Gout: 8 Things Doctors Want You to Know
- The number of people with gout in the U.S. is increasing. Do you have it?More than 8 million Americans deal with the painful inflammation in their joints known as gout, the most common form of inflammatory arthritis. Cases of gout are on the rise because it tends to develop in people with obesity, diabetes, high blood pressure, and other health conditions that have become widespread in the United States. Here’s what some top doctors have to say about what causes gout, common gout symptoms, gout treatment options, possible complications of gout, and what you can do to avoid them.
- 1. “You can get gout if you have high levels of uric acid in your blood.”“The uric acid deposits in the soft tissues and the joints, and that can cause gout attacks,” says Umbreen Hasan, MD, director of rheumatology at North Memorial Health in Plymouth, Minn. “When uric acid builds up too high, it is not able to dissolve in your blood, and it forms solids in the form of crystals,” says Dr. Jonathan Greer, MD, president of Arthritis and Rheumatology Associates of Palm Beach, Fla. The crystals, smaller than a grain of sand, cause the painful inflammation. “I’ve had some people tell me it hurts more than having a baby,” says Dr. Greer.
- 2. “You’re more likely to get a gout attack after midnight.”“Most of the attacks happen early in the morning because the blood is more concentrated then, so the crystals also become concentrated. Most patients will say they get up with their gout attack in the middle of the night,” says Dr. Hasan. Gout comes on more suddenly than other forms of arthritis, with redness, warmth, swelling and stiffness. “You might have a normal joint and by morning it’s swollen, with an intense amount of inflammation that goes into the joint.”
- 3. “The gout pain will probably be in your big toe.”“Gout presents as redness, pain and swelling most often in the toe, but it can certainly occur in other joints,” says Minna Kohler, MD, director of the rheumatology program at Massachusetts General Hospital in Boston. Why your toe? “Uric acid becomes less soluble in parts of the body furthest away from your heart because it’s colder. It’s like sugar; it dissolves better in warm tea than cold tea. So that’s why you have people with attacks of gout in their big toe, because it’s so far away from the core,” says Dr. Greer.
- 4. “Gout can progress from an occasional flare to a chronic condition.”“If you don’t treat gout, what happens is the attacks become more frequent, they last longer and then they don’t go away,” says Dr. Greer. “Most people think of gout as just the acute attacks but there’s more to it than that. There’s chronic inflammation that can lead to bony damage or deformities that can really be debilitating if left untreated.” Adds Dr. Kohler: “I think a lot of people don’t recognize that gout can cause permanent damage to the joints as well as increased risk for heart attack and stroke.”
- 5. “There are do's and don’ts that can help you avoid painful gout attacks.”Avoid foods that are high in purines, such as red meat, organ meats, shellfish, and sodas and sweets containing high fructose corn syrup. “Purines get metabolized into uric acid,” says Dr. Greer. “Alcohol is a big, big factor. Beer has a chemical that gets directly metabolized into uric acid. So beer’s the worst. Consume foods that are low in purines,” he says. That includes fruit and vegetables, dairy products, and even a reasonable amount of coffee. “Cherries decrease your uric acid,” notes Dr. Hasan, and taking vitamin C may be helpful. A healthy lifestyle can also help minimize flares and complications.
- 6. “We’ll probably give you two kinds of medicines for gout.”“There are two methods of treating gout. One is to treat the acute attack, but the more important way is to prevent those attacks from occurring in the first place, and that is designed to lower the level of uric acid,” says Dr. Greer. “Allopurinol is the first line therapy for lowering uric acid, and it’s the most commonly prescribed and effective. Colchicine is an anti-inflammatory medicine and it’s often prescribed in combination with allopurinol to reduce the discomfort,” says Dr. Kohler.
- 7. “Whatever you do, don’t stop your gout meds.”“I have people who say, ‘Oh, I’ve been on allopurinol for 10 years, I’ve never had an attack, so I’m going to stop my drug,’ and guess what, a year later they get attacks again. So you never stop treatment for gout, ever,” cautions Dr. Greer. “Let’s say you have a patient who starts allopurinol and then they think, ‘OK, I’m taking this medicine which is decreasing the uric acid, so I can actually start increasing my beer intake because it’s neutralizing the effect.’ It really doesn’t work that way,” adds Dr. Hasan.
- 8. “Gout is a lifelong condition but we can lessen or eliminate your pain and swelling.”“We have lots of options now to treat gout and help manage it,” says Dr. Greer. “The medications we have for gout are very effective, so if you’re able to stay on the medicine and make the lifestyle changes you need to, you can actually be symptom free and reduce your overall cardiac and stroke risk,” says Dr. Kohler. If you follow your physician’s advice, you are likely to live without the discomfort and damage that can come with gout, and as a bonus end up a healthier, fitter individual.
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What Is Gout? | What Causes Gout? | What Doctors Want You to Know