I Have Gout - Now What?

Any Doctor will tell you that in medicine, things come in threes.  As expected, I diagnosed three cases of gout this week.  If you have been told you have gout you may wonder "Now what?"

Gout can affect anyone and it usually occurs quite suddenly, often at night.  It is caused by uric acid crystals that deposit suddenly in a joint, most commonly the big toe, but any joint can be affected.  Patients describe deep throbbing pain that is very intense and sometimes even a sheet touching the joint can cause exquisite pain.  The pain is worse within the first 12 hours.

Uric acid is present in our blood and gout occurs when the urate levels are too high and deposit crystals in the joint.  Uric acid is made from purines that are broken down from certain foods such as steak, seafood and organ meats.  Alcohol and juices sweetened with fructose are also causes of excess purines.  Usually uric acid is excreted in the kidneys but if there is an excess in the blood or if the kidneys can't excrete fast enough, the crystals lodge in the joint and cause gout.  The joint becomes red, painful and swollen.

If you have a first gout attack, your doctor can get a blood uric acid level and usually make the diagnosis.  If there is confusion, a sample of the joint fluid will show gouty crystals under a microscope.  Pain is relieved with Nsaids and ice on the joint. 

To prevent a gout attack in the future consider these factors noted by the Mayo Clinic:

• Diet. Eating a diet rich in meat and seafood and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.

• Obesity. If you're overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.

• Medical conditions. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.

• Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.

• Family history of gout. If other members of your family have had gout, you're more likely to develop the disease.

• Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women's uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.

• Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing a gout attack.

Gout was once called the "Disease of Kings" or "Rich Man's Disease" as this old painting shows.  Only royalty could afford meat and alcohol.  

You can manage recurrent gout attacks with diet and if that doesn't work, prescription medications that block excess uric acid.