Gout pain may be eased with changes

Dr. Susan Blatt
Posted 1/27/19

Do you have gout or does someone you know have gout? Or does it run in your family? There is more known about gout than there was when Benjamin Franklin had it. It can be controlled with medication …

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Gout pain may be eased with changes

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Do you have gout or does someone you know have gout? Or does it run in your family?

There is more known about gout than there was when Benjamin Franklin had it. It can be controlled with medication and eased with lifestyle intervention. About 4 percent of American adults have gout. It is most common in overweight men and it tends to run in families.

Uric acid is always present in the body, but if the level of uric acid in the blood becomes high, gout may be the result. High levels of uric acid form crystals called tophi or urate crystals. The crystals get into the joint spaces and cause pain, inflammation and redness. This causes a painful form of arthritis.

The most common site is the big toe, in the joint connecting the toe to the foot. However, it can cause pain in any joint, such as the ankle or knee or various other parts in the body.

The pain is severe, often making it impossible to walk. After a week or so, the pain goes away, even without treatment. It then has a tendency to recur.

Uric acid crystals may also form in the kidney and cause the pain of kidney stones or even can cause kidney failure. Also, crystals may form in the skin, instead of the joints. These are usually called tophi and are not as painful as crystals in the joints. They may occur in the fingers, wrists, elbows, or feet. 

Gout develops because uric acid levels in the blood go up. Some people have high uric acid levels without gout. There are many things that may cause a person with high uric acid levels to have an attack of gout, including being overweight, eating red meat, drinking wine, and taking certain medications. If you have high uric acid or gout, your doctor will advise you about diet. 

Gout is diagnosed by a history of sudden severe pain in specific joints and by elevated uric acid levels. Diagnosis needs to be clarified. If a person has a red, painful joint, it might be gout, but it might be an infection in the joint that needs to be treated with antibiotics. Also, there are other causes of arthritis, such as osteoarthritis, rheumatoid arthritis, etc. These are unrelated to gout or uric acid.  

Uric acid is a breakdown product of purine, which is present in many every-day foods we eat, such as red meat, drinks high in sugar, and alcohol. Avoiding these foods is an important step in preventing recurrences of gout. Drinking lots of water also helps prevent crystals from forming and helps prevent kidney attacks.

Treatment involves two approaches. Medications are used for pain. These are the same medications used for other body discomfort, such as ibuprofen and acetaminophen. When you have an attack, ice-packs are also helpful. Then other medications are used to lower the uric acid. Medication to lower uric acid may be short-term or it may be used for long periods of time for prevention.

Your doctor may refer you to a specialist, such as a rheumatologist, for treatment of gout. If you are having recurrent, severe attacks it is worth considering long-term treatment and also lifestyle changes. You should lose weight if you are overweight and cut down on alcohol, especially beer. Between attacks you could get regular exercise and should always avoid being sedentary for long periods of time. 

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