Why Is Giant Cell Arteritis a Medical Emergency?

New-onset giant cell arteritis is considered a medical emergency because inflammation of the arteries can significantly reduce blood flow to vital organs and tissues. Without prompt treatment, the condition can lead to serious complications, including permanent vision loss (blindness) and stroke.

Early diagnosis and aggressive treatment are essential to control inflammation, prevent further damage to the arterial walls and maintain an adequate blood supply to affected organs and tissues.

Treatment should be started as soon as giant cell arteritis is suspected, particularly when there are symptoms involving the eyes. Delaying treatment while waiting for diagnostic test results can increase the risk of irreversible complications.

One of the most effective ways to manage gout and prevent future flare-ups is to keep uric acid levels within a healthy range.

Certain foods and drinks can increase uric acid levels or trigger gout attacks. These include:

• Red meat: Beef, lamb and pork.

• Organ meats: Liver, kidneys and other organ meats.

• Fish and seafood: Sardines, anchovies, shellfish and some oily fish.

• Alcohol: Particularly beer and spirits.

• Sugary drinks: Soft drinks, sweetened juices and beverages containing high-fructose corn syrup.

Foods and drinks that may help

• Low-fat milk and yogurt.

• Plenty of water.

• Fresh vegetables.

• Whole grains.

• Eggs.

• Whole fruits, including cherries.

Important: Diet can help manage gout, but it may not be enough on its own. Medication such as allopurinol may be needed to keep uric acid levels below 360 µmol/L (6 mg/dL), particularly for people with recurrent gout.

The goal is not just to relieve pain during an attack, but to prevent uric acid crystals from building up and causing future joint damage.

 Sudden and severe pain in a joint

Gout usually presents as an attack, also known as a flare. Attacks often develop suddenly, frequently during the night or early hours of the morning.

A person may go to bed feeling perfectly fine but wake up with a joint that feels extremely painful, hot and swollen.

In most cases, only one joint is affected during the initial attack.

• Big toe: The most commonly affected joint.

• Ankle: Another common site.

• Knee: Can also be affected.

The pain can be so severe that even light pressure from clothing or bedsheets becomes unbearable.

 Multiple joint involvement

As gout progresses, it can affect more than one joint.

Commonly affected joints include:

• Big toes.

• Ankles and other parts of the feet.

• Knees.

• Wrists.

• Elbows.

• Fingers.

When several joints are affected, pain and swelling can make everyday activities, such as walking, sleeping and using the hands, difficult.

 Tophi (deposits of uric acid crystals)

When uric acid levels remain high for a prolonged period, urate crystals can accumulate in soft tissues and form firm lumps called tophi (pronounced toe-fye).

Tophi commonly develop:

• Around the elbows.

• On the fingers and hands.

• Around the toes.

• On the tendons behind the ankles.

• Along the outer edges of the ears.

Tophi may initially be painless, but they can become painful and inflamed.

If left untreated, they can:

• Damage nearby bones and joints.

• Affect tendon function.

• Restrict joint movement.

• Break through the skin and release a chalky substance.

 Chronic gout

Gout can become a long-term condition if uric acid levels remain consistently high and treatment is inadequate.

Over time, people may experience:

• More frequent gout attacks.

• Persistent joint swelling and discomfort.

• Inflammation that does not completely settle between attacks.

• Tophi formation.

• Permanent joint damage and reduced mobility.

Long-standing untreated gout can eventually cause significant joint destruction.

Duration and frequency of gout flares

A typical gout attack can last approximately 7–14 days without treatment, although appropriate medication can shorten the duration and severity.

The frequency of attacks varies considerably.

• Some people may go months or even years between attacks.

• Others may experience repeated attacks within a year.

• Over time, untreated gout often becomes more frequent and may affect additional joints.

Having one gout attack increases the likelihood of experiencing another, although recurrence is not inevitable.

Important: Preventing long-term damage

The most important long-term goal of gout treatment is to lower and maintain uric acid levels so that existing crystals gradually dissolve and new crystals do not form.

1. Which doctor diagnoses gout?

Gout is usually diagnosed and managed by a primary care physician (family doctor).

If the diagnosis is uncertain, symptoms are complicated, or gout is difficult to control, the patient may be referred to a rheumatologist.

A rheumatologist is a specialist who diagnoses and treats arthritis, gout and other inflammatory and autoimmune conditions.

2. Medical history and physical examination

To diagnose gout, the doctor will take a detailed medical history and perform a thorough physical examination.

They will look for:

• Previous episodes of sudden joint pain and swelling.

• Which joints are affected.

• Whether attacks occur suddenly, particularly at night.

• Family history of gout.

• Medical conditions such as high blood pressure, diabetes and kidney disease.

• Medications that may increase uric acid levels, such as diuretics.

• Lifestyle factors, including alcohol consumption and dietary habits.

Gout commonly affects one joint at a time, particularly the big toe, ankle or knee, especially during early attacks.

3. Tests used to diagnose gout

Depending on the patient’s symptoms and examination findings, the doctor may recommend several tests.

A. Blood test (serum uric acid)

A blood test measures the amount of uric acid in the bloodstream.

• High uric acid levels can increase the likelihood of gout.

• However, having high uric acid does not automatically mean someone has gout.

• Uric acid levels can sometimes be normal during an acute gout attack.

If gout is suspected but the uric acid level is below the expected range during a flare, the doctor may repeat the blood test at least two weeks after the flare has settled.

To look for uric acid crystals

A needle is inserted into the affected joint to collect a sample of synovial fluid (the lubricating fluid found inside joints). The fluid is then examined under a microscope to check for the presence of urate crystals, which are characteristic of gout.

To rule out a joint infection

Sometimes, a joint infection can cause symptoms similar to gout. The collected synovial fluid can be sent to a laboratory for testing and culture to check for bacterial growth. If bacteria are detected, this may indicate a joint infection (septic arthritis), which requires urgent medical treatment.

People with gout often have high levels of uric acid in their blood. However, uric acid levels can sometimes drop during an acute gout attack, which may make diagnosis more difficult.

It is also important to remember that some people have high uric acid levels without ever developing gout. Therefore, blood uric acid results must be interpreted alongside the patient’s symptoms, medical history and findings from other tests.

Assessing kidney function

A blood test measuring creatinine levels helps doctors assess how well the kidneys are functioning.

This test is important because the kidneys are responsible for removing uric acid from the body. If kidney function is reduced, uric acid may build up in the bloodstream, increasing the risk of developing gout.

Gout occurs when uric acid builds up in the body and forms sharp, needle-shaped crystals in and around the joints. When the body’s immune system reacts to these crystals, it triggers inflammation, causing the affected joints to become red, hot, swollen and extremely painful.

How Uric Acid Builds Up

The body naturally produces uric acid when it breaks down substances called purines. Purines are also found in many foods and drinks.

In healthy individuals, the kidneys help maintain a balanced level of uric acid in the blood by filtering out excess amounts and removing them through urine.

However, if the kidneys cannot remove enough uric acid, it begins to accumulate in the bloodstream. When uric acid levels become too high, urate crystals can form and collect in the fluid surrounding the joints.

The body’s immune system recognizes these crystals as foreign substances and reacts to them, triggering inflammation and the sudden pain and swelling associated with gout.

There are several reasons why uric acid may build up in the body:

• Ageing: The body’s ability to eliminate uric acid can change as we get older.

• Genetics: Some people inherit genetic differences that affect how efficiently their kidneys remove uric acid. This explains why gout often runs in families.

• Kidney disease: Reduced kidney function can make it difficult to remove excess uric acid from the bloodstream.

A doctor may inject a corticosteroid directly into an affected joint to reduce inflammation and relieve pain.

This can be particularly useful when only one or two joints are affected or when oral medications are unsuitable.

Before injecting a joint, doctors may need to collect and test joint fluid to rule out an infection.

F. Anakinra (Kineret)

Anakinra is a biologic medication that blocks a substance called interleukin-1 (IL-1), which plays an important role in the inflammatory response associated with gout.

By blocking this inflammatory pathway, anakinra can help reduce pain and swelling during a gout attack.

It is sometimes used in selected patients when conventional treatments are unsuitable or ineffective.

Anakinra is not a routine first-line treatment for gout and its use for gout is generally off-label.

2. Long-Term Treatments to Prevent Future Gout Attacks

Treating the immediate pain is only part of gout management. The underlying problem of excess uric acid must also be addressed.

The long-term goal is to keep uric acid levels low enough to prevent new crystals from forming and allow existing crystals to dissolve.

A. Medications That Lower Uric Acid Levels

Two commonly prescribed medications are allopurinol (Zyloprim) and febuxostat (Uloric).

Both medications help lower uric acid levels and reduce the risk of future gout attacks.

Important points about uric acid-lowering medication:

• Treatment is usually started at a low dose and gradually increased until the target uric acid level is reached.

• Starting treatment can temporarily trigger a gout flare as existing crystal deposits begin to change.

• Doctors may prescribe colchicine or another anti-inflammatory medication to help prevent these early attacks.

• Patients who are already taking allopurinol or febuxostat should generally continue taking it during a gout attack unless their doctor advises otherwise.

• Regular blood tests help monitor uric acid levels and treatment effectiveness.

The usual treatment target is below 360 µmol/L (6 mg/dL). A lower target may be recommended for people with severe gout or tophi.

B. Maintaining Overall Health

Gout is often associated with other health conditions, including high blood pressure, high cholesterol, heart disease, diabetes and obesity.

Improving overall health can help reduce the risk of gout complications and support better long-term management.

People with gout should aim to:

• Keep blood pressure within a healthy range.

• Manage cholesterol levels.

• Maintain good blood sugar control if they have diabetes.

• Achieve and maintain a healthy body weight.

• Exercise regularly.

• Avoid smoking.

• Manage existing kidney and cardiovascular conditions.

Gradual weight loss, when appropriate, can help improve metabolic health and reduce uric acid levels.

C. Dietary Changes

Dietary changes can help reduce uric acid levels and lower the likelihood of gout attacks.

People with gout should consider limiting foods and drinks that are associated with increased uric acid levels.

Gout is one of the most common forms of inflammatory arthritis. It develops when uric acid builds up in the body, leading to the formation of sharp monosodium urate crystals in and around the joints.

When the body’s immune system reacts to these crystals, it triggers inflammation, causing the affected joints to become red, hot, swollen and extremely painful.

People with gout experience episodes known as gout flares, which can cause sudden and intense joint pain. The big toe is the most commonly affected joint, although gout can also affect the ankles, knees, wrists, elbows and fingers.

An important point: Gout is treatable. With appropriate medication, lifestyle changes and control of uric acid levels, many people can prevent future attacks and avoid long-term joint damage.

There is no specific diet proven to stopGout Education.  A Mediterranean-style pattern—vegetables and fruit, whole grains, legumes, nuts, fish, and unsaturated fats—is a reasonable approach for overall health. Foods such as tomatoes and bell peppers can be included, but they shouldn’t be considered treatments for Fibromyalgia.

Tomatoes and Gout Education

Tomatoes can be a nutritious addition to an arthritis-friendly diet, although they do not cure arthritis or directly reverse joint damage.

• Lycopene: Tomatoes are particularly rich in lycopene, an antioxidant that helps protect cells from oxidative stress. Cooked tomatoes and tomato products can provide especially well-absorbed lycopene.

• Vitamin C: Supports collagen formation and normal connective-tissue function.

• Antioxidants: Tomatoes contain vitamin C, carotenoids, and other plant compounds that contribute to overall antioxidant intake.

• Potential anti-inflammatory effects: Laboratory and observational research suggests that compounds in tomatoes may influence inflammatory pathways, but evidence that eating tomatoes significantly reduces arthritis pain or inflammation in people is still limited.

• Heart health: Tomatoes can contribute to a heart-healthy diet, which is particularly relevant for people with rheumatoid arthritis, because RA is associated with increased cardiovascular risk.

Some people with Diffuse Idiopathic Skeletal Hyperostosis report that tomatoes or other nightshade vegetables worsen their symptoms. There isn’t strong scientific evidence that tomatoes generally cause arthritis inflammation or should routinely be avoided. If you consistently notice symptoms after eating a particular food, discussing this pattern with a healthcare professional or dietitian can be more useful than eliminating foods unnecessarily.

For Diffuse Idiopathic Skeletal Hyperostosis, tomatoes are best viewed as part of an overall nutritious eating pattern. For rheumatoid arthritis, diet can complement medical treatment but shouldn’t replace disease-modifying medication when it is prescribed.

Treatment and Management of

Gout treatment focuses on two main goals. The first is to relieve the pain and inflammation associated with an immediate gout attack (flare). The second is to address the underlying problem of excess uric acid in the body.

Lowering uric acid levels over time helps prevent future gout attacks, reduce their frequency and severity, dissolve existing urate crystal deposits and minimize long-term damage to joints and other tissues.

1. Immediate Treatments for Gout Attacks

The main goal during an acute gout attack is to reduce inflammation, relieve pain and allow the affected joint to recover.

Rest, Ice, Compression and Elevation (RICE) can help provide comfort and reduce swelling during a gout flare.

For example, if gout affects the foot or big toe, the patient can:

• Rest: Avoid putting unnecessary weight or pressure on the affected joint.

• Ice: Apply a cold pack wrapped in a towel for approximately 15–20 minutes at a time.

• Compression: Avoid tight bandages or anything that puts pressure on the painful joint.

• Elevation: Raise the affected foot on a pillow or chair to help reduce swelling.

B. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are commonly used to treat acute gout attacks. They work by reducing inflammation, swelling and pain.

Examples include:

• Indomethacin: A prescription anti-inflammatory medication frequently used for gout.

• Celecoxib (Celebrex): An NSAID that selectively blocks COX-2 enzymes.

• Naproxen (Aleve): An anti-inflammatory medication available in prescription and lower-dose non-prescription forms.

• Ibuprofen (Advil, Motrin): A commonly used NSAID.

• Diclofenac (Voltaren): An anti-inflammatory medication available in different formulations.

NSAIDs can be effective, but they are not suitable for everyone.

Potential side effects include:

• Increased blood pressure.

• Kidney problems.

• Stomach irritation and ulcers.

• Increased risk of gastrointestinal bleeding.

• Increased cardiovascular risks in certain patients.

Patients should consult their doctor before taking NSAIDs, particularly if they have kidney disease, heart disease, high blood pressure or a history of stomach ulcers.

C. Colchicine (Colcrys)

Colchicine is an established medication used to treat acute gout attacks and prevent flares when starting uric acid-lowering treatment.

It works by interfering with the inflammatory response triggered by urate crystals, helping reduce pain and swelling.

Colchicine is derived from the autumn crocus plant, which contains naturally occurring toxic compounds. The medication is manufactured and carefully dosed for medical use.

Common side effects include:

• Diarrhea.

• Nausea.

• Vomiting.

• Abdominal pain.

Taking too much colchicine can cause serious and potentially life-threatening toxicity.

The appropriate dose depends on the treatment purpose, kidney and liver function, and other medications the patient takes. Patients should follow their doctor’s prescribed dosing instructions rather than adjusting the dose themselves.

D. Prednisone (Oral Corticosteroids)

Prednisone is a corticosteroid medication that reduces inflammation and can be very effective in treating acute gout attacks.

It may be prescribed for a short course when NSAIDs or colchicine are unsuitable or ineffective.

One important consideration is that prednisone can:

• Increase blood glucose levels, particularly in people with diabetes.

• Raise blood pressure.

• Cause fluid retention.

• Affect sleep and mood.

Patients with diabetes or other underlying health conditions may require additional monitoring.