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What is the outlook for gout?

Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months. In time, though, attacks tend to happen more often and new joints are affected.

Although acute attacks of gout are very dramatic, the inflammation goes down fairly quickly and the attacks themselves probably don’t cause long-term joint damage.

However, a continued build-up of urate crystals and formation of hard tophi can damage your cartilage and bone, leading to long-term (chronic) arthritis.

With modern treatments and possibly some changes to your diet and lifestyle, this type of damage can usually be prevented by bringing urate levels in your tissues down below the point at which crystals form.

Lowering your urate levels will prevent new crystals forming and slowly break down the crystals that are already there. It may take as long as two to three years of treatment to completely clear your body of urate crystals, but once they’re gone then the risk of acute attacks of gout and of further joint damage from tophi is removed.

Because gout is associated with metabolic syndrome, you should pay special attention to your cholesterol levels, blood pressure and diabetes. If these are treated effectively it can help reduce your urate levels.

As well as the threat of causing attacks of gout, persistently high urate levels can lead to other health concerns. For example:

  • High urate levels can cause inflammation and furring of the lining of arteries and lead to increased risk of heart disease (for example, angina, heart attacks, atrial fibrillation, heart failure) and stroke.
  • The crystals in your joints can cause long-term low-grade inflammation in between the acute attacks without you having any symptoms.
  • High levels of urate can make chronic kidney disease worse.
  • There is growing evidence that high urate levels increase the risk of cancers, especially prostate cancer.

Having acute attacks and eventually chronic joint symptoms due to gout is bad enough, but our increasing recognition of these additional health problems has made us realise that gout is a potentially serious condition that needs to be treated appropriately and not ignored.

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