What You Need to Know about Gout
What is gout?
Gout is a type of inflammatory arthritis caused by crystals forming in the joint. The particular crystals that cause gout are made of a substance called uric acid. Gout is much more common in men than women. The first gouty attack usually starts between age 30 and 45 in men. In women, gout commonly occurs after menopause.
What is uric acid?
Uric acid is a breakdown product from purines which are natural substances found in all of our body’s cells and many foods. Uric acid has strong antioxidant capacity, and therefore it is normal for uric acid to be formed in the body. However, when uric acid level becomes too high, either by excessive production or impaired removal by the kidneys, uric acid crystals will form in various tissues in the body. Uric acid crystals, when deposited in the joints, can lead to a gouty attack which causes inflammation and damage of the joints. Elevated uric acid level in the blood is referred to as hyperuricemia. Most people with hyperuricemia will not have gout during their lifetime, but the risk of gout attack increases as uric acid levels rise.
What are the risk factors for gout?
- High blood pressure
- Fasting or dehydration
- Excessive alcohol (particularly beer, whiskey, gin, vodka and rum)
- Recent injury or surgery
- Ingesting diets containing large amount of meat, seafood and high fructose corn syrup-containing beverages
- Taking medications that increase uric acid levels (diuretics for high blood pressure)
What are the symptoms of gout?
Gout attacks cause sudden intense joint pain and swelling. The joints are usually hot, tender and red. The most common joint involved is the big toe, although other joints can be affected as well. The pain is worse with movement and usually lasts a few days, sometimes several weeks.
How is gout diagnosed?
Your doctor can make the diagnosis of gout from the medical history and examination. Blood tests can be performed, but are not always reliable since uric acid level can be high or normal during the attack. The best way to confirm the diagnosis is to obtain fluid using a needle from the affected joint. The identification of uric acid crystals from the fluid confirms the diagnosis.
How is gout treated?
Anti-inflammatory medications including non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or steroids such as prednisone are commonly prescribed for treatment of acute gouty attacks. Removal of fluid from the joint, followed by cortisone injection can provide the fastest and best relief of pain and swelling.
What are the complications?
People who have gout have higher risk of kidney stones caused by uric acid crystals depositing in the urinary tract. Less commonly, the crystals can accumulate in the kidney and cause kidney failure. Tophi will form when large numbers of crystals develop in the joints or under the skin and can result in bone erosion and joint deformity.
How do we prevent gouty attacks?
Without preventive measures, most patients will experience a recurrent episode of gouty attack within two years. Lifestyle modifications and/or medications can be used to prevent further attacks.
Lifestyle changes for gout prevention
As obesity is associated with increased risk of gout, weight loss is recommended. Fasting, rapid weight loss and high-protein weight-loss diets can promote gouty attacks and should be avoided. The following are dietary recommendations to prevent gout.
- Limit meat, poultry and seafood. Animal proteins are rich in purine. Avoid organ meats (e.g., brain, liver, kidney), red meats (e.g., beef, pork, lamb) and seafood, especially fatty fish and shellfish (e.g., tuna, oyster, shrimp, lobster, scallops). Restrict your intake of these high-purine foods to 4 to 6 ounces (113 to 170 grams) daily.
- Cut back on fat. Saturated fat lowers the body’s ability to get rid of uric acid. The amount of saturated fat should be reduced and replaced with plant-based protein, low-fat or fat-free dairy product. Some studies showed low-fat or fat-free dairy products can actually reduce the risk of gout.
- Limit or avoid alcohol. Alcohol interferes with the elimination of uric acid. Beer and hard liquor (e.g., gin, vodka) are associated with increased gouty attacks. However, moderate amount of wine, one or two 5-ounce (148ml) servings a day, is not likely to increase the risk of attacks.
- Limit or avoid foods and drinks that contain high-fructose corn syrup. As fructose stimulates production of uric acid, sweets and beverages sweetened with high-fructose corn syrup, such as soft drinks or juice drinks, should be avoided. 100 percent fruit juices do not increase uric acid.
- Choose complex carbohydrates such as whole grains, brown rice, fruits and vegetables, and restrict refined carbohydrates such as white bread, cakes and candy.
- Drink plenty of fluids, especially water. You should drink at least eight 8 ounce (237ml) glasses a day.
- Coffee and vitamin C (500mg a day) may reduce uric acid level.
Medications for gout prevention
Indications for initiation of preventive medications include: frequent (two to three attacks a year) and prolonged gouty attacks, evidence of joint erosion and tophi deposits, development of kidney problems and recurrent kidney stones. While long-tern use of anti-inflammatory medications can prevent gouty attacks, they will not prevent joint erosion or development of tophi. Certain medications can prevent gouty attacks by increasing elimination or decreasing production of uric acid. They should be started once an acute gouty attack is resolved and continued indefinitely to be effective.
“Updates in Management of Gout.” American Journal of Medicine. 2007 (120); 221-224.