The Truth About Gout

One of the biggest misconceptions about gout that Spencer Lowe, M.D., a Palo Alto Medical Foundation rheumatologist and internist, encounters in his practice is that you can cause it by making poor diet and lifestyle choices.

“Gout is called ‘the disease of kings’ because for hundreds of years it has been associated with living a ‘rich lifestyle,’” Dr. Lowe says. “As a result there is a stigma to having gout that is really misplaced.”

Gout Basics

Gout is a very painful form of arthritis that most often affects men after age 40. Women can also get the disease, but typically only after menopause. Children almost never get gout. "Diet is not the exclusive cause of gout, and lifestyle changes alone cannot treat or prevent it", Dr. Lowe says.

The disease is caused by needle-like urate crystals forming in joints and causing severe inflammation and pain. When uric acid, a waste product normally excreted in urine, builds up in the blood, the odds that these crystals will form increases.

Gout attacks last until the crystals dissolve and can be so painful that it will wake a person from sleep and make even having a light sheet lay across the affected joint (typically the big toe) intolerable, Dr. Lowe explains.

There is no cure for gout, but the disease can be controlled with medications. Avoiding alcoholic drinks and foods high in sugar or purines (found in red meat and shellfish), which can raise uric acid levels, may also help.

Risks for Gout

Gout is not an exclusively male disease, but men are at much higher risk for developing it. Men under 65 are four times more likely than women under 65 to develop gout, and it affects Black men at almost twice the rate of White men, according to the U.S. Centers for Disease Control and Prevention. Other risk factors for gout include:

• Having a family member with the disease
• Being overweight
• Heavy alcohol consumption
• An enzyme defect
• Lead exposure
• A previous organ transplant
• Certain medications, including diuretics (drugs that decrease water in the body) and aspirin (pain reliever)
• Vitamin niacin supplements

Signs of Gout

Often, people do not recognize their first painful gout attack for what it is, Dr. Lowe says. First attacks may be relatively brief, lasting three to ten days, and the next attack may not occur for months or even years. However, when the next attack comes, it typically lasts longer and sends the person suffering the attack to the doctor in search of relief from the pain.

Painful, red, warm and swollen joints are not the only symptoms of gout. If you have gout, you may also have:

• Tophi, which are lumps under the skin caused by deposits of uric acid.
• Kidney stones from uric acid crystals in the kidneys.

To diagnose gout, a doctor will typically measure the uric acid level in your blood and study your symptoms. During an active gout attack, your doctor may also use a needle to withdraw a small amount of fluid from an inflamed joint and examine it under a microscope to look for the tell-tale uracil crystals.

Although big toes seems to be especially prone to gout inflammation, gout attacks can occur in most any joint in the legs or arms, including the instep, ankles, heels, knees, wrists, fingers and elbows.

Treating Gout

The myth that gout is largely self-inflicted sometimes discourages people from seeking the treatment they need, Dr. Lowe explains.

“They are embarrassed by something they think they did to bring on their gout attack and therefore do not bring it up with their doctor,” he says.

Unfortunately, when left untreated or poorly managed, gout will keep coming back in longer and more frequent attacks that cause severe joint damage and permanent disability. It is important to talk to your doctor if your gout attacks keep coming back so that your treatment plan can be adjusted.

“For the vast majority of patients, we can successfully treat their gout,” Dr. Lowe says.

Gout attacks may be brought on by stress, getting sick, rapid weight loss, drugs, alcohol or foods high in purines and fructose. However, they can also occur without an obvious trigger.

Treatment for gout usually involves medication. Along with pain relievers and anti-inflammatory drugs, medicines used to treat gout include:

• Colchicine – a medication used both to control pain and prevent the acute phase of gout.
• Allopurinol (Lopurin, Zyloprim) – medications that stop the body from producing uric acid.
• Febuxostat (Uloric) – a newer medicine that reduces uric acid production.

“When uric acid levels drop below 5 or 6 milligrams per deciliter (mg/dL), the uric crystals that cause the inflammation dissolve,” Dr. Lowe says. “At that point, pain resolves or becomes manageable.”

Healthy Living With Gout

Controlling gout attacks means working with your doctor to find the right treatment plan for you and adjusting that plan as needed over time. Take the medicines your doctor prescribes as directed and tell your doctor about all other medicines and vitamins you may take. Work with your doctor on healthy and safe gradual weight loss and to establish regular exercise.

“If your gout is significantly impacting your quality of life, tell your doctor,” Dr. Lowe says. “The truth about gout is that just like other chronic diseases, it needs to be as effectively controlled as possible.”