Gout

What is it?

Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. Gout is a form of inflammatory arthritis that causes sudden, severe pain, swelling and tenderness – most often in the large joint of the big toe. However, gout isn’t limited to the big toe; it can affect other joints including the feet, ankles, knees, hands, wrists, elbows and sometimes soft tissue and tendons. It usually affects only one joint at a time, but it can become chronic and, over time, affect several joints.

A gout attack can last anywhere from a few days to two weeks, if untreated. An estimated 6.1 million Americans have experienced at least one gout attack. The disease most commonly affects men and can manifest anywhere from age 30 onward. Women get gout too, although they are at a slightly lower risk, and it usually appears after menopause.

What are the effects?

For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee, before becoming chronic. In its chronic stage, gout can affect many joints, including those of the hands. Other problems related to gout can include the formation of tophi, or lumps of crystals under the skin, in the joints and in bone; kidney stones; and impaired kidney function.

How is it diagnosed?

A doctor who has experience with gout attacks may be able to recognize this type of inflammatory arthritis simply by evaluating signs and symptoms, such as:

  • how quickly the attack came on
  • the severity of the inflammation and pain
  • which joints are involved
  • the number of joints affected
  • your medical history, including medications you’re taking
  • your eating and drinking habits
  • the level of uric acid in your blood, as determined by a lab test

The only way for your doctor to make a definite diagnosis of gout is to examine synovial fluid – a lubricating liquid found inside your joints – under a microscope. The presence of uric acid crystals signifies gout. Blood tests can determine if your uric acid levels are elevated, but not everyone with a high level of uric acid develops gout.

What are the treatment options?

Although gout is chronic, it can be controlled – and you can get on with living your life. Once your doctor has confirmed a gout diagnosis, you’ll work together to come up with a treatment plan likely involving both medication and lifestyle changes.

The first objective will be to relieve the pain and inflammation of the current gout attack. Once the gout attack is under control, which can take a few hours or a couple of days, you and your doctor will focus on managing the disease long-term. Your efforts will center on preventing future attacks, avoiding the long-term damage to your joints and chronic pain associated with uncontrolled gout and preventing the formation of tophi, lumps of crystallized uric acid that can form in the affected joints or surrounding tissues.

Healthy Lifestyle Changes

The foods you eat aren't the cause of gout. But a high-purine diet can trigger gout attacks if you already have a high uric acid level. Maintaining a healthy weight and getting regular exercise is an important part of your overall health. So it makes sense to talk with your doctor about how improving your diet and getting more exercise can help make a difference for you.

Make sure you discuss your whole health picture with your doctor. If you notice that you have gout attacks after different foods and drinks, it's a good idea to avoid those choices. You should be aware that changing your diet alone isn't usually enough to reduce uric acid levels. In fact, even when people followed the strictest low-purine diet, they generally don't reduce their uric acid levels by much more than 1 mg/dL. Any reduction in uric acid level is positive, but you'll most likely need to do more to lower your level to the recommended target level of less than 6 mg/dL.

Healthy Tips

The role that diet plays in gout is often misunderstood, but here are some good tips that you can discuss with your doctor:

  • Drink plenty of liquids, like water. Fluids like water help remove uric acid from the body.
  • Add low-fat dairy products to your diet. Eating more of these dairy products is associated with a lower risk of gout.

High-Purine Foods

A high-purine diet is one of many things that can trigger gout attacks if you already have a high uric acid level. Limiting or avoiding these foods may help avoid triggering an attack:

 

Talk to your doctor about a comprehensive treatment plan that addresses healthy lifestyle changes, including diet and exercise, pain management for gout attacks, and the long-term treatment of high uric acid that causes gout.

Part of coming up with this plan is having an honest discussion with your doctor about what you are doing right now.

  • What is your daily diet like?
  • Are you taking herbal supplements or eating a lot of particular foods (such as cherries or drinking cherry juice) that you heard might help?
  • What kind of exercise are you doing and how frequently?
  • Are you taking your medication as prescribed?

Your doctor can tell you whether or not you are on the right track.