Gout

Q & A

What is Gout? 

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Gout is a form of inflammatory arthritis caused by a buildup of uric acid crystals in the joints that can lead to sudden, intense pain—often called a gout flare—and swollen joints that may become red and/or hot. While statistics show that more than 50 percent of gout flares start in the big toe, called podagra, the uric acid crystals associated with gout are also commonly found in knees, hands, and feet, and can deposit in organs throughout the body, such as the kidney, causing kidney stones.

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Causes

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It’s normal for everyone to have at least some uric acid in their bodies. However, too much uric acid can build up and increase the risk of developing gout. Uric acid typically dissolves in the blood and then passes through the kidneys, where it is eventually removed through urine. Gout attacks occur typically when there is an imbalance with either overproduction of uric acid  or under-excretion of uric acid where your body cannot get rid of the excess, usually because of kidney disease.

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Approximately two-thirds of uric acid is produced by the body naturally; the rest comes from diet, often in the form of purines, which are substances in animal and plant foods that the body converts to uric acid. A family history of gout, as well as other health issues such as high blood pressure, diabetes, or kidney disease, can increase risk for developing gout. Certain medications can also trigger gout.

Symptoms

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Gout is often associated with the sudden onset of severe pain and swelling, in which the affected joints are very tender, even to the lightest touch. Putting any weight on the affected joint can be very difficult, and the pain may last for a few days.

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In some instances, uric acid crystals may continue to build up and form tophi, or lumps under the skin. While generally not painful, these lumps can interfere with normal joint function and may lead to bone erosion or damage to the cartilage.

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Diagnosis and Treatment

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Gout can be diagnosed through clinical examination, a blood test, or by analyzing joint fluid. The approach to treatment is individualized and may include decreasing the amount of uric acid in the blood as well as controlling the joint pain. Lowering uric acid levels in the blood can prevent or lessen painful attacks and reduce the risk of gout complications such as kidney stones and the development of tophi. 

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Anti-inflammatory drugs or corticosteroids may be prescribed to help with joint pain in the acute flare. Chronic gout treatment may include taking oral uric acid-lowering medicines. Lifestyle changes can also help to decrease symptoms. These include weight loss, decreasing alcohol consumption, and diet modification.

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Prevention

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It is important to get treatment early if you are experiencing symptoms of gout. If you are prescribed medications for gout, be sure to take these as directed and discuss any problems with your podiatrist. Your symptoms and pain may resolve, but continuing uric acid-lowering medication as prescribed can help prevent the long-term problems associated with gout.

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To avoid gout and other medical problems associated with gout, uric acid levels should be regulated. People with gout should have their uric acid levels tested as recommended by their health-care provider.

Foods to Avoid if you have a History of Gout

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You should stay away from these types of food:

• Beer and grain liquors (like vodka and whiskey)

• Red meat- limit serving sizes of beef,  lamb, and pork

• Organ meats, such as liver, kidneys, and glandular meats like the thymus or pancreas (you may hear them called sweetbreads)

• Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines

• High-fructose products like soda and some juices, cereal, ice cream, candy, and fast food

Best Foods for a Gout Diet 

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You’ll want to go for low-purine options like:

• Low-fat and nondairy fat products, such as yogurt and skim milk

• Fresh fruits and vegetables

• Nuts, peanut butter, and grains

• Fat and oil

• Potatoes, rice, bread, and pasta

• Eggs (in moderation)

• Meats like fish, chicken, and red meat are fine in moderation (around 4 to 6 ounces per day).

• Vegetables: You may see veggies like spinach and asparagus on the high-purine list, but studies show they don’t raise your risk of gout or gout attacks.

Content credit: apma.org