Gout is one of the most painful forms of arthritis. It typically attacks the base of the big toe. Gout has been called "the rich man's disease" because of its association to a diet rich in red meat and alcohol, and because it affects men nine times more often than women.
Gout is a form of arthritis caused by elevated levels of uric acid in the blood (hyperuricemia). The excess uric acid forms painful crystals (tophi) in joints, tendons and surrounding tissues, causing recurring attacks of red, tender, hot, swollen and extremely painful joints, usually the joint at the base of the big toe. Other joints such as the ankles, heels, knees, fingers and wrists can also be affected, and crystals occasionally appear in the kidneys. Fatigue and fever sometimes accompany gout attacks.
Gout is caused by a combination of genetic and lifestyle factors. Dietary factors account for about 12% of gout, especially drinking alcohol and fructose-laden drinks and eating red meat and seafood. Gout is also associated with obesity, weight gain, high blood pressure, diabetes, lead poisoning, abnormal kidney function, joint trauma and surgery. Certain medications can also contribute to gout.
Until recently, it was believed that purine rich foods like asparagus, cauliflower, mushrooms, yeast, organ meats and legumes made gout worse, but recent studies found that's not the case. Some foods are known to help alleviate gout, including berries, bananas, pineapple, leafy green vegetables, low fat dairy products, complex carbohydrates, foods high in vitamin C, chocolate, coffee and tea. One encouraging study discovered that people with gout cut their repeated attacks almost in half just by eating 20 cherries a day. Good quality cherry extract, found in health food stores, was also an effective gout medicine. The finding reinforces years of anecdotal reports from patients who attested to the beneficial effects of cherry juice for gout.
Doctors take a three-pronged approach to treating gout, prescribing different gout medications to 1) manage pain, 2) decrease joint inflammation, and 3) reduce uric acid to avoid future flare ups. Analgesics such as acetaminophen are used to manage the pain, while the NSAID Indocin (indomethacin) is the most commonly prescribed anti inflammatory medication. Colchicine has been the standard of treatment for the acute stage of gout since the 1800s. Colchicine for gout is taken orally to both reduce inflammation and to prevent future gouty arthritis attacks. Corticosteroids such as prednisone are powerful anti inflammatory drugs that may also be administered for acute gout.
Under excretion of uric acid by the kidneys accounts for about 90% of hyperuricemia, while overproduction of uric acid accounts for fewer than 10% of cases. Medications to lower uric acid such as Zyloprim (allopurinol) or Uloric (generic febuxostat) are prescribed after the flare up has passed to help prevent further attacks. Since it received FDA approval for the chronic management of hyperuricemia in 2009, febuxostat has been prescribed increasingly over allopurinol. Febuxostat has been shown to be more effective in shrinking uric acid deposits, and not as likely to impact on kidney function.
Thanks to the effectiveness of today's gout medications, gout treatment is considered a modern medical success story – good news for America's 5 million sufferers.
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