What Is Gout?
There was a time when gout, a type of inflammatory arthritis, was known as the “disease of kings.” But today more than just royalty suffer from the painful condition: More than eight million adults in the U.S. have gout, and roughly a quarter of them are women.
“Gout is caused by excess uric acid in the body,” says rheumatologist Ronen Marmur, MD, PhD, a clinical assistant professor at Mount Sinai Icahn School of Medicine in New York City. When there's too much uric acid in the bloodstream, it can crystallize and collect in joints, causing swelling, redness, and tenderness.
Uric acid forms when the liver breaks down purines—substances that are found naturally in our bodies, and also in some foods. Eating purine-rich foods can trigger the agony of gout symptoms. (Check out a list of usual culprits here.)
Other risk factors for gout include obesity, untreated high blood pressure, and diabetes and metabolic syndrome. Genetics can play a role as well: If other people in your family have had gout, you're more likely to develop it too. And for women, the risk goes up with age, as uric acid level in the blood rise after menopause.
What is a gout attack?
For 80 percent of people with gout, the disease first shows up in the big toe, says Dr. Marmur. “The attack is acute, painful—but it typically goes away after two weeks," he says. Once the discomfort is gone, you may be tempted to move on with your life. See your doctor anyway, urges Dr. Marmur.
Many people don't seek treatment for their first gout attack. They pop NSAIDs for relief, and then ignore the issue. It's not until the second or third attack that they start to worry something is wrong, and make that first appointment, says Dr. Marmur. And that's a mistake.
“If not treated, gout attacks can become more frequent and severe, and the pain can spread to multiple joints, including ankles, knees, and elbows," he says. "Eventually, gout can become very crippling and deforming." After a delay, you may need more medication too.
“Gout is a preventable disease. There’s no reason to wait until it gets worse,” says Dr. Marmur.
RELATED: 9 Surprising Triggers of Gout Pain
How is gout diagnosed?
First your doctor will do a physical exam, and look at your medical history. If she suspects gout, she'll order a blood test to check your uric acid level. Typically 6 milligrams per deciliter (mg/dL) or higher indicates gout, says Dr. Marmur.
Your doc may also take a sample of joint fluid, to examine it for uric acid crystals; or do a test that evaluates kidney fluid (uric acid is excreted by the kidneys, in urine).
What treatments are available for gout?
The goal of therapy for a gout attack is two-fold: to relieve the pain, and reduce the inflammation. NSAIDs should alleviate the discomfort from acute attacks, and a cortisone shot (a coritcosteroid) can target inflammation.
Your physician may also evaluate whether you are a candidate for interleukin-1 inhibitors, a class of injectable medication that's prescribed off-label for gout. A Cochrane review of research published in 2014 found that an injection of an interleukin-1 inhibitor probably improved pain and swelling better than a steroid injection, but resulted in more side effects (including back pain, headaches, and high blood pressure). Interleukin-1 inhibitors also tend to be far more expensive than standard treatment.
If you're suffering repeated gout attacks, your doctor might suggest other drugs that can lower uric acid levels in the blood, such as allopurinol or febuxostat. To recommend the right medication for you, she'll consider other health conditions you may have, the potential side effects of the drugs, and their cost.
Are there non-drug treatments for gout?
Eating certain foods can help control the frequency of attacks. Take cherries, for example: One study with 633 participants found that eating the fruit over a two-day period was associated with a 35% lower risk of a gout attack, compared to not eating any cherries. The fruit is known to reduce levels or uric acid in the blood. Plus, cherries pack antioxidants called anthocyanins that may reduce inflammation.
Dr. Marmur recommends that his gout patients drink tart cherry juice daily. (You can skip cherry juice capsules, he adds, which are more expensive but not more effective.)
You’ll also want to tweak your eating pattern to avoid high-purine foods, like alcohol and many animal foods. To lean more about what to eat and what to skip, read this guide to a gout-friendly diet by Health contributing nutritionist, Cynthia Sass, MPH, RD.
Making dietary changes is never easy, but there is a bright upside to doing the work: “The goal of treatment is to decrease uric acid levels to 6 mg/dL or lower. You’ll have less frequent or severe attacks, and eventually you’ll recover from gout arthritis,” says Dr. Marmur.
It may take one to two years, and treatment (via diet or medication) is lifelong. But you can make painful gout attacks a thing of the past.
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