Gout & High Uric Acid

A sudden red, swollen, and severely painful big toe joint—that could be a gout attack.
Gout is a condition caused by persistently high uric acid levels, and repeated attacks lead to accumulated damage in joints and kidneys.
Don't think "it's fine now that the attack has subsided"; controlling uric acid levels is key to long-term health.

• Blood tests to check uric acid levels. We will carefully explain the cause and condition.
• From pain relief during attacks to uric acid-lowering therapy for recurrence prevention.
• We also provide advice on diet and lifestyle.
• No appointment needed, same-day visits welcome | Open daily from 9 AM to 9 PM.

👉 Same-day visits without an appointment are also possible. Please feel free to consult us first.

Book an appointment / Consult with a doctor　 Visit without an appointment

What is Gout?

Gout is a condition where persistently high uric acid levels in the blood (hyperuricemia) cause uric acid to crystallize and deposit in the joints, leading to severe inflammation. The expression "even the wind hurts" directly gives the disease its name.

Uric acid is a waste product produced when a substance called purine is broken down in the body. Normally, it is excreted in urine and feces. However, if uric acid accumulates in the blood due to excessive purine intake, reduced uric acid excretion, or excessive alcohol consumption, it crystallizes (urate crystals) and deposits in the joints. When white blood cells recognize these crystals as foreign bodies and attack them, acute inflammation and severe pain occur. This is a "gout attack."

Gout is common in middle-aged and older men, but recently it has been increasing among younger generations and women. If treatment is only sought during an attack and uric acid levels are not managed, repeated attacks can destroy joints and place continuous strain on the kidneys. Even if an attack seems to have "healed," the risk remains as long as uric acid levels are high.

⚠️ Seek medical attention early if you experience any of the following:

• Sudden severe pain, redness, and swelling at the base of your big toe.
• Sudden swelling and heat in joints like ankles, knees, or wrists.
• You were told you have high uric acid levels during a health check-up but haven't seen a doctor yet.
• You've had a gout attack before and are experiencing the same symptoms again.
• Pain persists even after taking painkillers.
• You have been told you have decreased kidney function or kidney stones.

Characteristics and Course of Gout Attacks

Gout attacks are characterized by their sudden onset without warning. They often occur during sleep or in the early morning, and it's common to wake up unable to walk due to foot pain, even though you felt fine the day before.

Course of an attack

Period	Symptoms/Condition
Just before an attack (prodromal phase)	Some people feel a tingling or slight discomfort in the affected area. Many attacks start suddenly without warning.
Attack onset - 24 hours	Pain intensifies rapidly. The joint becomes red, swollen, and hot. Even a light touch causes severe pain.
2-3 days	Pain reaches its peak. Significant difficulty walking and disruption to daily life.
1-2 weeks	Pain gradually subsides. Often improves naturally even without treatment.
After an attack (intercritical phase)	Symptoms disappear, and normal life can resume. However, if uric acid levels remain high, the next attack is likely.

Once an attack subsides, it's easy to feel "I'm okay now," but this intercritical period is a crucial time to begin treatment to lower uric acid levels. With repeated attacks, the intervals between them can shorten, and multiple joints may be affected simultaneously.

Common Sites for Gout Attacks

Site	Frequency/Characteristics
Base of the big toe (first metatarsophalangeal joint)	Most common (about 70% of cases). Typical site of gout onset.
Ankle	Second most common. The entire ankle may swell.
Knee	Fluid may accumulate in the knee. Onset in larger joints increases after middle age.
Top of the foot / Heel	Pain occurs with every step, often leading to difficulty walking.
Wrist / Fingers / Elbow	More likely to occur in the upper limbs as the disease progresses.
Helix (ear rim)	In chronic gout, lumps of urate crystals (tophi) can form.

Risk Factors for Hyperuricemia and Gout

Individuals with many of the following characteristics tend to have higher uric acid levels.

• Dietary habits: Consuming large amounts of purine-rich foods (liver, fish roe, shirako, dried fish, shrimp, bonito).
• Alcohol consumption: Beer, sake, shochu; beer, in particular, is high in purines. All alcohol can increase uric acid levels.
• Obesity: Increased weight leads to increased uric acid production and often reduced excretion.
• Intense exercise: Purines are produced through muscle breakdown. Anaerobic exercise and intense training can temporarily raise uric acid levels.
• Dehydration: Low urine volume makes it difficult to excrete uric acid.
• Diuretics / Certain antihypertensive drugs: Some medications can increase uric acid levels.
• Genetic predisposition: Overproduction or reduced excretion of uric acid can be related to genetics.
• Decreased kidney function: Kidneys become less able to excrete uric acid.

Diseases Often Comorbid with Gout

Hyperuricemia and gout do not occur in isolation but are known to be comorbid with the following diseases. For individuals with these conditions, comprehensive management, along with uric acid level control, is crucial.

• Hypertension
• Dyslipidemia (high cholesterol, high triglycerides)
• Diabetes / Insulin resistance
• Chronic Kidney Disease (CKD)
• Urinary tract stones (kidney stones): Uric acid crystallizes and deposits in the kidneys and ureters.
• Cardiovascular diseases (angina, myocardial infarction)
• Metabolic syndrome

It is dangerous to view gout as merely "a disease of foot pain." Persistently high uric acid levels over many years can gradually damage the kidneys, increasing the risk of chronic kidney disease and urinary tract stones. Management must consider the impact on the entire body.

Diseases Easily Mistaken for Gout

Symptoms of sudden red, swollen, and painful joints can also be caused by diseases other than gout. Distinguishing these from similar conditions is important, and differentiation is made through blood tests, X-rays, and other examinations.

Disease	Difference from Gout / Characteristics
Pseudogout (Calcium pyrophosphate deposition disease)	Arthritis caused by calcium crystals. Common in knees, wrists, shoulders. More prevalent in older adults. Uric acid levels are normal.
Septic arthritis	Arthritis caused by bacterial infection. Accompanied by fever and general malaise. Requires emergency treatment. Blood tests show strong inflammatory reactions.
Rheumatoid arthritis	Occurs symmetrically in multiple joints. Morning stiffness is characteristic. Chronic course. Rheumatoid factor and anti-CCP antibodies confirmed by blood tests.
Cellulitis	Bacterial infection of the skin and subcutaneous tissue. The entire skin, not just the joint, becomes red and swollen. Often accompanied by fever.
Sprain / Bruise	History of trauma. Sudden onset like gout is rare.

Tests and Treatments at Our Clinic

Tests

Test	Purpose / Content
Blood test (Uric acid level)	Confirmation of hyperuricemia. Uric acid > 7.0 mg/dL is the criterion for hyperuricemia. May be normal during an attack.
Blood test (Inflammatory markers, kidney function, lipids, blood sugar)	CRP and white blood cell count to assess inflammation. Evaluation of coexisting diseases such as kidney function (creatinine, eGFR), cholesterol, and blood sugar.
Urine test (Urinary uric acid, urine pH)	Assessment of uric acid excretion status and risk of urinary tract stones.
X-ray examination	Confirmation of degree of joint destruction, tophi, and calcification.

Blood test results can be provided as early as the next day if you visit by 5 PM. Please feel free to consult us even if "the attack has subsided but I want to check my uric acid levels" or "I was flagged during a health check-up but haven't seen a doctor yet."

Treatment

Treatment during an attack (when pain is severe)

When an attack occurs, suppressing pain and inflammation is the top priority.

• NSAIDs (Nonsteroidal anti-inflammatory drugs): Loxoprofen, indomethacin, etc. Early, high-dose administration can quickly suppress symptoms.
• Colchicine: Especially effective when used at the first sign or early stage of an attack. Helps to suppress attacks.
• Steroid drugs: Used when NSAIDs are not suitable (e.g., in cases of kidney dysfunction or gastrointestinal disease).

It is crucial to adjust medication during an attack under a doctor's guidance, as suddenly starting or stopping uric acid-lowering drugs can worsen or reignite an attack.

Post-attack / Intercritical phase treatment (lowering uric acid)

Once the attack subsides, treatment to lower uric acid levels is initiated to prevent recurrence. The goal is to maintain uric acid levels at 6.0 mg/dL or below.

• Uric acid production inhibitors (allopurinol, febuxostat): Medications that suppress uric acid production in the body.
• Uric acid excretion promoters (benzbromarone): Medications that increase uric acid excretion from the kidneys. Used for individuals with reduced uric acid excretion.

Uric acid-lowering drugs generally require long-term (often lifelong) use. Many people who "stop medication because attacks have ceased" experience recurrence, so it's essential not to stop on your own judgment.

Lifestyle improvements

Alongside medication, improving lifestyle habits is essential for controlling uric acid levels.

Item	Content
Diet	Limit purine-rich foods (liver, fish roe, shirako, dried fish). Vegetables and dairy products can help lower uric acid.
Alcohol consumption	All alcohol increases uric acid levels. Be especially careful with beer due to its high purine content. Include alcohol-free days.
Hydration	Drink over 2 liters of water daily to promote uric acid excretion. Water and barley tea are preferable. Avoid sugary drinks (fructose).
Weight management	Obesity increases the risk of hyperuricemia. Rapid dieting can paradoxically increase uric acid, so aim for gradual weight loss.
Exercise	Aerobic exercises like walking are effective in improving uric acid levels. Intense anaerobic exercise (sprinting, weightlifting) can temporarily increase uric acid levels.

Consultation Process

1. WEB booking, or walk-in directly
   If you are in pain and find it difficult to walk during an attack, please call us. We will assist you to ensure a smooth visit.
2. Reception and completion of medical questionnaire
   Please indicate when, where, and how the pain started, your history of attacks, alcohol and dietary habits, and any history of high uric acid levels noted in health check-ups.
3. Doctor's examination
   A visual inspection and palpation of the affected area will be performed, and necessary tests will be determined.
4. Blood test, urine test, X-ray
   Uric acid levels, inflammatory markers, and kidney function will be checked. Blood test results will be communicated as early as the next day.
5. Diagnosis, prescription, and lifestyle guidance
   Treatment policy will vary depending on whether you are in an attack phase or intercritical phase. Along with medication prescriptions, advice on diet, alcohol consumption, and exercise will be provided.
6. Payment and departure
   We will explain when to schedule your next visit and precautions for daily life. If ongoing management is required, we will guide you on regular check-ups.

Frequently Asked Questions

My attack has subsided. Do I still need to see a doctor?
Even if the attack has subsided, if your uric acid levels remain high, another attack is only a matter of time. The period after an attack settles is the optimal time to begin treatment to lower uric acid levels. "I'm fine now that it's over" does not apply to gout.

I was told my uric acid levels are high, but I have no symptoms. Is treatment necessary?
If your uric acid level is 8.0 mg/dL or higher and you have risk factors such as high blood pressure, decreased kidney function, or kidney stones, drug therapy may be recommended even if you have no symptoms. We recommend visiting us first to assess your condition.

If I stop drinking beer, do I still need medication?
Some people's uric acid levels normalize with diet and alcohol intake improvements alone, but for those with a predisposition for high uric acid production or low excretion, lifestyle changes alone may be insufficient. We will determine the course of action while monitoring blood test results.

Do I have to take gout medication for the rest of my life?
In most cases, uric acid-lowering drugs require long-term use. However, if uric acid levels stabilize within the normal range through lifestyle improvements, your doctor may consider reducing or discontinuing medication. Self-stopping medication can lead to recurrent attacks, so always consult with your doctor.

Should I apply heat or cold during a gout attack?
During an attack, applying cold to the affected area can help alleviate inflammation and pain. Warming can increase blood flow and worsen inflammation, so cooling is more appropriate during the acute phase. However, excessive cooling can make uric acid crystals more prone to deposition, so avoid prolonged cooling.

Is there a relationship between gout and kidney disease?
They are closely related. Uric acid deposits in the kidneys can accelerate chronic kidney disease, and conversely, decreased kidney function makes it harder to excrete uric acid, creating a vicious cycle. It is important for people with gout to have their kidney function checked regularly.

Clinic Hours and Access

Item	Content
Clinic Name	Jujo Station Halu Internal Medicine & Dermatology Clinic
Consultation Hours	Monday to Sunday, 9:00 AM to 9:00 PM
Closed	None (irregular holidays)
Location	J&MALL 1F, 2-27-1 Kami-Jujo, Kita-ku, Tokyo 114-0034
By Train/On Foot	Approx. 1-2 minutes walk from Jujo Station on the JR Saikyo Line, J&MALL 1st floor
By Bus	Right in front of the "Jujo Station" bus stop (Kokusai Kogyo Bus)
By Car	Please use nearby coin parking lots
Contact	TEL: 03-6698-2509　／　Official LINE: https://lin.ee/DRxcelo

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