“Men’s Health: How to Fight When Gout Attacks?”

What Is Gout? Gout is a kind of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality in handling uric acid and crystallization of these compounds in joints can cause attacks of painful arthritis, kidney stones, and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure. Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history.

 

Symptoms of Gout: Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. The small joint at the base of the big toe is the most common site for an attack. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. In some people, the acute pain is so intense that even a bed sheet touching the toe causes severe pain. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most people with gout will experience repeated bouts over the years.

 

Who's Affected by Gout? The prevalence of gout in the U.S. has risen over the last twenty years and now affects 8.3 million (4%) Americans. Gout is more common in men than in women and more prevalent in African-American men than white men. The chances of having gout rises with age, with a peak age of 75. In women, gout attacks usually occur after menopause. Among the U.S. population, about 21% have elevated blood uric acid levels, a condition known as hyperuricemia. However, only a small portion of those with hyperuricemia will actually develop gout. If your parents have gout, then you have a 20% chance of developing it.

 

Risk Factors for Gout: Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.

 

What Gout Looks Like: The Big Toe - The joint at the base of the big toe is the most common site of an acute gout attack. These attacks can recur unless gout is treated. See your doctor even if the pain from gout is gone. Over time, they can harm joints, tendons, and other tissues.

 

What Gout Looks Like: The Fingers - People may experience gout with deposits of uric acid crystals in their finger joints. To ease the pain during a gout attack, rest the joint that hurts.

 

What Gout Looks Like: The Elbow - Gout can also attack joints such as the elbows and knees.

 

Diagnosing Gouty Arthritis: Gout is considered when a patient reports a history of repeated attacks of painful arthritis, especially at the base of the toes or in the ankles and knees. The most reliable test for gout is detecting uric acid crystals in the joint fluid obtained by joint aspiration. This common office procedure is performed with topical local anesthesia. Using sterile technique, fluid is withdrawn (aspirated) from the inflamed joint with a syringe and needle.

 

Diagnosing Gout: Joint Fluid Analysis - Once joint fluid is obtained, it is analyzed for uric acid crystals and infection. Your doctor may also do a blood test to measure the amount of uric acid in your blood.

 

How Are Gout Attacks Prevented? Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.

 

More Prevention Techniques: Dietary changes can help reduce uric acid levels in the blood. Since purine chemicals are converted by the body into uric acid, purine-rich foods should be avoided. Foods rich in purines include shellfish and organ meats, such as liver, brains, and kidneys. Researchers have reported that meat or seafood consumption increases the risk of gout attacks, while dairy consumption seemed to reduce this risk. Weight reduction can be helpful in lowering the risk of recurrent attacks of gout.

 

Treating Gout with Medications: Certain medications reduce the pain and inflammation of gout attacks, such as anti-inflammatory drugs (ibuprofen and others), colchicine, and corticosteroids. Other medications decrease the level of uric acid in the blood and prevent the deposit of uric acid in joints (gouty arthritis), the kidneys (stones), and in tissue (tophi), helping to prevent further attacks and complications. These drugs include allopurinol, febuxostat, and probenicid.

 

What Does the Future Hold for Gout? Active research is ongoing in a variety of fields related to gout and hyperuricemia. Scientists have found that high animal protein slightly increased the risk for gout. New drugs are being developed that may be more versatile and safe in treating the elevated uric acid levels in patients with chronic gout.

Reviewed by Melinda Ratini, DO, MS on April 15, 2014

REFERENCES:

MedicineNet.com
WebMD Medical Reference from Healthwise: "Gout - Topic Overview."

GOUT: FOODS THAT HURT, FOODS THAT HELP

 

Drink More Water: Changing your diet may help you manage chronic gout and help symptoms such as joint pain. Start by drinking more water, because dehydration might trigger gout attacks. One study showed that men who drank five to eight glasses of water in a 24-hour period had a 40% lower risk of gout attacks. But avoid sugary sodas, which may raise your risk.

 

Find a Diet That Works for You: Being overweight raises your risk of gout. So eat a balanced diet and lose excess weight -- it can help your symptoms. Talk with your doctor about making diet changes. You may find that you can eat some foods without having a gout attack. Other foods may cause your body to react or may make your gout worse, though.

 

Avoid Flare-Up Foods: Weight loss is the most effective way to manage gout, but you also may benefit from eating a low-purine diet. Purines are found naturally in many foods. Your body breaks them down into uric acid. Too much uric acid in your blood causes gout. Some foods, like organ meats, sardines, and anchovies, are high in purines and can cause flare-ups. The good news is that many healthy options, like beans, lentils, and asparagus, have fewer purines. Talk to your doctor about what you can safely eat.

 

Eat Plenty of Fruits: Fruits provide good, fiber-filled carbohydrates and other nutrients that can help you maintain a balanced diet and healthy weight. Plus, they tend to have very few purines. Fruits high in vitamin C, like tangerines and oranges, may help prevent gout attacks. Some research shows that cherries or cherry juice can offer relief from gout. Ask your doctor if you should add cherries to your diet.

 

Choose the Right Carbs: If you follow diets that are low-carb or high in protein or fat, you may get too many purines. Processed carbohydrates like white bread and white-flour pasta have very few purines -- but they can lead to weight gain. Instead, focus on healthy carbs with high fiber such as oats, sweet potatoes, beans, and vegetables.

 

Essential Fats: Eat more foods rich in essential fatty acids, including cold-water fish like tuna and salmon, flaxseed and other seeds, and nuts. Fatty acids may help lower inflammation. Use a fatty acid-rich oil, such as olive oil, for cooking and for dressing salads. And try to cut back on, or get rid of, any trans fats in your diet.

 

Limit Your Alcohol: Alcohol may raise your risk of a gout attack -- especially if you have more than one drink a day -- because it's high in purines. Beer appears to be worse than other alcoholic drinks because it contains yeast. Moderate wine drinking doesn't appear to raise your risk, though. (HOWEVER, AVOIDANCE IS ALWAYS BEST!)

 

Use Caffeine With Caution: Moderate coffee drinking is thought to be OK for people with gout. And in some people who drink coffee regularly, drinking four or more cups a day may even lower the risk of gout attacks. But caffeinated drinks may raise uric acid levels in some people who drink them just occasionally. Talk to your doctor about whether caffeine might be causing your gout attacks.

 

Eat Less Meat: Eat limited amounts of chicken, pork, or lean beef -- at most, one serving a day. Those types of meat have fewer purines than organ meats like liver and sweetbreads. Other meat products like gravies and meat-based broths are also high in purines.

 

Enjoy Low-fat Dairy: Dairy products were once off-limits to people with gout, because they're made from animal proteins. But they're actually low in purines -- and dairy purines don't seem to cause gout. Low-fat milk and low-fat dairy may even lower your risk of gout by more than 40%. During a gout attack, low-fat dairy products may help you get rid of extra uric acid through your urine.

 

You Can't Eliminate Purines: You don’t need to limit all purines. A few foods that are high in purines don't trigger gout. One study found that peas, beans, mushrooms, cauliflower, spinach, and chicken -- formerly considered foods to avoid -- may not be linked to gout attacks.

Reviewed by Michael W. Smith, MD on May 06, 2014

REFERENCES:
Rachel Beller, RD, Beller Nutritional Institute.

Family Doctor: "Low-Purine Diet."

Arthritis Today: "Drink More Water for Fewer Gout Attacks."

Arthritis Today: "Milk Is Part of a Smart Gout Diet."

Arthritis Today: "Foods' Purine Content."

University of Maryland Medical Center: "Gout."

American College of Rheumatology: "Gout."

National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Gout."

Arthritis Foundation: "Safe Foods for Gout."

Zhang, Y. American Journal of Medicine, September 2006.

Choi, H. New England Journal of Medicine, March 11, 2004.

Boston University Medical Campus: "Online Gout Study."

Arthritis Today: "Fight Gout with Your Gut."

Palo Alto Medical Foundation: "Gout: Preventing Gout Attacks."

Arthritis Today: "Soda Increases Risk of Gout."

Johns Hopkins Health Alerts: "Gout and Soda: What's the Connection?"

Arthritis Foundation: "Coffee May Lower Gout Risk."

News release, American College of Rheumatology.

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