Learn About Your Pain

What is Gout?

Gout is an inflammatory joint disease (arthritis) caused by high uric acid (UA) levels in the bloodstream. The uric acid forms sharp crystals that collect in the joints and soft tissue, causing excruciating pain that is difficult to control. Often beginning in the big toe, pain from gout is so intense it sometimes makes the sufferer unable to walk. The attack can then spread to the feet, ankles, wrists, hands and elbows. Uric acid crystals can also land in other tissues, like the kidney, leading to kidney stones, another painful condition. In advanced stages of gout, crystals can destroy bone, leading to deformities and lack of function. Gout affects over eight million people and is on the rise as people live longer, have higher rates of obesity and eat diets that are more and more uric acid producing.

Symptoms and Comorbidities

Gout tends to come in episodes or attacks of pain, redness and joint tenderness, the first of which often brings the sufferer to the emergency room or urgent care clinic. If left untreated it can cause joint damage/chronic arthritis and therefore chronic pain. It is a systemic disease with comorbidities including obesity, hypertension, dyslipidemia (a disorder that may present as an elevation of LDL—“bad”—cholesterol and a decrease in HDL—“good” cholesterol), insulin resistance, hyperglycemia and coronary artery disease. Studies have also shown gout to be associated with higher rates of metabolic disease, coronary artery disease, myocardial infarction and cardiovascular disease. Because of these associated morbidities, it is important for those suffering from gout to be treated and institute lifestyle changes as soon as the disease is detected.

Diagnosis and Tests

  • Joint fluid test to check for urate crystals
  • Blood test to measure UA levels
  • X-ray imaging to rule out other causes of joint pain
  • Ultrasound to detect urate crystals
  • Dual energy CT scan to detect urate crystals

Treatment

An acute gout attack can be treated with initially heavy doses of ibuprofen, indomethacin, or other nonsteroidal anti-inflammatory drugs (NSAIDs). A drug called Colchicine can help treat and also prevent acute attacks, but it often has intolerable side effects, such as nausea, vomiting and diarrhea. A low dose may be prescribed for prevention. Corticosteroids, such as prednisone, are used to control inflammation and pain.

Medications that block UA production, called xanthine oxidase inhibitors, and drugs that improve UA removal may be used to prevent gout complications if gout attacks are frequent or particularly painful.

Management and Prevention

Gout is significantly affected by diet. Food triggers include:

  • Beer and grain liquors
  • Red meat (including lamb and pork)
  • Organ meats
  • Crash diets, including high-protein based
  • High-fructose and sugary foods and drinks
  • Seafood, particularly shellfish.

In addition, it is recommended that gout sufferers

  • Increase intake of omega-3 fatty acids
  • Increase intake of vegetables, legumes, nuts and vegetable proteins
  • Increase intake of low-fat dairy products
  • Drink plenty of water and consider adding coffee to reduce uric acid levels
  • Follow an alkalinizing diet, one that is low in animal protein and high in vegetable intake
  • Take a daily vitamin. Vitamin C in particular is useful

Risk factors for developing gout include

  • High blood pressure
  • Diabetes
  • Kidney disease
  • Being overweight or obese
  • A family history of gout
  • Age and sex: men are more likely to develop gout, and it usually happens between the ages of 30 and 50. Women tend to have lower levels of UA generally, but when they do develop gout it is usually after menopause, when their UA levels approach that of men
  • Recent surgery of trauma
  • Bed rest
  • Certain drugs, like thiazide diuretics, used to treat hypertension; low-dose aspirin; and anti-rejection drugs such as those used by organ transplant patients

Integrative Therapies

Talk with your health care provider to weigh the benefits and risks of alternative treatments and decide whether a particular treatment might interfere with your gout medication.

  • Drinking coffee (both decaf and regular) can lower uric acid
  • Vitamin C
  • Cherries
  • Relaxation techniques
  • Mindfulness meditation

Resources

The Gout & Uric Acid Education Society is a nonprofit organization of health care professionals dedicated to raising gout awareness. They offer web and print informational materials for care givers and gout sufferers.
http://gouteducation.org/about-us/press-room/

The Arthritis Foundation
http://www.arthritis.org/about-arthritis/types/gout/