Gout (podagra) – assessment and treatment at Charlottenlund Privathospital

What is gout?



Gout is a crystal arthritis. When blood urate levels remain high for a prolonged period, needle-shaped urate crystals can form in the joints, tendons and surrounding tissues. They form most readily in cooler areas, so the feet and hands are most commonly affected. The crystals trigger a strong inflammatory reaction, causing an attack. Podagra is the term for a gout attack in the joint at the base of the big toe, the most common site of a first attack.

According to the Danish Society for Rheumatology’s national treatment guidelines, urate deposits can form when blood urate levels exceed approximately 0.40 mmol/l. Gout affects men more often than women and becomes more common with age. If left untreated, it can progress from occasional attacks to more frequent attacks in several joints and, over time, to chronic arthritis with visible urate deposits (tophi) and joint damage. With appropriate preventive treatment, progression can be halted and existing deposits can dissolve.

What are the symptoms of gout?

An attack often starts at night and reaches peak pain within 24 hours, often within just a few hours. The joint becomes swollen, red, hot and so tender that even the light touch of a bedsheet can be unbearable. The first attack typically affects the joint at the base of the big toe, but the midfoot, ankle, knee, wrist and fingers can also be affected. The attack may be accompanied by feeling unwell and a mild fever. According to the treatment guidelines, an untreated attack usually clears up on its own within around 14 days—and sooner with treatment.

Between attacks, the joint is often completely normal. Over time, attacks may become more frequent, last longer and affect more joints. Some people develop hard lumps under the skin called tophi, which are urate deposits. They typically appear around the ears, fingers, elbows or toes.

What causes gout?

Uric acid is produced when purines from the body's cells and diet are broken down. In most people, high blood urate levels are caused by reduced excretion through the kidneys. This may be hereditary or worsened by high blood pressure, reduced kidney function and certain medicines, especially diuretics. Excess weight, alcohol, sugary drinks and a purine-rich diet also contribute. Gout often occurs alongside high blood pressure, excess weight and type 2 diabetes, so the assessment also includes a review of these risk factors.

How is gout diagnosed?

Diagnosis is based on your medical history, a joint examination and a blood urate test. According to the Danish Society for Rheumatology, gout is very likely when a typical attack or tophi occur alongside high urate levels—with the important exception that urate may be normal during an attack, so the test is repeated once the attack has settled.

An ultrasound scan can show characteristic signs of urate deposits in joints and tendons. It is used to support the diagnosis and guide joint aspiration if needed. X-rays may be useful in longstanding disease. Other causes of a swollen, red joint—especially joint infection, calcium pyrophosphate crystal arthritis and osteoarthritis flare-ups—are always considered. In addition to urate, blood tests check inflammatory markers, kidney function and blood sugar.

H2 How is gout treated?

Treatment has two parts. Medication for attacks reduces inflammation using anti-inflammatory medicines, colchicine or corticosteroids, given as tablets or injected directly into the joint. Preventive treatment lowers blood urate levels with medication to prevent new crystals from forming and help existing crystals dissolve. According to Danish and European guidelines, the treatment target is a urate level below 0.36 mmol/l, or below 0.30 mmol/l for people with tophi. Levels are monitored with blood tests, and the dose is adjusted until the target is reached.

During the first few months after starting treatment, attacks may temporarily become more frequent, so preventive medication is given at the same time. Once the treatment target is reached and maintained, attacks stop in most people and tophi shrink. Advice on alcohol, sugary drinks, weight and fluid intake is part of the treatment, and any diuretic medication is reviewed in consultation with your GP. All gout treatment can be provided on an outpatient basis at Charlottenlund Privathospital.

Calcium pyrophosphate crystal arthritis – the other crystal arthritis

Calcium pyrophosphate crystal arthritis (also known as CPP crystal arthritis, and formerly called pseudogout) is caused by calcium pyrophosphate crystals forming in the joint cartilage. It causes acute attacks of joint inflammation, most often in the knees or wrists, in people over 60, and can be mistaken for gout or joint infection. The diagnosis is made by detecting crystals in joint fluid and by X-ray or ultrasound, which may show calcification in the cartilage (chondrocalcinosis). No medication can remove the crystals, so treatment focuses on the attacks with anti-inflammatory medicines, colchicine or an injection. Calcium pyrophosphate crystal arthritis is assessed and treated on an outpatient basis by rheumatology specialists.

When should I see a rheumatologist?

A single, typical attack is often treated by a GP. A rheumatology assessment is recommended for recurrent attacks; attacks affecting several joints or unusual joints; tophi; uncertainty about the diagnosis; urate levels that remain above target despite preventive treatment; or when kidney function or other medication complicates treatment. A swollen, red and very painful joint accompanied by fever should always be assessed by a doctor the same day, as joint infection must be ruled out.

Assessment and treatment at Charlottenlund Privathospital

Assessment and treatment are provided by rheumatology specialists on an outpatient basis. The initial consultation usually lasts between 30 and 60 minutes. Blood tests and an ultrasound scan can often be done the same day, and joint aspiration is performed if needed. If the diagnosis is confirmed, a plan is made for treating attacks, preventive treatment and monitoring urate levels. You will be followed by the same specialist.

Most patients come through health insurance; insurers typically require a referral from your GP and prior authorisation before an appointment can be booked. No referral is needed if you are paying for your treatment yourself, and prices are listed in the price list. Appointments can be booked online around the clock or by phone on 44 98 19 21 Monday to Friday, 08:00–14:00. Outside phone hours, the digital phone assistant Anna can book, cancel and reschedule appointments.