If the pain in the joint is severe, or you have a high fever that does not get better with medicine, go to an emergency department now, or call 911 to have the emergency team come to you if you cannot wait: both are signs of an emergency. A fever with a hot, swollen joint, or a limb you cannot move, can mean an infection in the joint, so call your own doctor's office promptly, even if it is closed. For a flare without severe pain or a fever, call the office as soon as it opens, because a gout flare is a reason to contact your provider.
What can make one joint flare out of nowhere at night
Gout is one cause: its flares usually occur in one joint and often start suddenly at night, with pain that may be bad enough to wake you up and a joint that may feel swollen, red and warm. The pain is often severe, described as throbbing, crushing or excruciating, and the joint is most often very tender and swollen, to the point that a sheet or blanket over it may hurt. Many people have their first flare in one of their big toes, but gout can affect other joints too. The big toe, knee and ankle are the joints most often affected, sometimes many joints become swollen and painful, and there may be a fever.
The flare comes from urate, also called uric acid, which the body makes when it breaks down purines, found in its own tissues and in many foods. Urate normally leaves the body in urine, but when too much is made or too little is removed, urate builds up in the blood and needle-shaped crystals form in the joints, and the inflammation they cause is felt as a flare of pain and swelling.
Flares typically get better over a week or two, and in between you usually have no symptoms. Some people may have frequent flares while others may not have another for years, but if gout is left untreated, flares may happen more often and last longer over time. After a first attack, many people will have another in the next 6 to 12 months.
Gout is more common in men than in women and usually develops in middle age. Women usually do not develop gout before menopause, and younger people develop it less often, though when they do, it tends to be more severe. Gout tends to be relatively straightforward to diagnose, though a few conditions can mimic it.
Whether losing weight quickly set off the flare
A gout flare can be triggered by certain foods, alcohol, certain medications, physical trauma or certain illnesses. Losing weight quickly is not a named trigger.
During certain types of chemotherapy, rapid destruction of cancerous cells or weight loss, which may occur with such treatments, can rapidly increase the amount of uric acid in the blood. That rise is described for chemotherapy, and weight loss from diet or a weight-loss medicine is not on the trigger list above. Tell the doctor who sees the joint about anything that changed while you were losing weight, such as a new medicine, so they can judge whether it is one of those triggers.
Health conditions that may increase the risk of developing gout include overweight or obesity, high blood pressure and chronic kidney disease, and some medicines can increase it too, including diuretics, low-dose aspirin and niacin taken in large amounts. For people with overweight or obesity, losing weight through a reduced-calorie diet and more exercise helps reduce urate levels, which can help stop flares or lower how many you have. Exercising daily is one of the diet and lifestyle changes that may help prevent gouty attacks (see Can you start moving when your knees already hurt?).
When gout comes with frequent flares or tophi, which are hard lumps of needle-shaped crystals that form under the skin, in and around the joints, lifestyle changes alone are not sufficient to manage gout, and medicines that lower urate are the mainstay. Always talk with your doctor before making any changes to your diet or medications. Before slowing or stopping your weight loss because of this flare, talk with the doctor treating the flare, and also with your NicoCares care team if a physician you are connected with through NicoCares prescribes your weight-loss medicine.
How much a blood test tells you about gout
The uric acid level in your blood is one of several things a provider may check. To help diagnose gout, a health care provider may:
- ask for your medical history, including your symptoms, any risk factors and any medicines you have taken
- examine the affected joints
- order a laboratory test of the urate level in your blood
- take a sample of fluid from a painful joint, from a swollen bursa, which is a fluid-filled sac that cushions the joint, or from a tophus, and look for urate crystals under a special microscope
- order an ultrasound or a special CT scan to check for crystal buildup in the joint and to diagnose other conditions that may be causing the symptoms
Not everyone with a high uric acid level has gout, and many people with high levels of urate in the blood will not develop gout. For the history, have ready how much weight you have lost and over how long, and the name of every medicine you take, including any diuretic, also called a water pill, and any low-dose aspirin.
If the blood test is ordered, change none of your medicines without talking to your provider first: many medicines can interfere with blood test results, and your provider will tell you if any needs to stop. Normal ranges may vary slightly among laboratories, so ask your provider what your own result means. A level above the normal range may be due to a long list of things, among them obesity, dehydration, alcohol, a purine-rich diet and medicines such as diuretics.
Which gout medicine does which job, and who decides
Gout medicines do one of two jobs. Your doctor may recommend medicines to treat active gout flares and to manage the underlying cause, and because treatment plans may differ from person to person, your doctor chooses which ones you take. These are among the medicines for each job:
| Job | Among the medicines a doctor may recommend |
|---|---|
| Treating a flare | Over-the-counter or prescription anti-inflammatory medicines, which can reduce pain and swelling. Colchicine, which helps relieve gout pain. Corticosteroids, which can help decrease inflammation, provide pain relief and reduce joint swelling, which may be given by mouth or injected into the joint. |
| Lowering urate | 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 urate down into a form the body easily removes, recommended for people who have not responded to other medicines. |
Ibuprofen, naproxen and indomethacin are among the anti-inflammatory medicines taken for gout when symptoms begin. The doctor treating the flare chooses the medicine and the amount, so give them the name of everything else you take.
Colchicine works best when taken when symptoms first appear, which is one reason not to put off calling your doctor's office. Most people with gout are managed by their primary care providers, and rheumatologists, who specialize in arthritis, may treat it too.
A medicine to lower uric acid may be needed if you have several attacks during the same year or attacks that are quite severe, damage to your joints, tophi, or kidney disease or kidney stones. Tophi start out painless, but over time they can become painful and cause bone and soft tissue damage and misshapen joints. They can develop when gout goes untreated over long periods, and proper treatment can prevent them.
A hot joint that may be an infection, and should not wait
Septic arthritis, an infection in the joint, usually comes on quickly, with a fever and joint swelling that is usually in just one joint, and intense joint pain that gets worse with movement. In adults, its symptoms are:
- not being able to move the limb with the infected joint
- severe joint pain
- joint swelling
- joint redness
- fever
Chills may occur, but are uncommon. Gout can bring a fever too. The tests that may be done include drawing fluid from the joint to test it, including a look under the microscope for crystals, along with blood tests and an x-ray of the joint.
The knee and hip are the joints commonly affected, and the conditions that increase the risk include an artificial joint, a bacterial infection somewhere else in your body or bacteria in your blood, a chronic illness such as diabetes, rheumatoid arthritis or sickle cell disease, intravenous or injection drug or medicine use, medicines that suppress your immune system, and a recent joint injury, arthroscopy or other joint surgery. Recovery is good with prompt antibiotic treatment, and if treatment is delayed, permanent joint damage may result.
Severe joint pain is one of those symptoms, and because severe pain anywhere on the body needs an emergency department or 911, that is where it goes, as does a high fever that does not get better with medicine. For a fever with a swollen joint, or a limb you cannot move, without either of those, contact your provider promptly by calling your own doctor's office, even at night: a call to a closed office may be passed to the nurse or other provider on call, and you can describe your symptoms to whoever answers and find out what to do. If no one answers, call the nurse telephone advice line your provider or health insurance company may offer, tell the nurse your symptoms and ask what to do.
Until a doctor sees the joint
Rest the joint, put ice on the affected area to help reduce swelling and pain, and raise the limb if you can, which can also help reduce swelling.
The emergency and infection signs above need care you can reach now. For a NicoCares patient, the care team is not the place to send them: NicoCares does not provide emergency care, and messages to the care team go through the Spruce Health app and may not be answered tonight. Once a doctor has seen the joint, send the care team what was found and anything prescribed, together with any question about how fast you are losing weight.
