What is Gout?

[Linda Johnson, GlobalRPh Medical Writer]
Gout, a form of arthritis, is a disease that has plagued man for hundreds of years and continues to do so today. It is caused by too much uric acid in the blood. Uric acid is a natural waste product that occurs when your body breaks down certain types of foods such as organ meats, which contain a class of chemicals called purines. Due to a deficiency of the digestive enzyme uricase, people who have gout are unable to break down and excrete uric acid, allowing levels of it to build up in the blood, a condition called hyperuricemia. Thus, uric acid crystals accumulate in the body’s connective tissue in and around joints, causing pain and swelling. Uric acid crystals can also collect in the kidneys and lead to kidney stones and eventually kidney failure.

Who Suffers from Gout?

Approximately two million people suffer with gout, with between 75-90% being middle-aged men. Women usually get gout only after menopause, possibly due to the drop in estrogen women experience after menopause.

What Causes Gout?

There are numerous risk factors that are associated with gout, such as:

Alcohol consumption: drinking too many alcoholic drinks can lead to hyperuricemia because alcohol interferes with the removal of uric acid from the body.
Diet: Eating too many foods rich is purines can cause gout in some people.
Gender & Age: Men are more susceptible to gout than women. Children rarely get gout.
Genetics: Twenty percent of people with gout have a family history.
Health Problems: other health problems can lead to gout, such as high blood pressure, hypothyroidism, psoriasis, hemolytic anemia, or even some cancers.
Kelley-Seegmiller Syndrome or Lesch-Nyhan Syndrome: two rare conditions in which the enzyme that helps control uric acid levels either is not present or is found in insufficient quantities in the body.
Lead Exposure: sometimes lead exposure can cause gout.
Medications: Many medications may increase the chance of a person developing gout:
- Cyclosporine: a medication that suppresses the body’s immune system, used to treat some autoimmune diseases and to prevent the body’s rejection of transplanted organs.
- Diuretics: drugs such as furosemide, hydrochlorothiazide, and metolazone, which are taken to eliminate excess fluid from the body.
- Levodopa: a medication that is used to treat Parkinson’s disease.
- Niacin
- Salicylate containing drugs: aspirin
Renal Insufficiency: the inability of the kidneys to eliminate waste products.
Weight: Obesity increases the risk of developing gout because there is more tissue available for breakdown, which leads to excess uric acid production.

What are the Stages of Gout?

An attack of gout usually comes on suddenly and can last for days. Surprisingly a frequent area of a gout attack is in the big toe, commonly known as podagra or “gouty big toe.” Approximately 75% of first attacks are in the big toe. Other joints, such as the ankle, heel, instep, knee, wrist, elbow, fingers, and spine can also be affected.

There are four stages that the disease gout can pass through:

Asymptomatic hyperuricemia: The first stage where the patient has elevated levels of uric acid in the blood, but no other symptoms.
Acute gout: In the second stage of gout hyperuricemia has caused the deposit of uric acid crystals in the joints, causing intense pain and swelling in the affected joints. Attacks usually last between 3 to 10 days even without treatment. Initially acute attacks may not occur very often, sometimes not reoccurring for months or years. However, over time the attacks can last longer and occur more frequently.
Interval or intercritical gout: This is the stage that occurs between acute attacks. No symptoms are present at this time.
Chronic tophaceous gout: The fourth stage of gout is the most debilitating. It develops over many years and may have caused permanent damage to the affected joints and possibly the kidneys.

What Medications are Used to Treat Gout?

If untreated, gout can lead to high blood pressure, deformed joints, and even death from kidney failure. Fortunately gout can be easily controlled with medicine. Typically gout is treated with one or a combination of drug therapies. The main goals of treatment are to ease pain, prevent future attacks, and to avoid the formation of kidney stones.

Acute gout attacks are commonly treated with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, which reduce the inflammation caused by the uric acid crystals, and thus reduces pain. Another type of anti-inflammatory drug which may be prescribed is colchicine. This drug is most effective when taken within the first twelve hours of an attack.

Allopurinol reduces the amount of uric acid which is produced in the body.

Drugs such as allopurinol, probenecid, or sulifinpyrazone may be prescribed to treat hyperuricemia and to reduce the frequency of sudden attacks.

Drug	Brand Name	Use
Indomethacin (NSAID)	Indocin	Reduces inflammation
Naproxen (NSAID)	Anaprox, Naprosyn	Reduces inflammation
Corticosteroids	e.g. Prednisone	Reduces inflammation
Colchicine	Colchicine	Reduces inflammation
Allopurinol	Zyloprim	Reduces uric acid production
Probenecid	Benemid	Helps rid the body of excess uric acid
Sulfinpyrazone	Anturane	Helps rid the body of excess uric acid

Can a Proper Diet Help?

In addition to taking the proper medicines, following a special diet is important to try to keep gout symptoms under control.

If you experience gout symptoms it is best to limit your intake of foods high in purine (see table below). Alcohol, especially beer, should be avoided. In fact, limiting total alcohol consumption to 1-3 drinks per week is advised. However, do drink plenty of water as adequate fluid intake helps to dilute urinary uric acid.

Consume a moderate amount of protein, limiting meat, fish and poultry to 4-6 oz. per day. The best types of protein to consume are low purine proteins such as low fat dairy products, tofu, and eggs.

As obesity can result in increased uric acid production by the body, maintaining a healthy body weight is also important for gout sufferers. If you are over-weight do not follow a high-protein & low-carb diet as this type of diet can worsen gout conditions.

High Purine Foods to Avoid	Use in Moderation
Anchovies	Asparagus
Bacon	Beans
Brains	Beef
Beef Kidneys	Cauliflower
Game meats, goose	Dried peas
Haddock	Fish
Herring	Green peas
Liver	Lentils
Mackerel	Mushrooms
Mussels	Oatmeal
Sardines	Pork
Scallops	Poultry
Sweetbreads	Seafood
Tripe	Spinach
Trout, Tuna	Wheat bran
Yeast & yeast extracts	Wheat germ

Conclusion

Gout is a serious and painful disease which can potentially be debilitating and life threatening if untreated. Fortunately today, using modern medicine and diet, most people who suffer from gout do not develop to the fourth and most disabling stage of the disease. Almost all of the approximately two million people who are afflicted with gout are able to control their symptoms and live productive lives.