GOUT

What Is gout?

Nicknamed “the disease of kings” or “rich man’s disease,” gout tends to conjure up images of Henry VIII–bacchanalian-esque rulers who indulged in too much wine and rich meals that most people couldn’t afford. However, gout is a fairly common (and very painful) form of arthritis that has been on the rise for decades and may now affect more than three million Americans–men and women.

Gout definition

Also known as gouty arthritis, gout is caused by a buildup of uric acid in the bloodstream (hyperuricemia) triggering joint pain and inflammation. When too much uric acid accumulates in the body, it collects into needle-shaped crystal deposits that settle into the joints (often in the feet, particularly in the big toe), causing bursts of pain, redness, and swelling. Attacks tend to occur at night and subside after three to 10 days, even without medication. Flare-ups can also reoccur a few months or years later, and, left untreated, gout can cause permanent damage to the joints and the kidneys, which remove uric acid from the body.

Although gout can almost always be controlled with certain medications and by avoiding alcohol and foods that contain chemicals called purines, it may be hard for doctors to initially diagnose the disease, especially because other forms of arthritis cause similar symptoms.

Signs and symptoms of gout

When uric acid crystals settle into the joint, they trigger swelling and an intense bout of pain. About half of all people with gout will first experience these symptoms in their big toe, although any joint–including the ankles, knees, wrists, fingers, and elbows–can be affected. In some cases, the affected joint will be red and sore and radiate heat.

In the early stages of gout, these attacks tend to flare up at night and are painful enough to rouse you from your sleep. The symptoms usually subside after three to 10 days and can lie dormant after that for months or even years. Over time, however, the attacks can become more frequent and last for longer periods of time. And although gout is almost always treatable, it’s possible for gout to cause long-term damage–including severe attacks, chronic arthritis, and kidney stones–if you don’t seek medical care.

RELATED: 9 Surprising Triggers of Gout Pain

Because the symptoms of gout tend to mimic those of other forms of arthritis, doctors may have trouble finding a diagnosis right away. To test for gout, physicians use a needle to draw out joint fluid from the affected area, then they look for uric acid crystals under the microscope. (Complicating matters, however, is the fact that some people have normal or even lower levels of uric acid during a gout attack.) Doctors can also use CT scans and, for more chronic forms of gout, X-rays to check for signs of joint damage.

Experts also note that gout tends to be linked to high blood pressure, heart disease, kidney disease, and medications that increase the body’s level of uric acid.

Symptoms of gout:

• Intense pain in the affected joints (usually those of the foot, and specifically the big toe)
• Swelling
• Redness
• Warmth
• Joint stiffness

What causes gout?

Gout is caused by the buildup of uric acid, which is formed after the body breaks down substances called purines. Purines are part of human tissue, but they’re also found in foods like anchovies and venison.

After the body breaks down purines, the resulting uric acid travels into the bloodstream. Usually, it passes through the kidneys and is shuttled out of the body through urine. But when too much uric acid builds up–or the kidneys can’t metabolize it quickly enough–it collects into crystals and settles into the joints.

Although gout was once associated with medieval rulers–who were the only people wealthy enough to drink alcohol and eat meat regularly–anyone can develop gout. Eating high-purine foods (see below for a list) can increase your risk of the disease, but other culprits play a role too. For example, people who are overweight have more body tissue; more body tissue means more purines that need to be broken down, producing more uric acid in the process. If you have high blood pressureor an underactive thyroid gland, you may be more likely to have higher levels of uric acid. Or, if someone in your family developed gout in the past, your genetics may be partly to blame.

How is gout diagnosed?

Because the symptoms of gout–namely, inflammation and joint pain–are similar to those of other forms of arthritis, doctors might have trouble diagnosing the condition right away. Still, there are some signs: Unlike, for example, rheumatoid arthritis–in which multiple joints are affected–gout tends to target just one or two joints, and usually the big toe. (There is also a disease called pseudogout, which triggers symptoms that are similar to gout, but is caused by a buildup of calcium phosphate, not uric acid.)

Doctors can test for gout by ordering a uric acid test. The physician will insert a needle into the affected joint to extract joint fluid, then study the sample under a microscope to look for uric acid crystals. If uric acid crystals are present, the doctor can confirm the diagnosis. (That said, these test results can occasionally be misleading. Some people have lower or normal levels of uric acid in their joint fluid during a gout attack; likewise, people with higher levels of uric acid don’t always have gout.) The symptoms of gout are also similar to those of a joint infection, and your doctor may test the joint fluid sample for bacteria. 

For people with more advanced stages of gout, doctors may order a CT scan or an X-ray to check for joint damage.

Gout treatment

Corticosteroids like prednisone, which are hormones that target inflammation, can help ease the pain from a gout flare-up, as can non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and indomethacin. Although these medications can relieve short-term joint pain, they don’t reduce the levels of uric acid in the body.

In the early stages of an attack, doctors may prescribe an anti-gout medication called colchicine, which relieves swelling and other symptoms of gout. This type of medication not only helps ease an immediate attack, but can also prevent an attack before it starts. For severe attacks, doctors can prescribe a medication called anakinra; although it’s approved for people with rheumatoid arthritis, it is sometimes used off-label to ease the symptoms of gout.

If your gout flares up repeatedly, your doctor may want you to start taking a medication that can lower the levels of uric acid in the blood. These drugs include allopurinol (which blocks uric acid production), probenecid and lesinurad (which help the kidneys remove uric acid), and an injection called pegloticase (which breaks down the uric acid itself). You may also want to avoid alcohol and foods like anchovies and mackerel, which are high in purines.

RELATED: 8 Famous People With Gout

Gout medications

• NSAIDs: non-steroidal anti-inflammatory drugs help to ease pain and swelling
• Colchicine: an anti-gout attack medication that helps relieves swelling and other gout symptoms
• Corticosteroids: medications like prednisone, which help reduce inflammation in the body, much like the naturally occurring hormone called cortisol
• Anakinra: a rheumatoid arthritis medication that blocks a specific protein called interleukin, which causes joint damage
• Allopurinol: available in tablet-form and taken once or twice a day, this medication decreases the production of uric acid in the bloodstream
• Probenecid: used to treat chronic gout, this medication prevents painful attacks by helping the kidneys remove uric acid from the body
• Lesinurad: available in tablet-form and taken once daily, this medication helps the kidneys remove uric acid from the body
• Pegloticase: an injection that decreases the amount of uric acid in the body, thereby preventing gout attacks

Home remedies for gout

• Cherry products: A 2012 study found that people with gout were 35% less likely to have an attack if they also ate cherries or consumed cherry extract. The researchers suspect that the fruit can lower the levels of uric acid in the blood.
• Ice: Holding an ice pack or a cold compress over the painful joint might help ease gout pain.
• Water: Staying hydrated has been linked to fewer gout attacks, possibly because extra water helps flush out uric acid through urine.

Is gout curable?

Gout is treatable–meaning, that with the right medications or dietary adjustments, it’s possible to prevent future flare-ups from occurring and to decrease the severity of the ones that you do experience. But because there’s a risk for another attack–even years down the road–it’s hard to say whether gout is “cured.” Luckily, there are medications available that can treat both the short-term joint pain during a gout attack and lower the levels of uric acid in the body to help prevent future symptoms of gout. Adjusting your diet to avoid foods that are high in purines can also help reduce your risk of another gout attack.

Gout diet and foods to avoid

Because alcohol can thwart the kidneys’ ability to remove uric acid from the body, experts say to limit intake to one drink per 24 hours. In a 2014 study, having one to two drinks a day increased a person’s risk of a gout attack by 36%; having two to four drinks a day increased a person’s risk by 51%. Foods that are high in purines–a compound that, when broken down in the body, produces uric acid–can also trigger a gout attack. Some offenders include shellfish, red meats, and sugary drinks. According to a 2012 study, people with gout who ate the most purine-rich foods were almost five times as likely to have an attack than those who ate the lowest amount of purine-rich foods. The Boston University researchers also found that the impact from animal products were much larger than that of plant products. While doctors previously recommended avoiding plant-based foods that are rich in purines, some now believe they are safe to eat for people with gout.

Some doctors suspect that eating dairy might help prevent gout attacks. Older research found a link between eating more low-fat dairy productsand having lower uric acid levels, but experts don’t entirely understand why that might be.

Foods to avoid or limit if you have gout:

• Alcohol
• Anchovies
• Asparagus
• Dried beans
• Dried peas
• Fruit juice
• Game meats (i.e., quail, duck, deer, etc.)
• Gravy
• Herring
• Lobster
• Mackerel
• Mushrooms
• Sardines
• Scallops
• Shrimp
• Sugar-sweetened drinks
• Sweetbreads