As a Rheumatologist, one of our doctor's specialties is evaluating and treating gout. Gout is a painful and potentially disabling form of arthritis. Initial symptoms usually involve intense episodes of painful swelling in single joints, most often in the feet, especially the big toe. The swollen site may be red and warm.
Treatments are available to control most cases of gout. However, diagnosing gout can be hard, and treatment plans often must be tailored for each person. Gout can affect anyone, and its risk factors vary. Fortunately, it is possible to treat gout and reduce its very painful attacks by avoiding food and medication triggers and by taking medicines that can help.
Who Gets Gout and Why?
Gout affects more than 3 million Americans. This condition and its complications occur more often in men, women after menopause, and people with kidney disease. Gout is strongly linked to obesity, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides) and diabetes. Because of genetic factors, gout tends to run in some families. Gout rarely affects children.
Gout occurs when excess uric acid (a normal waste product) collects in the body, and needle‐like urate crystals deposit in the joints. This may occur because either uric acid production increases or, more often, the kidneys cannot remove uric acid from the body well enough.
What Can Trigger a Gout Attack?
Certain foods and drugs may raise uric acid levels and lead to gout attacks.
These include the following:
Foods such as shellfish and red meats
Alcohol in excess
Sugary drinks and foods that are high in fructose
low-dose aspirin (but because it can help protect against heart attacks and strokes, we do not recommend that people with gout stop taking low-dose aspirin)
certain diuretics (“water pills”) such as hydrochlorothiazide (Esidrix, Hydro‐D)
immunosuppressants used in organ transplants such as cyclosporine (Neoral, Sandimmune) and tacrolimus (Prograf)
Some other kinds of arthritis can mimic gout, so proper diagnosis (detection) is key. Health care providers suspect gout when a patient has joint swelling and intense pain in one or two joints at first, followed by pain‐free times between attacks. Early gout attacks often start at night.
Diagnosis depends on finding the distinguishing crystals Crystals also can be found in deposits (called tophi) that can appear under the skin. These tophi occur in advanced gout. Uric acid levels in the blood are important to measure but can sometimes be misleading, especially if measured at the time of an acute attack. Levels may be normal for a short time or even low during attacks. Even people who do not have gout can have increased uric acid levels.
X-rays may show joint damage in gout of long duration. Ultrasound and dual energy computed tomography (commonly called dual energy CT) can show early features of gouty joint involvement. These imaging techniques also can help suggest the diagnosis.
What works well for one person may not work as well for another. Therefore, decisions about when to start treatment and what drugs to use should be tailored for each patient. Treatment choices depend on kidney function, other health problems, personal preferences and other factors. What you eat can increase uric acid levels. Limit the amount of high-fructose drinks, such as nondiet soda. Also, do not drink alcohol, especially beer. Restrict eating foods that are rich in purines, compounds that break down into uric acid. These compounds are high in meat and certain types of seafood. Purines in vegetables appear to be safe, new research has found. Low‐fat dairy products may help lower uric acid levels. In almost all cases, it is possible to successfully treat gout and bring a gradual end to attacks. Treatment also can decrease the number and size of tophi.