-reactive Protein, Fat cells

C-reactive protein (CRP) is a substance made by the liver that is released into the bloodstream by inflammation and infection as part of the body's immune response. Researchers have found, however, that fat cells also seem to trigger the production of C-reactive protein (CRP), which is why individuals who are overweight or obese tend to have chronically higher levels of CRP.

Image by TheVisualMD

What is C-Reactive Protein & How to Lower it? – Dr.Berg

Video by Dr. Eric Berg DC/YouTube

C-reactive protein

Video by University of Rochester Introductory Biochemistry (Bio250H)/YouTube

C-Reactive Protein (CRP) | Inflammation | Acute phase reactant

Video by Medicosis Perfectionalis/YouTube

C-reactive protein

C-reactive protein drawn from PDB: 1GNH by JFW | T@lk

Image by User Jfdwolff on en.wikipedia/Wikimedia

1lj7

C-reactive protein homopentamer, Human

Image by Deposition authors: Ramadan, M.A., Shrive, A.K., Holden, D., Myles, D.A., Volanakis, J.E., DeLucas, L.J., Greenhough, T.J.; visualization author: User:Astrojan/Wikimedia

C Reactive Protein: Phagocytosis

Different white blood cells have specialized immune functions; certain WBCs, for example, are able to ingest harmful foreign particles, including pathogens, in a process called phagocytosis. CRP is believed to enhance this defense mechanism.

Image by TheVisualMD

The C-Reactive Protein (CRP) blood test and what the results can mean

Video by Pathology Tests Explained/YouTube

4:26

Cardiovascular Inflammation

TheVisualMD

C-Reactive Protein (CRP) Molecule

TheVisualMD

C Reactive Protein: Liver and Heart

TheVisualMD

Lipoprotein (a) or Lp(a), Heart Attack

TheVisualMD

2:33

NBC Nightly News and C-Reactive Protein

SAVI Health/YouTube

1:33

CRP Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing

NURSINGcom/YouTube

2:12

CRP And Homocysteine Inflammation Markers, How Do They Relate To Coronary Artery Disease? - Dr. Lyel

EmpowHER/YouTube

1:51

CRP High Sensitivity Cardiac Risk Assessment from Walk-in Lab

Walk-In Lab LLC/YouTube

2:25

What Can Give False Readings on an hs-CRP Test? : Health Tips

ehowhealth/YouTube

3:37

CRP Indicates Heart Disease Risk Video - Brigham and Women's Hospital

Brigham And Women's Hospital/YouTube

C Reactive Protein: Fat cells

TheVisualMD

C-reactive Protein, Atherosclerosis and Heart Disease

TheVisualMD

C-reactive Protein, Fat cells

TheVisualMD

4:26

What is C-Reactive Protein & How to Lower it? – Dr.Berg

Dr. Eric Berg DC/YouTube

5:13

C-reactive protein

University of Rochester Introductory Biochemistry (Bio250H)/YouTube

12:14

C-Reactive Protein (CRP) | Inflammation | Acute phase reactant

Medicosis Perfectionalis/YouTube

C-reactive protein

User Jfdwolff on en.wikipedia/Wikimedia

1lj7

Deposition authors: Ramadan, M.A., Shrive, A.K., Holden, D., Myles, D.A., Volanakis, J.E., DeLucas, L.J., Greenhough, T.J.; visualization author: User:Astrojan/Wikimedia

C Reactive Protein: Phagocytosis

TheVisualMD

1:39

The C-Reactive Protein (CRP) blood test and what the results can mean

Pathology Tests Explained/YouTube

Erythrocyte Sedimentation Rate Test

Erythrocyte Sedimentation Rate Test

Also called: ESR, Westergren sedimentation rate

An erythrocyte sedimentation rate measures how quickly red blood cells settle in a test tube. It can help detect inflammation in the body.

Erythrocyte Sedimentation Rate Test

Also called: ESR, Westergren sedimentation rate

An erythrocyte sedimentation rate measures how quickly red blood cells settle in a test tube. It can help detect inflammation in the body.

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Use the slider below to see how your results affect your health.
mm/h
5
22
40
Your result is Normal.
Normal results vary based on the laboratory and the method used.
Related conditions
Your health care provider may order an ESR if you have symptoms of an inflammatory disorder. These include:
- Headaches
- Fever
- Weight loss
- Joint stiffness
- Neck or shoulder pain
- Loss of appetite
- Anemia
If your ESR is high, it may be related to an inflammatory condition, such as:
- Infection
- Rheumatoid arthritis
- Rheumatic fever
- Vascular disease
- Inflammatory bowel disease
- Heart disease
- Kidney disease
- Certain cancers
Sometimes the ESR can be slower than normal. A slow ESR may indicate a blood disorder, such as:
- Polycythemia
- Sickle cell anemia
- Leukocytosis, an abnormal increase in white blood cells
If your results are not in the normal range, it doesn't necessarily mean you have a medical condition that requires treatment. A moderate ESR may indicate pregnancy, menstruation, or anemia, rather than an inflammatory disease. Certain medicines and supplements can also affect your results. These include oral contraceptives, aspirin, cortisone, and vitamin A. Be sure to tell your health care provider about any drugs or supplements you are taking.

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (6)

This browser does not support the video element.

What Is Inflammation?

Inflammation is the body's response to damage. It takes many forms. Chronic inflammation is common in overweight and obese people, because their fat cells manufacture damaging substances that trigger a reaction from the immune system's white blood cells. Keeping track of a key biomarker for inflammation, C-reactive Protein or CRP, helps doctors determine whether an overweight patient is at risk for such conditions as heart disease, dementia, diabetes, cancers, and more.

Video by TheVisualMD

Asthma - Inflammation in the Airways

Asthma is a condition in which the airways of your lungs are chronically inflamed. Allergens or other triggers can cause the smooth muscle tissue that surrounds your airways to constrict (narrow). These triggers can also prompt an inflammatory response from the immune cells that line your airways, causing them to release an excessive amount of mucus. The constriction and the mucus narrow your airways, creating symptoms that can include shortness of breath, wheezing, coughing, and chest tightness.

Image by TheVisualMD

Mast Cell

Mast cells produce histamine. Histamine is known for its role in inflammation. It affects a variety of behavior patterns including the sleep-wake cycle and food intake. Antihistamines may work at odds with inflammation and depression.

Image by TheVisualMD

Subsiding Inflammation in blood vessels

Monocytes, having matured into macrophages continue to destroy pathogens and cellular debris by ingesting them, while the inflammation process begins to subside.

Image by TheVisualMD

Basophil

Visualization of a basophil. A type of leukocyte (white blood cell) responsible for combating infection.

Image by TheVisualMD

erythrocyte sedimentation rate

Westergren pipettes in automated StaRRsed ESR analyzer

Image by MechESR

1:57

What Is Inflammation?

TheVisualMD

Asthma - Inflammation in the Airways

TheVisualMD

Mast Cell

TheVisualMD

Subsiding Inflammation in blood vessels

TheVisualMD

Basophil

TheVisualMD

erythrocyte sedimentation rate

MechESR

Cyclic Citrullinated Peptide Antibody Test

Cyclic Citrullinated Peptide Antibody Test

Also called: CCP Antibody, Anticitrullinated peptide antibody, Citrulline antibody, Anti-cyclic citrullinated peptide, Anti-CCP antibody, ACPA

This test looks for CCP (cyclic citrullinated peptide) antibodies in the blood. CCP antibodies are made by the immune system. Instead of fighting disease-causing substances, CCP antibodies attack healthy tissues in the joints. CCP antibodies can be a sign of rheumatoid arthritis.

Cyclic Citrullinated Peptide Antibody Test

Also called: CCP Antibody, Anticitrullinated peptide antibody, Citrulline antibody, Anti-cyclic citrullinated peptide, Anti-CCP antibody, ACPA

This test looks for CCP (cyclic citrullinated peptide) antibodies in the blood. CCP antibodies are made by the immune system. Instead of fighting disease-causing substances, CCP antibodies attack healthy tissues in the joints. CCP antibodies can be a sign of rheumatoid arthritis.

This test looks for CCP (cyclic citrullinated peptide) antibodies in the blood. CCP antibodies, also called anti-CCP antibodies, are a type of antibody called autoantibodies. Antibodies and autoantibodies are proteins made by the immune system. Antibodies protect you from disease by fighting foreign substances like viruses and bacteria. Autoantibodies can cause disease by attacking the body's healthy cells by mistake.
CCP antibodies target healthy tissues in the joints. If CCP antibodies are found in your blood, it can be a sign of rheumatoid arthritis. Rheumatoid arthritis is a progressive, autoimmune disease that causes pain, swelling, and stiffness in the joints. CCP antibodies are found in more than 75 percent of people who have rheumatoid arthritis. They are almost never found in people who don't have the disease.
You may need this test if you have symptoms of rheumatoid arthritis. These include:
- Joint pain
- Joint stiffness, especially in the morning
- Joint swelling
- Fatigue
- Low-grade fever
You may also need this test if other tests couldn't confirm or rule out a diagnosis of rheumatoid arthritis.
If your CCP antibody results were positive, it means these antibodies were found in your blood. A negative result means no CCP antibodies were found. The meaning of these results may depend on the results of a rheumatoid factor (RF) test as well as a physical exam.
If you have symptoms of rheumatoid arthritis, and your results show:
- Positive CCP antibodies and positive RF, it likely means that you have rheumatoid arthritis.
- Positive CCP antibodies and negative RF, it may mean you are in the early stages of rheumatoid arthritis or will develop it in the future.
- Negative CCP antibodies and negative RF, it means you are less likely to have rheumatoid arthritis. Your provider may need to do more tests to help find out what is causing your symptoms.
Rheumatoid arthritis can be difficult to diagnose, especially in its early stages. Your provider may order one or more tests in addition to CCP antibody and RF tests. These include x-rays of your joints and the following blood tests:
- Erythrocyte sedimentation rate (ESR)
- Synovial fluid analysis
- C-reactive protein
- Antinuclear antibody
These blood tests can show signs of inflammation. Inflammation is a type of immune system response. It can be a symptom of rheumatoid arthritis.
1. Lab Tests Online: Cyclic Citrullinated Peptide Antibody [accessed on Aug 20, 2018]
2. Mayo Clinic: Cyclic Citrullinated Peptide Antibodies, IgG, Serum [accessed on Aug 20, 2018]
3. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=ccp [accessed on Mar 14, 2019]
4. https://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=11173 [accessed on Mar 14, 2019]
5. https://www.labcorp.com/test-menu/23566/cyclic-citrullinated-peptide-ccp-antibodies-iga-igg-elisa [accessed on Mar 14, 2019]

Additional Materials (2)

Abdomen Showing Small Intestine and Large Intestine

TheVisualMD

Small Intestine and Large Intestine

TheVisualMD

ANA (Antinuclear Antibody) Test

ANA (Antinuclear Antibody) Test

Also called: ANF (Anti-Nuclear Factor) Test, Fluorescent Anti-Nuclear Antibody (FANA) Test

The test looks for antinuclear antibodies (ANA) in a sample of your blood. It is used to see if you have an autoimmune disorder, a condition where the immune system attacks healthy cells.

ANA (Antinuclear Antibody) Test

Also called: ANF (Anti-Nuclear Factor) Test, Fluorescent Anti-Nuclear Antibody (FANA) Test

The test looks for antinuclear antibodies (ANA) in a sample of your blood. It is used to see if you have an autoimmune disorder, a condition where the immune system attacks healthy cells.

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Use the slider below to see how your results affect your health.
Your result is Negative.
A negative result means that your blood has no detectable levels of ANAs. An autoimmune disorder is less likely.
Related conditions
{"label":"ANA titer reference range","scale":"lin","step":1,"hideunits":false,"items":[{"flag":"normal","label":{"short":"Negative","long":"Negative","orientation":"horizontal"},"values":{"min":0,"max":40},"text":"A negative ANA titer (<1:40) result indicates that there are no antinuclear antibodies present in the sample of your blood.","conditions":[]},{"flag":"borderline","label":{"short":"Low antibody level","long":"Low antibody level","orientation":"horizontal"},"values":{"min":40,"max":80},"text":"A borderline ANA titer (1:40 - 1:80) indicates that there is a low level of antinuclear antibodies present in the sample of your blood. This result is inconclusive and further testing may be necessary.","conditions":[]},{"flag":"abnormal","label":{"short":"Elevated antibody level","long":"Elevated antibody level","orientation":"horizontal"},"values":{"min":80,"max":800},"text":"A positive ANA titer (>1:80) indicates that antinuclear antibodies were found in your blood. However, this does not mean you have an autoimmune disease and further testing may be necessary.","conditions":["Systemic lupus erythematosus (SLE)","Rheumatoid arthritis (RA)","Sj\u00f6gren syndrome (SS)","Myositis (inflammatory muscle disease)","Drug-induced lupus erythematosus","Scleroderma (systemic sclerosis)","Juvenile diabetes mellitus","Addison disease","Vitiligo","Glomerulonephritis","Pernicious anemia","Collagen vascular disease","Chronic liver disease","Chronic infection","Cancer"]}],"units":[{"printSymbol":"{titer}","code":"{titer}","name":"titer"}],"value":20,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"normal":0},{"borderline":0},{"abnormal":0}]
Use the slider below to see how your results affect your health.
{titer}
40
80
Your result is Negative.
Related conditions
{"label":"ANA pattern reference range","scale":"lin","step":0.25,"hideunits":true,"items":[{"flag":"abnormal","label":{"short":"H","long":"Homogenous","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"A homogenous staining pattern means the entire nucleus is stained with ANA. It\u2019s the most common type of staining pattern. A homogenous pattern can mean any autoimmune disease but more specifically, lupus or Sj\u00f6gren\u2019s syndrome.","conditions":[]},{"flag":"abnormal","label":{"short":"S","long":"Speckled","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"A speckled staining pattern means fine, coarse speckles of ANA are present throughout the nucleus. A speckled pattern may indicate various diseases, including lupus and Sj\u00f6gren\u2019s syndrome.","conditions":[]},{"flag":"abnormal","label":{"short":"C","long":"Centromere","orientation":"horizontal"},"values":{"min":2,"max":3},"text":"A centromere staining pattern means the ANA staining is present along the chromosomes. A centromere pattern may indicate scleroderma.","conditions":[]},{"flag":"abnormal","label":{"short":"N","long":"Nucleolar","orientation":"horizontal"},"values":{"min":3,"max":4},"text":"A nucleolar staining pattern means ANA staining is present around the nucleoles. The nucleoles is inside the nucleus and produces the cell\u2019s ribosomes. A nucleolar pattern may indicate scleroderma. But it can also indicate Sj\u00f6gren\u2019s syndrome or mixed connective tissue disease or be a false positive.","conditions":[]},{"flag":"abnormal","label":{"short":"P","long":"Peripheral","orientation":"horizontal"},"values":{"min":4,"max":5},"text":"A peripheral staining pattern means ANA staining is present around the edges of the nucleus. It has a shaggy appearance. A peripheral pattern may indicate lupus.","conditions":[]}],"value":0.5,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"abnormal":0},{"abnormal":1},{"abnormal":2},{"abnormal":3},{"abnormal":0}]
Use the slider below to see how your results affect your health.
Your result is Homogenous.
A homogenous staining pattern means the entire nucleus is stained with ANA. It’s the most common type of staining pattern. A homogenous pattern can mean any autoimmune disease but more specifically, lupus or Sjögren’s syndrome.
Related conditions
An ANA test is used to help diagnose autoimmune disorders, such as:
- Systemic lupus erythematosus (SLE), the most common type of lupus. Lupus is a chronic (long-lasting) disease that affects many parts of the body, including the joints, skin, heart, lungs, blood vessels, kidneys, and brain.
- Rheumatoid arthritis, a condition that mostly affects joints, causing pain and swelling often in the wrists, hands, and feet.
- Scleroderma, a rare disease that may affect the skin, blood vessels, and organs.
- Sjögren's syndrome, a rare disease that affects the glands that make tears and saliva (spit) and other parts of the body.
- Addison Disease, which affects your adrenal glands, causing fatigue and weakness.
- Autoimmune hepatitis, which causes swelling in your liver.
Your health care provider may order an ANA test if you have symptoms of an autoimmune disorder. The symptoms depend on the part of the body that's affected. They may include:
- Fever
- Rash, blisters, or skin color changes
- Fatigue
- Joint pain, stiffness, and swelling
- Muscle pain
Results from an ANA test alone cannot diagnose a specific disease. Your provider will use your ANA test results along with other tests and information about your health to make a diagnosis.
A negative result on an ANA test means that antinuclear antibodies were not found in your blood, and you're less likely to have an autoimmune disorder. But a negative ANA test doesn't completely rule out the possibility that you could have an autoimmune disorder.
A positive result on an ANA test means that antinuclear antibodies were found in your blood. A positive result may be a sign of:
- Systemic lupus erythematosus (SLE)
- A different type of autoimmune disease
- A viral infection (antinuclear antibodies from a virus are usually temporary)
- Another health condition that can cause antinuclear antibodies, such as cancer.
If your ANA test results are positive, your provider will likely order more tests to make a diagnosis.
Having antinuclear antibodies in your blood doesn't always mean you have a disease. Some healthy people have antinuclear antibodies in their blood, and levels tend to increase with age. As many as one-third of healthy adults over the age of 65 may have a positive ANA test result. Also, certain medicines can cause antinuclear antibodies.
If you have questions about your results, talk with your provider.
1. ANA (Antinuclear Antibody) Test: MedlinePlus Medical Test [accessed on Jan 19, 2024]
2. Antinuclear Antibody - Health Encyclopedia - University of Rochester Medical Center [accessed on Oct 01, 2018]
3. Anti-Nuclear Antibody (ANA) Test [accessed on Oct 01, 2018]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (6)

ANA - dsDNA antibody

Antibody binding to DNA. These antibodies are found in the sera of systemic lupus erythematosus.

Image by Simon Caulton/Wikimedia

Antinuclear antibodies

Kit for carrying out a test for antinuclear antibodies : The immune system makes an abundance of proteins called antibodies. Antibodies are made by white blood cells and they recognize and combat infectious organisms in the body. Sometimes these antibodies make a mistake, identifying normal, naturally-occurring proteins in our bodies as being "foreign" and dangerous. The antibodies that target "normal" proteins within the nucleus of a cell are called antinuclear antibodies (ANA). ANAs could signal the body to begin attacking itself which can lead to autoimmune diseases, including lupus, scleroderma, Sjögren's syndrome, polymyositis/ dermatomyositis, mixed connective tissue disease, drug-induced lupus, and autoimmune hepatitis. A positive ANA can also be seen in juvenile arthritis.

Image by J3D3

Main antinuclear antibody patterns on immunofluorescence

Main antinuclear antibody patterns on immunofluorescence: Speckled, homogenous, mixed, nucleolar, centromere and peripheral patterns.

Image by Mikael Häggström, M.D./Wikimedia

SSA SSB ANA

Immunofluorescence pattern of SS-A and SS-B antibodies. Produced using serum from a patient on HEp-20-10 cells with a FITC conjugate.

Image by Simon Caulton/Wikimedia

DsDNA antibodies

Homogeneous immunofluorescence staining pattern of double stranded DNA antibodies on HEp-20-10 cells. Interphase cells show homogeneous nuclear staining while mitotic cells show staining of the condensed chromosome regions.. Immunofluorescence pattern of double stranded DNA antibodies. Produced using serum from a patient with lupus erythematosus on HEp-20-10 cells with a FITC conjugate.

Image by Simon Caulton/Wikimedia

CENTROMERE

Immunofluorescence pattern of centromere antibodies. Produced using serum from a patient on HEp-20-10 cells with a FITC conjugate

Image by Simon Caulton/Wikimedia

ANA - dsDNA antibody

Simon Caulton/Wikimedia

Antinuclear antibodies

J3D3

Main antinuclear antibody patterns on immunofluorescence

Mikael Häggström, M.D./Wikimedia

SSA SSB ANA

Simon Caulton/Wikimedia

DsDNA antibodies

Simon Caulton/Wikimedia

CENTROMERE

Simon Caulton/Wikimedia

Synovial Fluid Analysis

Synovial Fluid Analysis

Also called: Joint fluid analysis

Synovial fluid is a thick liquid located between the joints. A synovial fluid analysis checks for disorders that affect the joints. These include arthritis, inflammation, and infections.

Synovial Fluid Analysis

Also called: Joint fluid analysis

Synovial fluid is a thick liquid located between the joints. A synovial fluid analysis checks for disorders that affect the joints. These include arthritis, inflammation, and infections.

Synovial fluid, also known as joint fluid, is a thick liquid located between your joints. The fluid cushions the ends of bones and reduces friction when you move your joints. A synovial fluid analysis is a group of tests that checks for disorders that affect the joints. The tests usually include the following:
- An exam of physical qualities of the fluid, such as its color and thickness
- Chemical tests to check for changes in the fluid's chemicals
- Microscopic analysis to look for crystals, bacteria, and other substances
A synovial fluid analysis is used to help diagnose the cause of joint pain and inflammation. Inflammation is the body's response to injury or infection. It can cause pain, swelling, redness, and loss of function in the affected area. Causes of joint problems include:
- Osteoarthritis, the most common form of arthritis. It is a chronic, progressive disease that causes joint cartilage to break down. It can be painful and lead to loss of mobility and function.
- Gout, a type of arthritis that causes inflammation in one or more joints, usually in the big toe
- Rheumatoid arthritis, a condition in which the body's immune system attacks healthy cells in your joints
- Joint effusion, a condition that happens when too much fluid builds up around a joint. It often affects the knee. When it affects the knee, it may be referred to as knee effusion or fluid on the knee.
- Infection in a joint
- Bleeding disorder, such as hemophilia. Hemophilia is an inherited disorder that can cause excessive bleeding. Sometimes the excess blood ends up in the synovial fluid.
You may need this test if you have symptoms of a joint disorder. These include:
- Joint pain
- Joint swelling
- Redness at a joint
- Joint that feels warm to the touch
Your synovial fluid will be collected in a procedure called arthrocentesis, also known as joint aspiration. During the procedure:
- A health care provider will clean the skin on and around the affected joint.
- The provider will inject an anesthetic and/or apply a numbing cream to the skin, so you won't feel any pain during the procedure. If your child is getting the procedure, he or she may also be given a sedative. Sedatives are medicines that have a calming effect and help reduce anxiety.
- Once the needle is in place, your provider will withdraw a sample of synovial fluid and collect it in the syringe of the needle.
- Your provider will put a small bandage on the spot where the needle was inserted.
The procedure usually takes less than two minutes.
If your results show your synovial fluid was not normal, it may mean one of the following conditions:
- A type of arthritis, such as osteoarthritis, rheumatoid arthritis, or gout
- Bleeding disorder
- Bacterial infection
Your specific results will depend on what abnormalities were found. If you have questions about your results, talk to your health care provider.

Additional Materials (8)

Cholesterol Crystals Synovial Fluid Polarized Light

Numerous cholesterol crystals, as viewed in a direct microscopic examination of fresh synovial (joint) fluid, using crossed optical polarizers and a quarter-wave retarder plate. Cholesterol crystals are a rare finding in synovial fluid but have been reported in cases of rheumatoid arthritis. Cholesterol crystals are identified in medical specimens by their plate-like structures, which are often notched. They are much more commonly observed in urine.

Image by Ed Uthman, MD, pathologist, Houston, Texas, USA

Synovial Membrane

This illustration shows a healthy joint. In this healthy joint, the ends of the bones are encased in smooth cartilage and are protected by a joint capsule that is lined with a synovial membrane that produces synovial fluid. The capsule and fluid protect the cartilage, muscles, and connective tissue. The muscles, medial collateral ligament, joint capsule, tendons, synovial membrane, anterior cruciate ligament, posterior cruciate ligament, cartilage, lateral collateral ligament, synovial fluid, and bone are labeled.

Image by National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Symptoms of Osteoarthritis

The symptoms of OA of the knee and hip are similar to those of other types of arthritis, but there are some important differences:Pain. OA pain tends to get worse as the day goes on, rather than get better. Activity increases pain, and rest relieves it. For instance, you may experience pain in your knees when you walk or in your hip when you climb stairs. However, in the later stages, pain may be constant and unrelieved by rest. Pain due to knee OA may be localized in different areas of the knee, depending on what part of the knee is affected by the disease. Pain due to hip OA may occur in the groin, thigh, buttocks, or even extend down to the knee. Stiffness and decreased motion. Stiffness may be worst when you get out of bed in the morning or after you have been sitting for a long time. Over time, you may lose range of motion in your hips or your knees. Swelling. This is caused by excess synovial fluid in the joint. Swelling in the knee is sometimes called “water on the knee.” Sounds in the joint. You may hear clicking or crunching noises when moving the affected joint Deformity of the joint. Your body may attempt to compensate for damage in the joint by growing additional bone, resulting in bone spurs. Bone spurs may visibly enlarge the joint.

Image by TheVisualMD

Slippery Business

Synovial joints are encased in a capsule that holds slippery synovial fluid. A healthy synovial joint moves with less friction than a frozen hockey puck over ice. Parts of a synovial joint include muscles, ligaments, bursae, menisci, and cartilage. Your knee joint is the largest joint in your body. Because it carries most of your weight, the knee requires a great deal of cushioning. The hip is a ball-and-socket joint located where your femur (thigh bone) meets your pelvic cone. The femoral ball—the ball-shaped head of the femur—fits into a hollow socket in the hip called the acetabulum. The femoral ball is attached to the femur by a thin neck region, and this is the part of the hip joint that most often fractures in the elderly.

Image by TheVisualMD

Joint effusions

Video by Medicosis Perfectionalis/YouTube

Fluid Examination Specific

Video by LabsforLifeProject/YouTube

Synovial Joints

Synovial joints allow for smooth movements between the adjacent bones. The joint is surrounded by an articular capsule that defines a joint cavity filled with synovial fluid. The articulating surfaces of the bones are covered by a thin layer of articular cartilage. Ligaments support the joint by holding the bones together and resisting excess or abnormal joint motions.

Image by OpenStax College

Normal Knee

1

2

3

Osteoarthritis in Knee

The knee joint, the largest joint in the body, connects the femur (thigh bone), tibia (shin bone), fibula (outer shin bone), and patella (kneecap). Because it carries most of the body's weight, and because that load is compounded with each step, the knee requires a great deal of cushioning. Knee cartilage may start to break down long before any symptoms are noticed. It's thought that in the earliest stages of osteoarthritis, inflammation occurs as cytokines (signaling substances released by the immune system) and other chemicals are released into the joint. As a result, the cartilage matrix begins to degrade. In an effort to repair this damage, chondrocytes increase their production of proteoglycans, swelling the cartilage. This stage can last for years, even decades. Over time, however, the level of proteoglycans decreases drastically. The cartilage softens and loses elasticity. Microscopic flakes and clefts appear on the surface of the cartilage. Joint space narrows as cartilage is lost. The cartilage in the joint continues to deteriorate until the underlying bone is exposed. Bone then rubs against bone inside the joint. This breaks down the bone and causes its structure to change. The bone becomes increasingly vascularized (filled with blood vessels), thicker, and denser. Cysts may form in the bone as well, sometimes due to the penetration of synovial fluid. Changes in the structure of the underlying bone often cause osteophytes (bone spurs) to form. The osteophytes or the cartilage itself fragment and enter the joint space as intra-articular loose bodies (joint mice). Connective tissue, ligaments, nerves, muscles, and even the synovial fluid are often damaged as a result of these changes in the joint's structure and stresses.

Interactive by TheVisualMD

Cholesterol Crystals Synovial Fluid Polarized Light

Ed Uthman, MD, pathologist, Houston, Texas, USA

Synovial Membrane

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Symptoms of Osteoarthritis

TheVisualMD

Slippery Business

TheVisualMD

17:25

Joint effusions

Medicosis Perfectionalis/YouTube

25:28

Fluid Examination Specific

LabsforLifeProject/YouTube

Synovial Joints

OpenStax College

Osteoarthritis in Knee

TheVisualMD

Uric Acid Test

Uric Acid Test

Also called: Urate

A uric acid test measures the amount of uric acid in a sample of blood or urine. Uric acid is a normal body waste product. High levels can cause gout, kidney disease, and other problems.

Uric Acid Test

Also called: Urate

A uric acid test measures the amount of uric acid in a sample of blood or urine. Uric acid is a normal body waste product. High levels can cause gout, kidney disease, and other problems.

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Use the slider below to see how your results affect your health.
mg/dL
3.4
7
Your result is Normal.
Normal results vary based on the laboratory and the method used.
Related conditions
A uric acid blood test may be used to:
- Help diagnose gout, usually when done with a synovial fluid analysis.
- Monitor uric acid levels in people who are having cancer chemotherapy or certain other cancer treatments. When treatment kills cancer cells quickly, they release large amounts of purines into the blood. This can lead to serious problems from high uric acid levels. Testing helps catch an increase in uric acid so it can be treated early.
A uric acid urine test may be used to:
- Help find out whether high levels of uric acid are causing kidney stones
- Monitor the risk of developing kidney stones in people who have gout
You may need a uric acid blood test if you:
- Have symptoms of gout. Symptoms usually happen in one joint at a time. The big toe is most commonly affected, but your other toes, ankle, or knee may have symptoms, which include:
  Intense pain
  Swelling
  Redness
  Feeling warm
- Had or are having certain types of cancer treatments.
You may also need a uric acid urine test if you:
- Have symptoms of a kidney stone, including:
  Sharp pain in your lower abdomen (belly), side, groin or back
  Blood in your urine
  Frequent urge to urinate (pee)
  Not being able to urinate at all or only urinating a little bit
  Pain when urinating
  Cloudy or bad-smelling urine
  Nausea and vomiting
  Fever and chills
- Have gout and your health care provider wants to monitor your risk for developing kidney stones
A uric acid test may be done as a blood test or a urine test. Your provider will decide which test you need.
For a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
For a uric acid urine test, you'll need to collect all your urine during a 24-hour period. This is called a 24-hour urine sample test. You will be given a special container to collect your urine and instructions on how to collect and store your samples. Your provider will tell you what time to start. The test generally includes the following steps:
- To begin, urinate in the toilet as usual. Do not collect this urine. Write down the time you urinated.
- For the next 24 hours, collect all your urine in the container.
- During the collection period, store the urine container in a refrigerator or in a cooler with ice.
- 24 hours after starting the test, try to urinate if you can. This is the last urine collection for the test.
- Return the container with your urine to your provider's office or the laboratory as instructed.
High uric acid levels in a blood test may happen if:
- Your body makes too much uric acid
- Your kidneys can't remove uric acid from your blood
- You are eating too many foods that cause high levels of purines such as:
  Red meat and organ meats, including liver and kidney
  Certain kinds of seafood, including shellfish, anchovies, sardines, trout, and tuna
  Alcohol (all types)
  High fructose corn syrup in soda and sweets
Your provider may order more tests to help diagnose what's causing the problem. High levels of uric acid may be related to many conditions, including:
- Gout
- Kidney disease
- Leukemia, multiple myeloma, or cancer that has spread in your body (metastatic cancer)
- Side effects from certain cancer treatments
- Alcohol use disorder
- Preeclampsia, a condition that can cause dangerously high blood pressure in pregnant women
Low levels of uric acid in blood are uncommon and usually don't cause health problems. Health conditions that are related to low uric acid levels are usually diagnosed using other tests.
High uric levels in urine, may be related to:
- Gout
- Kidney stones or having a high risk for kidney stones
- Leukemia, multiple myeloma, or cancer that has spread in your body
- Obesity
- An inherited genetic condition, such as Lesch-Nyhan syndrome, that makes it hard for your body to get rid of uric acid
Low levels of uric acid in urine may be related to kidney disease, lead poisoning, or alcohol use disorder.
If your results show a high level of uric acid in your blood or urine, it doesn't always mean you have a condition that needs treatment. Many people have high levels of uric acid without having health problems.
If you have questions about your results, talk with your provider. Medicines and/or changes in your diet may help you keep your uric acid levels in a healthy range.
1. Uric Acid Test: MedlinePlus Lab Test Information [accessed on Nov 05, 2018]
2. LabCorp: Uric Acid [accessed on Oct 29, 2018]
3. Hyperuricemia (High Uric Acid) [accessed on Oct 29, 2018]
4. Uric acid - blood : MedlinePlus Medical Encyclopedia [accessed on Oct 29, 2018]
5. Uric Acid [accessed on Oct 29, 2018]
6. URIC - Clinical: Uric Acid, Serum [accessed on Oct 29, 2018]
7. Hyperuricemia: Symptoms, Treatment, and More [accessed on Oct 29, 2018]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (15)

Uric Acid: Uric Acid Is a Waste Product

Uric acid is produced when the body breaks down substances called purines. Purines have two sources: They're end products of the breakdown of body proteins, and they're also found in a number of foods, including liver, anchovies, lentils, spinach, and beer. Uric acid is filtered out of the blood as a waste product by the kidneys. Two thirds of the uric acid produced daily is excreted by the kidneys, and the remaining one third leaves the body in the stool. Levels of uric acid in the body vary widely during the day as well as from day to day and from season to season, so several uric acid tests may be performed over an extended period of time.

Image by TheVisualMD

Uric Acid: Obesity and Gout

Gout is linked with obesity--and as the incidence of obesity has escalated, so has that of gout. Gout prevalence has doubled over the last 20 years or so. About 70% of people with gout are overweight, and 14% are obese (defined as having a body mass index of 30 or over). People who are obese are two to four times more likely to develop gout and are likely to develop it at a younger age. It's not entirely clear why obesity is linked with gout, but it's thought that it may be due to the increased insulin resistance associated with obesity. Moderate-intensity exercise benefits gout because it helps to control uric acid levels in the body while stretching and strengthening joints. The best forms of exercise for gout place minimal stress on the joints, such as swimming and water aerobics.

Image by TheVisualMD

Uric acid

Fluorescent uric acid : Spiked rods of monosodium urate crystals photographed under polarized light from a synovial fluid sample. Formation of en: monosodium urate crystals in the joints are associated with gout.

Image by Bobjgalindo

Nitrogenous Wastes

Nitrogenous waste is excreted in different forms by different species. These include (a) ammonia, (b) urea, and (c) uric acid. (credit a: modification of work by Eric Engbretson, USFWS; credit b: modification of work by B. "Moose" Peterson, USFWS; credit c: modification of work by Dave Menke, USFWS)

Image by CNX Openstax

Who Is Likely to Develop Gout?

Chronic Gout : Gouty tophi on knee and elbow of middle aged nurse

Image by NickGorton

What Is Gout?

Gout in left foot : A side-by-side comparison shot of gout in the main toe of the left foot, showing significant swelling of the surrounding tissue.

Image by Fatlittlebastard

What Are the Four Stages of Gout?

Gout in foot.

Image by vagawi

Gripped by Gout - Avoiding the Ache and Agony - NIH News in Health

Gouty inflammation

Image by cnick

Gout - causes, symptoms, diagnosis, treatment, pathology

Video by Osmosis/YouTube

Preventing Gout with a Healthy Diet

Video by Lee Health/YouTube

Gout - Mayo Clinic

Video by Mayo Clinic/YouTube

Gout and Pseudogout, Joint Pain- Everything You Need To Know- Dr. Nabil Ebraheim

Video by nabil ebraheim/YouTube

Psuedogout - Everything You Need To Know - Dr. Nabil Ebraheim

Video by nabil ebraheim/YouTube

How Do Kidney Stones Form? How Can We Prevent Them?

Video by VIP Urology/YouTube

How to Recognize the Signs and Symptoms of Kidney Stones

Video by Howcast/YouTube

Uric Acid: Uric Acid Is a Waste Product

TheVisualMD

Uric Acid: Obesity and Gout

TheVisualMD

Uric acid

Bobjgalindo

Nitrogenous Wastes

CNX Openstax

Who Is Likely to Develop Gout?

NickGorton

What Is Gout?

Fatlittlebastard

What Are the Four Stages of Gout?

vagawi

Gripped by Gout - Avoiding the Ache and Agony - NIH News in Health

cnick

6:12

Gout - causes, symptoms, diagnosis, treatment, pathology

Osmosis/YouTube

1:51

Preventing Gout with a Healthy Diet

Lee Health/YouTube

2:02

Gout - Mayo Clinic

Mayo Clinic/YouTube

4:36

Gout and Pseudogout, Joint Pain- Everything You Need To Know- Dr. Nabil Ebraheim

nabil ebraheim/YouTube

2:19

Psuedogout - Everything You Need To Know - Dr. Nabil Ebraheim

nabil ebraheim/YouTube

7:00

How Do Kidney Stones Form? How Can We Prevent Them?

VIP Urology/YouTube

1:10

How to Recognize the Signs and Symptoms of Kidney Stones

Howcast/YouTube

Treatment

Box of Colchicine

Image by Eversame/Wikimedia

How Is Gout Treated?

Depending on your symptoms and the cause of your gout, treatment plans may differ from person to person. However, the goals for treating gout are the same for each person and include:

Reduce the pain from gout flares.
Prevent future flares.
Prevent and resolve tophi to stop damage to your joints.
Care for other conditions or complications that happen with gout, such as heart and kidney diseases.

When you have gout, your doctor may recommend medications to manage the underlying cause of gout and treat active gout flares.

To treat a gout flare, your doctor may recommend medications including:

Over-the-counter or prescription anti-inflammatory medications, which can reduce pain and swelling.
Colchicine, which helps to relieve gout pain. This medication works best when taken when symptoms first appear.

Corticosteroids, which can help decrease inflammation, provide pain relief, and reduce joint swelling. Corticosteroids may be given by mouth or injected directly into the affected joint. Because they are potent medications, your doctor will prescribe the lowest dose possible to achieve the desired benefit.

Another key step to treating gout is managing hyperuricemia, which is the underlying cause of gout. There are medications available to lower urate levels, including:

Xanthine oxidase inhibitors, which help prevent the production of urate.
Uricosuric agents, which help the kidneys flush more urate out of the body.
Uricase, which breaks down urate into a form that is easily removed from the body. This medication is recommended for people who have not responded to other medications.

Other treatments may include making diet and lifestyle changes to reduce risk factors you can control.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Additional Materials (3)

4:35

Acute Gout Treatment - How You Can Relieve the Sudden Onset of Pain (5 of 6)

Johns Hopkins Rheumatology/YouTube

2:24

Gout Diagnosis & Treatment

Everyday Health/YouTube

6:32

Chronic Gout Treatment - The Second Phase of Treating Gout (6 of 6)

Johns Hopkins Rheumatology/YouTube

Side Effects of Medicines

Ibuprofen tablets in palm of hand

Image by Derrick Coetzee

What Are Possible Side Effects of Medicines for Gout?

The following possible side effects of medicines for gout are listed by the U.S. Food and Drug Administration (FDA) and in reports from research. Just because a side effect is possible does not mean you will have it.

Possible Side Effects of Medicines for Gout

Drug Class	Medicine	Possible Side Effects	Warnings
NSAIDs (nonsteroidal anti-inflammatory drugs)	Ibuprofen (Advil®), indomethacin (Indocin®), and naproxen (Aleve®, Naprosyn®)	Headache Dizziness Upset stomach Nausea Pain in the belly	NSAIDs can increase the risk of serious stomach problems such as bleeding or ulcers. NSAIDs can increase the chance of having a heart attack or a stroke. People with kidney problems should talk with their health care professional before taking NSAIDs.
Anti-inflammatory medicine	Colchicine	Diarrhea Pain in the belly Nausea Headache Tiredness	In people with kidney and liver problems, colchicine can cause a life-threatening interaction when taken with certain other medicines. People with kidney and liver problems should talk with their health care professional before taking colchicine. In rare cases, colchicine can cause muscle damage and blood disorders. Taking more colchicine than prescribed can lead to overdose and death.
Corticosteroids	Prednisone and triamcinolone	Fluid rentention (body tissues hold extra water) Mood changes Increased appetite Weight gain Insomnia (trouble falling asleep or staying asleep	Corticosteroids can cause high blood pressure, high blood sugar, or both.
Medicines to lower uric acid	Allopurinol (Zyloprim®)	Nausea Diarrhea Skin rash Increased risk of gout attack when first starting to take it	If you get a skin rash while taking allopurinol or febuxostat, call your health care professional right away. In very rare cases, allopurinol and febuxostat can cause severe skin reactions that can be life threatening. Symptoms may include red, blistered, or peeling skin; red or sore eyes; fever; and sores in your throat, mouth, or nose. Allopurinol and febuxostat may affect how well your liver works. These medicines can also cause liver damage. Signs of liver problems can include feeling tired and weak, nausea, vomiting, yellowed skin or eyes (jaundice), and dark-colored urine.
Medicines to lower uric acid	Febuxostat (Uloric®)	Nausea Skin rash Joint pain (not caused by gout) Increased risk of a gout attack when first starting to take it	If you get a skin rash while taking allopurinol or febuxostat, call your health care professional right away. In very rare cases, allopurinol and febuxostat can cause severe skin reactions that can be life threatening. Symptoms may include red, blistered, or peeling skin; red or sore eyes; fever; and sores in your throat, mouth, or nose. Allopurinol and febuxostat may affect how well your liver works. These medicines can also cause liver damage. Signs of liver problems can include feeling tired and weak, nausea, vomiting, yellowed skin or eyes (jaundice), and dark-colored urine.

Source: Agency for Healthcare Research and Quality (AHRQ)

Additional Materials (2)

Managing Gout: A Review of the Research for Adults

Agency for Healthcare Research and Quality (AHRQ)

Coated 200 mg ibuprofen tablets

Ragesoss

Living With

Human nutrition - Healthy Diet

Image by TheVisualMD

Living With Gout

There are many things you can do to help manage gout. You can make some lifestyle changes to help you have fewer gout flares and manage your symptoms, such as:

Losing weight. If you are overweight or obese, losing weight through a reduced calorie diet and increased exercise helps reduce urate levels, which can help stop or lower the number of flares you have.
Making diet changes to help reduce blood urate levels and gout flares, such as:
- Drinking fewer alcoholic beverages. This includes nonalcoholic beer.
- Avoiding sugar-sweetened drinks, such as soda.
- Avoiding red meats and organ meats (liver, kidney, tongue, and sweetbreads) that are higher in purines and may increase the risk for other health conditions.
- Avoiding certain seafood, such as shellfish (shrimp and lobster), sardines, and anchovies.
Following the Dietary Approaches to Stop Hypertension (DASH) eating plan. This diet is particularly helpful for the many gout patients who also have high blood pressure. The DASH eating plan can help improve high blood pressure and may help lower blood urate levels. By lowering urate levels, this plan may help prevent gout flares. The DASH eating plan includes:
- Eating plenty of vegetables, fruits, and whole grains.
- Eating low-fat or fat-free dairy products, poultry, and oils.
- Limiting foods high in saturated fats.
- Limiting sugar-sweetened foods and drinks.
When you have a gout flare, you can do the following to help reduce symptoms from the flare:
- Applying ice to the affected area to help reduce swelling and pain.
- Elevating the affected limb, if possible, to help reduce swelling.
- Resting the affected joint.
When gout is associated with frequent flares or tophi, lifestyle changes alone are not sufficient to manage gout and medications to lower urate levels in your blood are the mainstay for managing gout. Taking the medications prescribed for this purpose by your doctor regularly is the key to preventing gout flares from occurring and preventing or reducing tophi. Nevertheless, maintaining healthy weight and diets are also important to help lower the risk of cardiovascular complications, which are common among gout patients.

Always talk with your doctor before making any changes to your diet or medications.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Additional Materials (6)

1:51

Preventing Gout with a Healthy Diet

Lee Health/YouTube

11:07

Best & Worst Foods to Eat with Gout | Reduce Risk of Gout Attacks and Hyperuricemia

JJ Medicine/YouTube

9:04

What's the DASH Diet and Why Doctors Call It the Best Diet

BRIGHT SIDE/YouTube

2:13

Video: What's the Dash Diet?

WBAL-TV 11 Baltimore/YouTube

1:12

DASH Diet Basics | WebMD

WebMD/YouTube

3:43

DASH diet basics

Ohio State Wexner Medical Center/YouTube

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