Gout is a common type of inflammatory arthritis characterized by a red, hot, swollen, extremely painful joint. Gout frequently affects joints in the big toe, ankle or knee. Gout can also involve the fingers, wrist and elbow. A “gout attack” usually starts all of the sudden and the pain increases rapidly. Often the symptoms begin in the early morning and increase over the course of the day. Because of the skin redness, warmth, and pain intensity, gout attacks are often confused with an infection.
What is gout?
A gout attack is caused when high levels of uric acid in the blood forms crystals in the joints or soft tissues. These crystals are needle-shaped and create a painful inflammatory reaction. Uric acid is naturally produced in the body. It is a normal breakdown product of a chemical in food called purine. Our bodies remove uric acid through the urine. Gout occurs when there is either too much uric acid produced in the body or too little being removed by the kidneys. Multiple gout attacks can cause joint damage over time. Bumps or nodules of uric acid can develop around the joints in long-term gout, and these nodules are called tophi.
Doctors have known about gout for many centuries. Historically, gout was thought to be a disease of only the wealthy or royalty class, and it was called the “disease of the kings.” Overindulgence in diets rich in meats, seafood, and alcohol has long been associated with gout, and the people who could afford such a lifestyle were typically affected. We now know that animal proteins such as red meat, pork, oily fish, and shellfish are high in purines. Additionally, alcohol reduces the metabolism of uric acid. This type of diet increases the uric acid in the blood stream which can lead to gout.
What are the risk factors for gout?
Gout occurs more often in males than females. Other risk factors for gout are family history, purine rich diets, alcoholism, kidney disease, obesity, diabetes, dehydration, use of chemotherapy drugs, and use of some diuretics medications (water pills). Also, food products with added fructose and sugary drinks can also increase the risk of gout. Occasionally trauma and surgery can precipitate a gout attack.
How is gout treated?
Treatment of acute gout attacks involves rest, splinting, and anti-inflammatory medications. Naproxen and ibuprofen are examples of common over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). Indomethacin and prednisone are stronger prescription anti-inflammatory medications. Colchicine is another commonly prescribed medicine for gout attacks. A corticosteroid injection into the joint (cortisone shot) can also be used to reduce the inflammation from gout. Gout attacks usually lasts for a few days, and prompt treatment can make the symptoms go away sooner.
How is gout prevented?
Multiple attacks of gout can lead to joint damage over time, therefore prevention of gout attacks is important. Treatment of gout involves decreasing the uric acid level in the diet and/or increasing the excretion of uric acid in urine. There are several lifestyle changes which can reduce the risk of a gout attack: Stay hydrated and drink adequate amounts of water to flush the uric acid through the kidneys. Limit the intake of animal meats high in purines such as beef, pork, oily fish, and shellfish to reduce the production of uric acid. Organ meats such as liver, kidneys, and sweetbreads are especially high in purines. Limit the intake of alcohol in general and beer in particular. Limit the intake of processed foods such as refined flour, sugary drinks, and food products with added fructose. Instead choose foods with complex carbohydrates such as whole grains, fresh fruits and vegetables. Purine-rich vegetables such as asparagus and spinach have not been shown to increase the risk of gout. Also the intake of dairy products such as milk, cheese and yogurt can reduce the risk of gout.
If diet and lifestyle changes are not enough to control the gout attacks, medications may be needed. Most doctors recommend starting a medication to reduce uric acid in the blood if patients have more than 2 gout attacks in a year. These medications include allopurinol, probenacid, and febuxostat. Primary care physicians often prescribe these medications and monitor the uric acid level with blood tests. These medications are not taken during a gout attack, they are designed to be used to prevent gout attacks long-term. Please talk to your doctor if you have questions about gout.
Recommended dietary changes for patients with gout:
- Limit excess alcohol intake
- Limit animal meat intake, especially beef, organ meats, oily fish and shellfish
- Limit sugary drinks and food products with added fructose
- Stay hydrated by drinking water
- Choose whole grains, fresh fruits and vegetables
- Increase dairy products in the diet, such as low-fat milk and yogurt