Managing Painful Gout

Many people have heard gout described as the “disease of kings” or the “rich man’s disease.”

This is because gout was thought to afflict only those who led a gluttonous, lifestyle that included excessive drinking and meat consumption.

Today, healthcare providers know that gout is not entirely dependent on diet.  It is primarily the result of how the body handles uric acid, says Milton Bengoa, M.D., an internal medicine physician affiliated with Homestead Hospital.

Gout is a form of inflammatory arthritis triggered by a buildup of uric acid in the joints. It causes sudden, severe attacks of pain, redness and tenderness in the joints, most often in the joint at the base of the big toe. Gout also can affect other joints, including the ankles, knees, hands, wrists and elbows. Acute gout usually affects only one joint at a time, but it can become chronic and affect several joints. A gout attack can last from a few days to two weeks if untreated.

“Gout can be very painful and debilitating,” said Dr. Bengoa. “It’s not something to be taken lightly.”

More than 8 million Americans have this painful affliction, according to the Arthritis Foundation. Gout most commonly strikes men older than 30, but also occurs in women after menopause and affects people with kidney disease. Because of genetic factors, gout tends to run in some families. Other risk factors are obesity, diabetes, high blood pressure and high cholesterol and triglycerides.

The Arthritis Foundation also reports that in about 10 percent of people with gout, uric acid builds up in the blood because their body produces too much of it. In the other 90 percent of gout sufferers, the kidneys do not eliminate uric acid efficiently.

“Some people are more susceptible to gout,” said Dr. Bengoa. “Fortunately, it is possible to treat gout and reduce its painful attacks by avoiding food and medication triggers, and by taking medications that can help.”

If you suffer from gout, Dr. Bengoa recommends you work with your doctor to determine your gout triggers, which may include:

• Foods: Beef, organ meats, pork, anchovies, herring, scallops, sardines, mussels, trout, codfish, haddock; spinach, cauliflower, asparagus, mushrooms, peas, oatmeal, dried beans or lentils.
• Drinks: Alcohol or sugary drinks.
• Medications: Low-dose aspirin, diuretics (water pills) or immunosuppressants.

Your doctor may also recommend that you add low-fat dairy products to your diet and drink plenty of liquids, especially water, to help remove uric acid from your body.

“Healthy lifestyle changes, like good nutrition, exercise and weight loss, may make a difference in your gout – and your overall health,” said Dr. Bengoa.

In addition to positive lifestyle habits, your doctor may recommend medications to treat your gout. A gout treatment plan is often divided into two stages: short-term and long-term.

During a gout attack, the short-term treatment plan may include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids or colchicine to relieve pain and reduce inflammation. These medications should be taken until symptoms are gone, Dr. Bengoa says.

After the inflammation from a gout attack has subsided, your doctor may recommend long-term treatment to reduce the uric acid level in your blood and the frequency and severity of future attacks.  Most doctors do not start these medicines until several days to weeks after a gout attack is over. Long-term treatment depends on your uric acid levels and the likelihood of recurrent gout attacks.