The Ultimate Guide to Gout

So...what is gout?

Gout is caused by hyperuricemia which is when there is too much uric acid in the body. Uric acids form when the body breaks down purines, which are chemicals in some of our food.

Too much uric acid causes crystals to form in the joints, fluids, and tissues. The accumulation of these crystals causes gout, though not everyone with hyperuricemia develops the condition.

Gout can move through several phases. Hyperuricemia is the first; some people with increased uric acid levels may not have symptoms. As the uric acid crystals accumulate, the person can experience gout flares, which are periods of intense pain and swelling. Between flares are intercritical or interval gout, symptom-free periods between attacks.

Late-stage gout can also cause tophi, which is when crystals build up in the skin or other areas of the body. Depending on their location, tophi can permanently damage the joints and internal organs.

Risk factors for gout include the following:

• Eating a diet rich in red meat and shellfish
• Drinking beverages with fruit sugars
• Drinking alcohol
• Being overweight
• Having certain medical conditions, like untreated high blood pressure, metabolic syndrome, and kidney diseases
• Taking certain medications, like low-dose aspirin and some antihypertensive
• Having a family history of gout

Pain in the affected joint is the most common gout symptom. The big toe is a common location for gout, especially for someone having their first flare.

Flares generally start at night; the pain can be bad enough to wake someone. The affected joint may also feel warm and be red and swollen. Some people can have frequent flares, while others may have years between attacks.

Gout typically comes on suddenly and usually starts at night. The pain is usually the most severe in the first four to 12 hours.

Joints may swell and become warm, red, and tender, and the range of motion of the affected joint may be affected. Once the intensity subsides, joint pain can linger for days or weeks, and subsequent attacks are likely to last longer and be more widespread.

The  are to reduce the pain of flares, prevent future flares, and manage conditions contributing to gout. Doctors may prescribe medication to manage gout flares by reducing pain, inflammation, and swelling, including anti-inflammatory medication and corticosteroids.

Anti-inflammatory medications can also help manage gout pain but are most effective when symptoms first appear. Another way to treat gout is to manage hyperuricemia, the underlying cause of gout. These medications can prevent the production of urate, flush urate out of the body, or break down urate into a form that is easier for the body to eliminate.

Surgery may be required to treat some cases of gout. If there is a bacterial infection in the joint, the doctor may recommend surgery to wash the bacteria out of the joint. Surgery may also be required to remove tophi.

Gout that leads to joint destruction may be treated with joint fusion, a surgery that fuses the joints together to limit movement and relieve chronic pain. When gout leads to severe arthritis, a doctor may recommend joint replacement.

If you are experiencing gout symptoms, it is important to work with a healthcare professional to get a proper diagnosis and personalized treatment. Many healthcare providers can help manage gout.

Most people go to their PCP for gout management, but you can also work with a rheumatologist, dietician, nurse educator, or pharmacist if you need additional support.

Untreated gout can have severe complications, so working with a healthcare professional to manage and monitor the condition is critical.

Without treatment, gout can reoccur several times a year and cause erosion and destruction in the affected joints. Urate crystals can also accumulate in the urinary tracts of people with gout, which can cause kidney stones.

If you have gout, maintaining normal uric acid levels is key to preventing not only gout attacks but also long-term complications. You can also use to reduce the pain and disability of gout attacks so that the condition has less of an impact on your quality of life.

Many self-management techniques can help manage gout and maintain joint health. Maintaining physical activity can help reduce the pain and deficits of gout and other forms of arthritis and can improve mood and mobility.

Aim for moderate physical activity for 150 minutes per week, doing 30 minutes every day of low-impact activities like walking, biking, or swimming to protect joint health. Losing weight can also help manage your risk of developing gout. Staying hydrated is also important for gout management.

Making to limit purine can help prevent gout attacks. Generally, people with gout should avoid alcohol (particularly beer), sweetened drinks, red meats, organ meats, and some kinds of seafood.

Following the Dietary Approaches to Stop Hypertension eating plan, or DASH diet, can also help prevent flare-ups. This diet involves eating vegetables, fruits, whole grains, lean meats, low-fat dairy products and oils and limiting foods with added sugar or those that are high in saturated fat.

Significant research has shown that many foods can contribute to increasing uric acid.

Avoiding the following foods can help prevent gout flares:

• Sugary drinks and snacks
• Foods with high fructose corn syrup
• Alcohol
• Organ meats, like liver, brains, and kidneys
• Game meats, like goose, duck, deer, and veal
• Some seafood, like cod, herring, muscles, tuna, and sardines
• Red meats, like beef, pork, and lamb
• Turkey
• Fatty poultry
• Gravy

Other foods are not as high in purine but should still be eaten in moderation, including:

• Meats and poultries not mentioned above
• Other seafood, like crab, lobster, and shrimp
• Lunch meats
• Peas, beans, and lentils
• Oatmeal
• Spinach
• Cauliflower
• Mushrooms
• Asparagus

Low-purine foods that you can safely eat if you have gout include:

• Nuts
• Peanut butter
• Low-fat and fat-free dairy, like milk, cheese, and yogurt
• Vegetables (except spinach, broccoli, asparagus, and mushrooms)
• Potatoes
• Bread
• Rice
• Pasta
• Fruit

Some foods may improve gout. Studies have found that [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125106/]some foods and drinks, including dairy products, cherries, and coffee, can lower uric acid levels. Vitamin C found in citrus fruits and other foods may also reduce uric acid.

Uric acid comes from the breakdown of purine in the foods we eat but it is also synthesized from the breakdown of damaging and dying cells.

While high uric acid levels crystalize and cause gout, uric acid may have other effects on the body. Research shows that it may function as an antioxidant and is involved in some immune and allergic responses. It may also have some protective qualities against multiple sclerosis.

Eating low-purine foods, avoiding high-purine foods, and taking any medication your doctor prescribes can help manage uric acid levels. Your doctor may order blood tests during a flare or to monitor your progress, but interpreting these results may not be straightforward.

While uric acid levels are generally higher in people with gout, they may be lower during an attack and may not accurately measure the condition. For example, one study showed that 14 percent of people have serum uric acid levels below 6 mg per dL during an acute attack, which is considered a normal lab result.

Gout and rheumatoid arthritis are considered rheumatic diseases. Rheumatic diseases affect the joints, muscles, tendons, and ligaments. Lupus and fibromyalgia also fall under this term.

While gout and rheumatoid arthritis may have similar symptoms, like pain and swelling, they are separate conditions. Gout is caused by uric acid crystals accumulating in the joints, whereas rheumatoid arthritis is caused by an autoimmune response that causes the body to attack the joints. Gout symptoms recede between flares, but symptoms of rheumatoid arthritis can be chronic and lead to deformed joints and loss of function.

Doctors diagnose gout based on symptoms, but they may use other tests to rule out other conditions or check for complications. These tests may include:

• Joint fluid tests involve a doctor using a needle to draw fluid from the affected joint and then examining it for uric acid crystals. If necessary, this fluid can also be analyzed for infection.
• Blood tests to check uric acid levels, though these test results can be misinterpreted
• X-rays to rule out other forms of inflammation or check for complications
• Ultrasound to detect uric acid or tophi

Gout can lead to chronic kidney disease and nephrolithiasis or kidney stones and people with gout often have one or both of these conditions. As gout progresses, uric acid crystals can begin accumulating in other body parts, including in the kidneys, which can inhibit kidney function, leading to kidney disease. This connection between gout and kidney disease is one of the reasons why managing gout is so essential for long-term health.

Gout is a painful condition that can lead to many complications. The more attacks you have, the more widespread and lengthy they can be. By integrating medical and lifestyle approaches to treatment, you can learn to manage gout and avoid these complications. Work with your healthcare provider to learn more about a low-purine diet and other techniques for managing gout in your daily life.