As a sub-type of arthritis, gout can occur when you have high uric acid levels in your blood. The presence of uric acid causes crystallization within the joints, which then causes sudden and severe pain episodes. Gout can also cause redness, swelling, tenderness, and warmth at the affected site. Approximately eight million people in the United States have gout. It is three times more prevalent in men than it is in women until the approximate age of 60. The presence of estrogen likely protects women from the disease until that point.
Understanding the Risk Factors of Gout
In addition to being male, several other risk factors increase your likelihood of developing gout.
These include:
- A previous diagnosis of diabetes, high blood pressures, or high cholesterol
- Having a close family member with the disease
- A diet high in shellfish and red meat
- Drinking more than two beverages containing alcohol every day
- Obesity, which can also lead to a diagnosis of gout at an earlier age
- Previous gastric bypass surgery for morbid obesity
- Frequent consumption of sweet sodas
- Dehydration
- Frequent dieting
Your body normally forms uric acid when it breaks down the purines located in cells and many types of food. The blood then delivers the uric acid to the kidneys where it remains until you eliminate it through urination. Gout can result from your body producing too much uric acid or your kidneys not being able to process a normal amount of it.
Besides the lifestyle factors listed above, gout can also result from the following medical factors:
- Chemotherapy
- Joint injury
- Surgery
- A sudden or severe illness
- Starting a treatment regimen to lower uric acid
- Having an infection
- Diuretic medication to control high blood pressure or drugs to suppress the immune system taken by people with psoriasis or rheumatoid arthritis
- Use of the drug cyclosporine
If you currently have any risk factors you can control, we encourage you to work with your doctor or a rheumatologist at United Hospital Center to reduce the likelihood of developing gout.
Most Common Symptoms Associated with Gout
It is common for the symptoms of gout to come on suddenly, especially as you are trying to sleep at night. You will likely feel intense pain in your joints. Although this pain is most common in the big toe, it can occur in any joint of the body. Other typical areas of joint pain include the ankles, elbows, fingers, knees, and wrists. The intense pain may remain for up to 12 hours or disappear in as little as four hours.
After the severe pain of a gout attack subsides, you can expect mild to moderate pain in your joints for a few days or even a few weeks. Unfortunately, subsequent attacks of gout pain often last longer and impact more joints than the first attack. During an attack and as the disease progresses, your joints will appear red and feel swollen, warm, and tender. This can affect your ability to move your joints in a normal range of motion.
Treating and Managing Gout
When it comes to living with gout, you need to know how to treat an attack as it happens as well as manage the condition through medication and lifestyle changes. We recommend that you take a non-steroidal anti-inflammatory medication as soon as you start to feel pain. Be sure to drink plenty of fluids to stay hydrated, but avoid soda and any other sweet drinks or alcohol.
Although it can seem impossible, do your best to relax since stress can aggravate the symptoms of gout. Keep in mind that the worst pain usually occurs within the first 24 to 36 hours. Do not be afraid to ask friends and family for help when you are in a lot of pain. Most will want to help but may feel unsure of what to do.
It is important to contact your doctor soon after you have experienced a gout attack for help in reducing your uric acid levels.
In addition to recommending non-steroidal anti-inflammatory drugs, he or she may prescribe one of the following:
Allopurino: This medication reduces uric acid production. You normally start at a low dose and increase the dosage over time.
Colchicine: This plant-based medication has helped people relieve the pain and swelling of gout for more than 2,000 years. It is most effective when you take it at the first sign of an attack.
Corticosteroids: You can take Prednisone, a common prescription-strength corticosteroid, by mouth as a pill or as an injection into the affected joint.
Febuxostat: Febuxostat is a good option if you can not tolerate Allopurino or if you have kidney disease.
Lesinurad: This oral drug eliminates uric acid from the body through urination.
Pegloticase: Your doctor may recommend Pegloticase when other medications fail to reduce uric acid. This means that you likely have a condition known as refractory chronic gout.
Probenecid: This drug travels to the kidneys to aid in the elimination of uric acid. Your doctor may recommend that you take it with antibiotics for maximum effectiveness.
As with all drugs, each of the above have minor and serious side effects associated with them. You should discuss these with your doctor to determine if the benefit of the proposed drug outweighs the risk.
The Importance of Diet and Exercise in Managing Gout
The lifestyle choices you make each day can have a dramatic effect on the severity and regularity of your symptoms. One place to start is by choosing to eat a low-purine diet. Although it is impossible to avoid purine entirely since it is in so many foods, try to stay away from foods known to have high purine content.
These include:
- Alcoholic beverages of all types
- Anchovies
- Bacon
- Codfish
- Haddock
- Herring
- Liver and other organ meats
- Mussels
- Sardines
- Scallops
- Trout
- Turkey
- Veal
- Venison
Except for alcohol, all of these are a type of meat, seafood, or fish. This is also true of foods with moderate levels of purine, including:
- Beef
- Chicken
- Crab
- Duck
- Ham
- Lobster
- Oyster
- Pork
- Shrimp
It is also essential to engage in regular exercise when you have gout, especially those that improve range of motion, increase strength, and build endurance. The good news is that range of motion exercises are easy to do. You just need to rotate your ankles, feet, head, neck, and wrists frequently throughout the day. This helps to reduce stiffness and keep your joints flexible.
To increase your strength, try doing some low-impact exercises such as Pilates, tai chi, or yoga. Do not forget to stretch and warm up before you start exercising. Resistance exercises using weights helps to maintain and increase muscle strength, which is important because it takes the pressure off your sore joints and helps to strengthen them.
Cardiovascular and endurance exercises, including bicycling, swimming, dancing, and walking all help to increase blood circulation, give you more energy, manage your weight, and keep your heart as healthy as possible. These are examples of low-impact exercises that put minimal pressure on your joints. Swimming is the best exercise you can do when you have gout because it does not put any stress on your joints as you move through the water.
It is important for your doctor to complete a physical exam before you start any exercise regimen to ensure that you are healthy enough for exercise and that you do not cause further inflammation to your joints. While strenuous exercise can increase uric acid in the blood, moderate or low-impact exercise can help to decrease it. Lastly, make sure you stay hydrated while exercising by drinking plenty of water.
If you think you could be suffering from gout but do not have a diagnosis yet, call 681-342-3490 to schedule an appointment with your doctor at United Hospital Center or request a referral to one of our rheumatologists.
Please note, the information provided throughout this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and video, on or available through this website is for general information purposes only. If you are experiencing related symptoms, please visit your doctor or call 9-1-1 in an emergency.