At least once a week, I have patient who presents to the clinic due to pain from gout. It is a painful condition that develops in some patients who have elevated levels of uric acid in their blood (hyperuricemia). Up to 66% of patients who have elevated uric acid levels never develop symptoms. We’re not sure why some people develop symptoms and others don’t have symptoms at all.
Uric acid crystals most commonly affect one or multiple joints in the body, but may also cause uric acid crystals to develop within the kidney or urinary tract. A stone within the kidney may cause impaired kidney function or pain. Only 15% of people with gout develop kidney stones due to uric acid.
Gout risk factors: Gout is estimated to affect about 2% of the population in the USA. It is most common in men between 30-45 and women between 55-70. There is an increased risk of gout with the following:
1) Taking medications that affect uric acid levels, such as diuretics
3) Ingesting large amounts of meat or seafood
4) High blood pressure
5) Consuming high quantities of alcohol
7) Recent surgery or injury
1) Sudden severe joint pain (usually one joint), sometimes with redness and swelling
2) Pain and inflammation are worst within several hours and improve over a few days to weeks completely even if untreated
1) Acute gouty arthritis: attacks usually involve the big toe or knee which become painful and inflamed
2) Intercritical period: The time between attacks. Usually a second attack occurs within 2 years. If uric acid levels are uncreated over several years the time between attacks may shorten or the symptoms may become more severe when attacks occur.
3) Chronic tophaceous gout: Large numbers of uric acid crystals may collect in joints, bones or cartilage and cause a nodule called a tophus to form. This tophus is not usually tender, but cause erosion of bone and permanent deformity. The tophi when the occur on the knuckles can cause an unfortunate cosmetic problem.
Diagnosis: Gout may be suspected if the person has the sudden onset of joint pain in the commonly affected joints such as the big toe. If the patient has a period when there are no symptoms, and then symptoms return this is very typical of the disease. The best way to diagnose gout is to examine fluid from the affected joint to look for uric acid crystals. A medical provider uses a needle and syringe to withdraw a small sample of synovial fluid from the joint and this fluid is sent to the lab for microscopic analysis. Other criteria for diagnosis gout may be:
1) Blood testing showing high uric acid levels
2) Rapid improvement of symptoms after the patient is treated with colchicine
3) History of pain and inflammation involving one joint at a time, especially at the base of the large toe
4) The symptoms totally go away between attacks
Treatment: The goals of gout treatment are to decrease the pain of a gout attack and also to reduce the frequency of their attacks. Some of the treatment options are listed below:
1) Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the swelling in the joint. Examples of these are Ibuprofen or indomethacin. They are most effective if started as soon as possible after the gout attack starts.
2) Colchicine is a medication that may decrease the pain of a gout attack very rapidly.
3) Steroids such as prednisone may be used if an NSAID is not used. This type of medication can be injected directly into the affected joint or can be given as pills or intramuscular injection. There is a risk of “rebound gout attack” as the steroids are stopped however, so usually steroids are slowly tapered over 7-10 days.
Prevention therapy: Some medications as well as dietary changes can be helpful to reduce the frequency of gout attacks.
1) Uric acid lowering medications are used indefinitely because there is not a benefit from taking a break from the medications. Examples of this are Probenacid, Losartan, and Allopurinol. Rapid lowering of uric acid can cause a gout flare .
2) Increased water intake – at least 2 liters/day are recommended
Dietary changes: Obesity is a major risk factor for gout so changing diet may decrease the frequency of gout attacks. Current recommendations also include eating less of the following:
1) Red meat
3) Beer and hard alcohol (gin, vodka, etc.)
4) Foods and drinks that contain high-fructose corn syrup (fond in some non-diet sodas for example)
Some foods that may be good to eat or drink if you have gout may include:
1) Low fat dairy
2) Foods with complex carbohydrates such as whole grains, brown rice, oats and beans
3) Vitamin C (500mg/day has been found to have a mild uric acid lowering affect).
4) Coffee in moderation
5) Wine in moderation – (1-2 5oz servings/day me be helpful)
6) Pineapples – see my blog article about preventing gout by eating pineapples
7) Drink plenty of water – twelve 8oz glasses of water during every day.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO