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What is gout
ICD-10 code: M10
Gout is a systemic disease caused by the deposition of sodium monourate crystals (uric acid) in joints and soft tissues. Each gouty attack is a microcatastrophe for the joint: crystals damage the cartilage, synovial membrane, and subchondral bone. Recurrent attacks lead to irreversible joint destruction.
Stages of Gout
1. Asymptomatic Hyperuricemia
Uric acid above 360 µmol/L, but no attacks yet. Crystals are already beginning to deposit. Lasts for years. At this stage — diet and urate-lowering therapy if necessary.
2. Acute Gouty Arthritis
Sudden attack: joint is red, hot, sharply painful, swollen. Impossible to touch. Most commonly the 1st metatarsophalangeal joint (gout = «foot trap»). Also: ankle, knee, elbow, wrist. Attack duration: 3-10 days without treatment.
3. Intercritical Period
No symptoms between attacks, but crystals continue to accumulate. Without treatment, intervals between attacks shorten.
4. Chronic Tophaceous Gout
Tophi — nodules of uric acid crystals in soft tissues (fingers, ears, elbows, Achilles tendon). Chronic arthritis. Joint destruction on X-ray (punched-out erosions). Whether regenerative treatment is an option in this condition is assessed by the clinic doctor.
Affected Joints
1st Metatarsophalangeal Joint (90%)
«Podagra» — classic location of the first attack. Pain is so severe that the patient cannot wear shoes or even tolerate the weight of the bedsheet.
Ankle and Knee
Frequent locations, especially in recurrent gout. Massive effusion, limited motion.
Elbow and Wrist
Involvement of upper extremities — in long-standing and severe gout. Tophi on hand fingers and in the olecranon area.
Diagnosis
Blood Uric Acid
Normal: less than 360 µmol/L (6 mg/dL). Target level in gout: less than 300 µmol/L. Note: during an acute attack, the level may be normal!
Polarized Light Microscopy
Gold standard — joint aspiration with examination of synovial fluid. Sodium monourate crystals: needle-shaped, negative birefringence. 100% specificity.
Joint Ultrasound
«Double contour» sign — crystal deposition on the cartilage surface. Tophi. Sensitivity 85%. Non-invasive first-line method.
Dual-Energy CT (DECT)
Visualizes urate deposits in all joints simultaneously. High sensitivity and specificity. Indicated for uncertain diagnosis.
Gout: treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Treatment by a rheumatologist | Disease-modifying or specific drug therapy — the basis of treatment | Well studied, recommended |
| Painkillers and NSAIDs | Ease pain during flare-ups; long-term use is limited by side effects | Well studied, recommended |
| Corticosteroid injection | Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable | Moderate evidence |
| Load management, weight loss | Takes load off the affected area; if overweight, losing 5–10% noticeably reduces pain | Moderate evidence |
| PRP / CGF | — | Not usually used for this diagnosis |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In inflammatory joint diseases the key is treating the cause with a rheumatologist: disease-modifying drugs for rheumatoid arthritis and ankylosing spondylitis, lowering uric acid for gout. An intra-articular corticosteroid injection helps with a flare in a single joint. Regenerative injections do not affect the inflammatory process and have hardly been studied for these diagnoses.
When surgery is discussed. Surgery (synovectomy, joint replacement) is discussed for joint destruction or persistent synovitis despite drug treatment.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Good to know: diagnosis, self-help, outlook
How to tell gout from similar conditions
A gout attack starts suddenly, often at night: a joint, usually at the base of the big toe, becomes extremely painful, red, hot and swollen, with peak pain within a day. Pseudogout (more often the knee and wrist in older people) and septic arthritis, which needs urgent treatment, look similar. A bunion becomes inflamed gradually from footwear. The diagnosis is confirmed by crystals in joint fluid, uric acid level and ultrasound.
What you can do yourself
During an attack: rest, ice and anti-inflammatories as prescribed, as early as possible. Reduce alcohol (especially beer), sugary drinks with fructose, red meat and offal; drink enough water; lose weight. Discuss with your physician any medicines that raise uric acid.
Outlook and timelines
An attack settles within 1–2 weeks, but without treatment it recurs and gradually damages the joints. With frequent attacks, tophi or kidney involvement, long-term urate-lowering therapy is prescribed, which reliably prevents attacks. Orthopaedic treatment is rarely needed, only when a joint is destroyed.
Recovery and timelines
After an outpatient injection procedure, most patients return to normal activity within 1–3 days. Sport and heavy loads are resumed according to the physician’s plan, usually after 2–6 weeks, alongside therapeutic exercise. The effect is assessed after 6–12 weeks. After surgery, rehabilitation takes longer and depends on the operation.
When surgery is needed
Surgery is discussed if conservative and injection treatment has not helped for 3–6 months, with advanced joint destruction, a complete tendon or ligament tear with loss of function, or neurological problems such as increasing weakness, numbness or bladder and bowel dysfunction. The clinic physician decides based on the images and examination; we can arrange a surgeon’s consultation.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Monto RR. Platelet-rich plasma and plantar fasciitis. Sports Med Arthrosc Rev, 2013.
- Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Questions about Gout
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request