All About Gout
There are many myths and misconceptions about the common condition known as gout. That’s why our primary care doctors want to take a look at gout, and tell you how it’s treated, along with what steps you can take to avoid it.
It’s unfortunate that gout is sometimes treated as a joke, in which only rich overweight people (usually men) are thought to encounter the condition.
The fact is that anyone, regardless of income, can get gout, a common form of inflammatory arthritis. Although those who are overweight or obese are at higher risk for gout, it can attack normal-weight individuals, as well.
It’s also true that it primarily affects men over the age of 40—until women reach menopause. Then the incidence of the disease becomes roughly equal in both sexes.
Another misconception is that it’s only seen in the big toe. While that’s the most frequent location for an attack, it can also occur in any joint, including the ankles, knees, elbows, wrists, and fingers.
Finally, gout is no laughing matter. Left untreated, it can lead to other serious complications, including kidney disease, joint damage, cardiovascular disease, or stroke.
What is gout?
According to the Centers for Disease Control and Prevention (CDC), gout is a common form of inflammatory arthritis that is very painful. It usually affects one joint at a time (often the big toe joint).
The symptoms suddenly get worse at times (called “flares”), alternating with long periods when sufferers experience no symptoms at all (remission). Repeated attacks of gout can lead to gouty arthritis, a worsening form of arthritis.
Gout flares start suddenly and can last for days or weeks. For some unknown reason, they often start in the middle of the night and awaken the individual with severe pain.
These flares are followed by long periods of remission, which can last anywhere from weeks to years.
Symptoms in the affected joint may include:
- pain, usually intense
- tenderness to any touch, even a bed sheet
- intense heat
The most severe pain usually lasts between four and 12 hours, then gradually subsides to discomfort, which can last from a few days to a few weeks.
What causes gout?
An excess of uric acid in the body leads to a condition known as hyperuricemia, which produces urate crystals that accumulate in joints, fluids, and tissues in the body. If not flushed out in the urine, these needle-shaped crystals can gather in and around a joint, causing the intense pain and swelling of gout.
Oddly, not everyone who has hyperuricemia develops gout, and if there are no symptoms, there is no need to treat the condition. On the other hand, some individuals can experience an attack of gout yet show normal levels of uric acid in their blood.
Gout can occur in anyone at any age. However, there are certain risk factors for the condition. Besides being male or a menopausal female and being overweight, the odds of developing gout increase in those who:
- have a family history of gout
- have congestive heart failure
- have hypertension (high blood pressure)
- are insulin resistant or have metabolic syndrome
- are diabetic
- have poor kidney function
- use certain medications such as low-dose aspirin, niacin (in large amounts), diuretics, or cyclosporine following an organ transplant
- drink alcohol, especially beer and hard liquor (higher intake increases risk)
- eat or drink foods or beverages high in fructose (a type of sugar)
- have a diet high in purines*
*The body breaks down purines into uric acid, making this one risk factor that individuals can control. Foods rich in purines include red meat, organ meat, and many kinds of seafood, including anchovies, shrimp, lobster, sardines, mussels, scallops, trout, and tuna.
How is gout treated?
Left untreated, gout can also cause serious—possibly fatal—conditions, including heart attack, stroke, kidney disease, and insulin resistance, a syndrome that can lead to diabetes. So it’s important to contact us if you experience a gout attack to receive treatment.
Contrary to myth, there are effective treatments for gout. We can help you manage the pain of a flare with certain anti-inflammatory drugs, including ibuprofen, steroids, and colchicine. The latter drug is most effective the sooner it is taken after the onset of a flare. Corticosteroids, either in pill form or injected into the joint, can also be effective in controlling inflammation and pain.
In addition, there are medications that can not only reduce the risk of gout flares but also reduce the risk of gout-related complications. Certain prescription drugs can block uric acid production, and/or help the body remove excess amounts of uric acid. If you’re on a diuretic, we may also change your medication or suggest you stop taking it, at least temporarily.
Finally, lifestyle changes do help. These include:
- avoiding high-purine foods and drinks
- avoiding beverages containing high-fructose corn syrup
- avoiding alcohol for at least six months until the drugs take effect
- losing weight to help protect your joints
- participating in low-impact exercises, such as walking, bicycling, and swimming
Once you experience an attack of gout, it’s likely you’ll have to be on maintenance levels of uric acid-reducing drugs for the rest of your life. But gout doesn’t have to be debilitating if it’s properly managed.