9 Important Facts to Know About Gout from a Rheumatologist
A famous American horticulturist, George H. Ellwanger, once said: "Gout is the foe that may be lying amid the sauces, the bottles, the sweets and the fleshpots." Gout is often referred to as a “disease of kings” because of the lavish diet of the rich, like King Henry VII, who suffered from it. But in 2023, the rate of gout has increased worldwide. Is eating unhealthily the cause of this disease?
What is gout?
Gout is a form of inflammatory arthritis; caused by too much uric acid (a waste product found in blood) buildup in your body. Gout is considered a disease, just like diabetes, high blood pressure, high cholesterol, obesity and kidney disease. It is the most common type of arthritis and can cause significant disability. Gout cases have steadily increased worldwide and are now adults' most common type of arthritis. Currently, gout affects more than 4% of adults in the United States.
What is uric acid?
Uric acid is a natural substance in your blood, and kidneys must filter it every day. If the levels get too high and if the kidneys cannot remove enough of it, uric acid can crystalize and settle into a joint and cause pain, swelling and redness in the joints.
How do people get gout?
Gout is caused because of high uric acid circulating in the blood. Uric acid is measured by a unit called milligrams per deciliter, and a normal range of uric acid is between 3.5 to 7.2 milligrams per deciliter. Uric acid is usually considered high when it’s over 7 milligrams per deciliter (mg/dL) for men and over 6 mg/dL for women. A good way to understand this is to compare your blood to a glass of water; if you add a teaspoon of salt, it dissolves, but if you add a tin of salt, it does not dissolve and settles down, which is what happens in gout. Your first attack is in the big toe.
How do I know that I have gout?
Gout causes sudden and severe pain attacks in the joints of the big toe. Ankles and knees can also be affected, and hands and elbows rarely get it. However, if untreated, these flares can be debilitating and intensely painful.
The flares can happen in one or more joints. They are triggered by certain foods, alcohol or by undergoing physical trauma or illness. Flares will last for a week; they can happen frequently or happen far and few. There are symptom-free periods in between, but the bursts will increase in frequency and severity with time.
This disease can advance, with severe arthritis causing daily symptoms causing joint damage and deformity. If the uric acid buildup continues, you will have a buildup of needle-shaped uric acid crystals called tophi forming hard lumps under the skin in and around the joints and organs. They are distributed on the elbows, hands, feet and outer edge of ears. The tophi can be painless or painful and can cause bone and soft tissue damage.
If you are experiencing pain and swelling in a joint that starts suddenly and is intense, visit your doctor immediately. The physician may withdraw fluid from the joint and send it to the lab to look for uric acid crystals in the joint fluids. By doing so, they can also eliminate common infections. In addition, they will do x-rays of the feet or hands, which may show bony damage, called erosions.
What factors increase the risk of gout?
The following may make it more likely for you to experience gout:
- Men – The risk of getting gout is three times higher for men. Women after menopause get gout more frequently than women before menopause.
- Obesity – The chances of developing gout for the first time are very high. Therefore, losing weight helps reduce uric acid levels and gout flares.
- Fluid pills – Fluid pills, or diuretics, will increase urination, which reduces the amount of fluid in your body. But the remaining fluid is more concentrated, which can increase the risk that you'll develop the crystals that cause gout.
- Low-dose aspirin – Aspirin in low doses can impair the excretion of uric acid from the kidneys.
- Blood pressure medications – Diuretics taken to lower high blood pressure increase uric acid levels, so the treatment and the disease are associated with gout.
- Metabolic syndrome – Includes high blood pressure, high blood sugar, abnormal cholesterol levels and excessive body fat around the waist. A study among young men found that the risk of gout in subjects with metabolic syndrome more than doubled than in subjects without metabolic syndrome.
- Chronic kidney disease – When you have kidney disease, your kidneys cannot filter out uric acid as well as they should.
- Psoriasis – Doctors have noticed for decades that there’s a connection between psoriasis and gout, according to the Arthritis Foundation. The common denominator is uric acid. In psoriasis, uric acid is thought to be a byproduct of rapid skin cell turnover and systemic inflammation.
- Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome – Kelley- Seegmiller syndrome is a disorder that occurs when there is a partial deficiency of the enzyme hypoxanthine guanine phosphoribosyl transferase. It is involved in the metabolism of purines (chemical compounds in food) and can lead to gout, among other conditions. Lesch-Nyhan syndrome is a condition that occurs almost exclusively in males. It is characterized by neurological and behavioral abnormalities and the overproduction of uric acid
Why should I get treated if I have gout?
Treatment is necessary to reduce flares, circulating uric acid and joint pain, which can all improve the quality of life and overall activity. Also, high circulating uric acid can deposit in the kidneys and cause cardiovascular disease. You can apply ice to the joint as soon as a flare starts; it reduces the pain and swelling. Your doctor will treat the severe flare using prescribed medications like colchicine to prevent gout attacks.
What should I know about limiting purine intake if I have gout?
Purines are chemical compounds in food known to cause gout. A low purine diet is recommended but does not necessarily lower uric acid concentration. A high purine intake can increase the risk of gout flares. Purine-rich foods include:
- Red meat
- Organ meat
These types of food should be consumed in minimal amounts. Avoid gravies and soups. Reduce saturated fats in red meat, fatty poultry and high-fat dairy products. Limit sugar-sweetened foods, such as sweetened cereals and candies, and limit naturally sweet fruit juices.
What can I eat if I have gout?
Consider switching to the DASH diet if you have gout and high blood pressure; this will reduce uric acid and gout flares. Eat purine-rich vegetables like:
- Low-fat dairy foods
- Lean meat and poultry
- Whole grains
- Moderate portions of fish
Can I drink alcohol or coffee if I have gout?
Beer and distilled liquors increase the risk of gout flares. Therefore, moderate wine consumption is allowed. If you limit or abstain from alcohol, your uric acid will be lower.
If you consume one or two alcoholic beverage servings in 24 hours, you run a 40% higher risk of getting a flare than when you do not drink alcohol, even if you take your treatment correctly. Heavy drinking can cause gout flares, and it is best to avoid alcohol during gout attacks and limit alcohol, especially beer, between attacks. Just a unit of beer can increase uric acid.
Drinking coffee in moderation, especially regular caffeinated coffee, may be associated with a reduced risk of gout as well.
Is there a cure for gout?
Gout has no cure, but you can treat and manage the condition with medication and self-management strategies. With simple changes made throughout your daily activities, you can improve the quality of life of gout.
Learn more about Chandana Keshavamurthy, MD, and rheumatology at Ochsner Health.