Not Your Granddad’s Disease: Here’s What to Know About Gout

Gout. Unless you’ve suffered it firsthand, you could dismiss it as something your grandfather might have had. Despite its fuddy-duddy name, gout – a type of arthritis that occurs when extra uric acid in the body forms crystals in the joints – affects more than 8 million people in the United States. Sufferers have likened the pain of a gout “flare” to glass chards or needles pressing in and out of the affected joint, often at the base of the big toe (though other joints can be involved). The immune system’s attack on the crystals in the joint causes redness, swelling and extreme pain, often while the victim sleeps, and can last several days.  

You may have heard gout referred to as the “disease of kings,” stemming from its long association with a diet heavy in red meats, shellfish and alcohol: all foods high in purines, which prompt the body to make uric acid to break the substance down. Purines, it should be noted, also occur naturally in our bodies. But gout cases are rising in current times, as the population ages, gains weight and consumes more of what is linked to the disease. Yet studies show us that several genes may also play a role in the development of gout, including those that regulate the body’s processing of uric acid. This might explain why some people can have hyperuricemia, or too much uric acid in their body, but never suffer the symptoms of gout.  

Given that gout is here to stay, despite its antiquated image, I talked with Virginia Mason rheumatologist Erin Bauer, MD, about how to reduce flares for those who have gout, and the red-flag signs that it may be causing more serious health problems.

According to Dr. Bauer, the first line of defense against dreaded flares includes:

  • Diet mindfulness. Though diet does not play as big of a role as once thought, there are some foods that increase the risk for flares due to high levels of purines – the compounds in animals and plants that our bodies convert to uric acid. These foods include potatoes, poultry, red meats, seafood and drinking alcohol (especially beer) or beverages containing high-fructose corn syrup.

  • Targeting helpful foods. There are some foods that may slightly lower uric acid levels in the body, including eggs, peanuts, non-fat milk, whole grain breads, cheese and non-citrus fruits.

  • Drinking more water. Keeping adequately hydrated is extremely important, as any decrease in your kidney function will prevent your body from getting rid of uric acid and could lead to the formation of crystals. Studies have shown that increasing water consumption is associated with significantly fewer gout flares.  

  • Dropping those extra pounds. Losing weight will prevent flares over time, though losing weight too quickly or on a diet that is too high in protein may actually cause more flares.

  • Medication consistency. If a uric acid reducing drug is prescribed, such as allopurinol or febuxostat, it’s very important to stay on it regularly. Stopping and starting these medications often causes flares. To prevent this for people starting the medication, another medication is often added for a short time to protect patients as much as possible.
Which gout symptoms say it’s time to see the doctor?
  • Count your flares. Dr. Bauer points to the most recent guidelines, which indicate that having two or more flares of gout in a year could be damaging your joints. Work with your doctor to determine what lifestyle changes or treatments might be appropriate for your repeat flares.

  • Lumps could mean trouble. Deposits of urate crystals (called tophi) can make visible lumps under your skin and tend to appear in the hands, feet, elbows, or the outer edges of the ear. Large ones are easy to spot, but smaller ones may only show up with imaging. Tophi can be painful if they are infected or pressing on a nerve. However, another threat of tophi is they can damage joints and lead to bone erosion.

  • Arthritis seen on X-ray. The longer you have gout, the higher the chances are for joint damage, or arthritis. X-ray evidence of arthritis in the joints affected by gout warrants further evaluation.

  • Beware of stones. The same urate crystals that cause painful gout symptoms can also invade the kidneys, interfering with kidney function and causing severe pain. Uric acid-lowering medications are often recommended for gout sufferers who also have kidney disease.

  • Check your medication. If you’re already on medication to reduce flares but are still having them, talk with your doctor about increasing your dose. Also, taking diuretics tends to increase uric acid levels. Lowering the dose of diuretics or switching to a different medication may be something to try.

Dr. Bauer says gout can be initially managed by a primary care provider, while more complex cases can benefit from evaluation by a rheumatologist. The good news is if diagnosed early, most people with gout can live normal, productive lives. Even if gout has advanced, lowering uric acid levels, with medications and lifestyle choices, can improve joint function and reduce the frequency and severity of flares.


Erin Bauer, MDErin Bauer, MD, is board-certified in internal medicine and rheumatology, specializing in general rheumatology, inflammatory myopathies, inflammatory arthritis and lupus. Dr. Bauer practices at Virginia Mason Seattle and Virginia Mason Federal Way locations. 

 

 

How to Avoid a Gout Flare Up

Steer clear of corned beef and beer on St. Patrick's Day and avoid a gout flare up.

Steer clear of corned beef and beer on St. Patrick’s Day to avoid a gout flare up.

Even though it was 15 years ago, I still remember the pain. I stepped out of my mom’s car and collapsed on the ground in agony. The pain was so intense I thought I had stepped on a scorpion and actually looked around for the poor creature. (This was in Hawaii, where people often wear sandals and where those critters can roam the pavement.)

I wasn’t stung, yet my left big toe grew flaming red and hot, to the point where a slight breeze brushing against it could cause me agony. I made an appointment with my doctor, and he suspected I had gout, a form of arthritis that is caused by a buildup of uric acid in the body. It usually zeros in on a joint of the big toe. Gout is a disease that affects more than 3 million Americans each year.

Now I was a slim, pretty healthy young guy, so I thought this couldn’t be happening to me. I discovered that gout can sometimes affect healthy younger men or women, although it is rare in children. It can be prevented or treated by following a diet low in purine (which breaks down into uric acid) and an overall healthy lifestyle.

I spoke with VM rheumatologist Stanford Peng, MD, PhD, who provides some tips below to prevent gout and treat a flare up if you’ve been diagnosed.

Can I enjoy corned beef and beer this St. Patrick’s Day?

Dr. Peng: Stick to something else if you’re at risk for gout or have been diagnosed. Beef and beer are some of the foods that have the highest purine content and can be very bad for gout. Beef and other red meats are especially high in purine [a byproduct of protein], and beer contains more purines than spirits and wines.

What other foods can cause gout flare ups?

Dr. Peng: Avoid shellfish, as it contains very high purine content – there’s a reason gout is referred to as “the rich man’s disease.” Some veggies are moderately high in purine. This list includes some green vegetables, such as spinach and asparagus, beans, broccoli and artichokes. However, clinical research suggests they are not major factors in causing gout and that the benefits of eating vegetables outweigh the risks.

How do you treat gout?

Dr. Peng: Some medications are highly effective in lowering the amount of uric acid in your body, and your doctor can help determine if that is an appropriate option for you. Also, anti-inflammatory medications, like ibuprofen, can reduce pain. If you have concerns, you can also lower your uric acid levels by changing your diet. Research suggests adding dairy to your diet may reduce gout.

Any other advice for preventing gout?

Dr. Peng: In addition to diet changes, maintain a healthy body weight. If you need to lose weight, lose it gradually. There’s evidence that losing weight too quickly can actually cause a gout attack and increase the level of uric acid in your system in the short term. As an added benefit, you’re more likely to stay on a weight loss routine if you lose weight at a moderate pace. Research suggests that gout is a cardiovascular risk factor, so losing weight has many added benefits in maintaining a healthy lifestyle.

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Dane Fukumoto is the patient communications manager at Virginia Mason Medical Center.