Gout

Gout is a form of arthritis characterized by a sudden flare of severe pain and swelling, especially of the big toe, and in joints such as the hips, wrists, ankles, elbows and knees. Learn what causes gout and how to prevent it.

What is gout?

Gout is a condition that occurs when uric acid in the blood rises above normal levels (a condition called hyperuricemia). Uric acid, a waste product normally produced by the body, is excreted by the kidneys. If too much uric acid is present and the kidneys can’t eliminate the excess, it accumulates in a joint, causing inflammation and pain.

Gout attacks (or flares) are caused by the formation of crystals in the joints. The likelihood of having an attack increases with the amount of uric acid in the blood: the more there is, the greater the risk. However, some people have abnormally high levels of uric acid in the blood yet never develop symptoms.

Gout symptoms

Gout attacks are unpredictable: they strike fast and without warning, commonly at night or in the early morning. You may only have them once in your life, or they can recur. The pain of an attack is sharp and intense. Even the weight of a bed sheet on the joint can be unbearable. The joint becomes swollen, warm and sensitive and its skin becomes red or purplish.

The joint most often affected by gout is in the foot at the base of the big toe, but gout can also strike joints in the fingers, wrists, ankles, elbows and knees. Attacks can affect more than one joint at a time.

If not properly treated, gout can lead to long-term complications. For example, excess  uric acid crystals can cause kidney stones or lead to kidney failure. Also, uric acid deposits known as tophi (singular: tophus) can form under the skin and cause visible lumps around the joints.

What causes gout?

Gout is more common in men than women, and the risk of an attack increases with age. Women are more prone to attacks after menopause. Before menopause, the protective effect of estrogen naturally lowers uric acid levels.

Other risk factors associated with hyperuricemia and crystal formation are as follows:

• Heredity.
• Some kidney problems.
• High blood pressure.
• Diabetes.
• High blood cholesterol or triglyceride levels.
• Excessive alcohol intake.
• Obesity.
• Some medications.
• Physical or emotional stress.
• A diet of foods high in purines, which are molecules transformed into uric acid by the body. Purines are found in many foods, which means that gout foods to avoid include anchovies, liver, lamb and veal sweetbreads, sardines, kidney, shrimp, scallops, herring, salmon, mackerel, venison, goose, peas, lentils, spinach and meat broth.

How to prevent gout

You can reduce the likelihood of rebound (or repeated) gout attacks and complications by following these recommendations:

• Limit alcohol intake (beer is thought to be more of a problem than wine).
• Limit intake of red meat and other high-purine foods (see above). 
• Lose weight or maintain a healthy weight.
• Follow the prescribed treatment for your hypertension, diabetes and high cholesterol.
• Replace acetylsalicylic acid (aspirin) with acetaminophen or an anti-inflammatory to relieve pain or fever.
• Drink between 8 and 10 glasses of water daily (unless contraindicated).

Some medications can contribute to hyperuricemia, so ask your pharmacist whether this is the case for any drugs you’re taking. If necessary, adjustments can be made with your doctor’s consent.

Factors such as the frequency of attacks and the appearance of complications will determine whether your gout needs chronic management. For example, if you have two or more gout attacks per year or have elevated blood uric acid levels, preventive medication could be recommended to bring your levels back to normal and prevent further flares.

Coffee and soft drinks
Coffee is believed to help reduce uric acid levels and could help limit the formation of crystals that bring on a gout attack. Soft drinks, on the other hand, increase uric acid levels in the blood, so it’s best to avoid them.

Treatment for gout attacks

Without treatment, gout attacks generally subside on their own within 3 to 14 days. However, medication can reduce the severity and duration of gout symptoms. Start taking the medication as early as possible once the attack starts in order to increase its effectiveness.

Medication

The most common gout medications are colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and cortisone. Colchicine brings quick relief, but its side effects (diarrhea, nausea) can limit its usage. NSAIDs are a good alternative choice because of their effectiveness and fewer side effects, but they can cause heartburn (which can be prevented by taking the medication with food). Cortisone is another treatment option if the attack affects only a few joints. This medication is injected into the joint by a health care professional.

If the intensity and frequency of your gout attacks don’t significantly affect your quality of life, you may want to consider symptomatic treatment, i.e., only as needed when flares occur. Discuss this option with your doctor.

Other gout remedies 

You can maximize your treatment by taking the following important steps:

• rest the affected joint
• apply cold compresses  to the affected area to reduce pain and swelling
• drink plenty of water
• avoid alcohol and reduce intake of high-purine foods

Don’t let a gout attack affect your quality of life. Talk to your pharmacist about how to control gout and prevent its complications.