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Take a stand against gout: How to detect and manage the disease

Take a stand against gout: How to detect and manage the disease

Gout is an extremely painful form of inflammatory arthritis caused by an accumulation of uric acid crystals in joints and other tissues. Untreated, it can lead to permanent joint and tissue damage. More than 8.3 million Americans are living with gout – a number that has increased sevenfold over the past five decades. Despite the growing incidence of gout, research from the Gout & Uric Acid Education Society has shown that just 10 percent of gout sufferers are getting needed, ongoing treatment.

While gout cannot be cured, it can be treated and better managed – even to a point where symptoms are completely controlled. For the best possible outcome, people suffering from gout are encouraged to seek treatment immediately – right at their first attack. If you have gout, your doctor may recommend a treatment plan that combines the right medication with diet and lifestyle changes. Because gout is associated with other serious health issues – including kidney disease, heart disease and diabetes – an accurate diagnosis and ongoing management is critical.
 


Do

Do understand the classic signs and symptoms of gout

Gout is characterized by sudden and severe episodes of pain, warmth, redness and swelling in one or more joints. Gout often begins in the big toe, but can affect other areas including the feet, ankle, wrists, hands and elbows. A typical gout attack comes on quickly and lasts for several days before symptoms subside. The pain experienced during a gout attack is so excruciating that many sufferers go to the emergency room for relief. On a pain scale of one to 10, most gout patients rank their pain as a nine or a 10. Even something as light as a bed sheet grazing against the affected area is enough to cause unbearable pain.

Do seek medical attention immediately

Gout is easier to control and manage when it is diagnosed early. Symptoms of a gout attack subside after a few days, but after the first attack, most people will unfortunately experience another painful flare within a year. Subsequent attacks are typically more painful and last longer in duration. Gout is a lifelong condition and, left untreated, it can lead to irreversible joint and tissue damage. Over time, this can lead to deformities – particularly of the hands and feet – and lead to loss of normal use.

Because of this, those suffering from gout should seek medical attention immediately – right at their first attack – and work with their doctor to develop a treatment plan that combines taking the right medications with dietary and lifestyle changes. Once someone is diagnosed with gout, they must adhere to a treatment plan for life.

Do take medications as directed

Gout attacks are extremely painful, prompting many sufferers to seek treatment for their symptoms. However, because subsequent attacks of gout often don’t strike for months, or even years, many people with gout stop treatment after their symptoms subside. Because untreated gout can lead to serious and permanent damage – and because gout has also been connected with other serious health issues, including kidney disease, heart disease and diabetes – it is important for people with gout to take their medications as directed to avoid future attacks and complications.

People with gout may be put on several medications for gout. Some will help ease pain, while others will help to lower uric acid levels for long-term relief. Some of these medications may trigger flares early on, but it’s important to keep taking medications as directed for the best long-term outcome.

Do make changes to your diet and lifestyle

One of the myths about gout is that those suffering from the disease must follow a strict gout diet. This is not the case – but living with gout does mean making smarter choices. If you have been diagnosed with gout, your doctor may recommend that you limit foods and beverages that are high in purines – including red meat, seafood (especially shellfish like shrimp and lobster) and alcohol (especially beer). Foods that contain high-fructose corn syrup should also be limited. Taking steps such as exercising regularly and staying hydrated are also important to help reduce painful attacks of gout.

Do check your uric acid levels regularly

It’s normal for everyone to have at least some uric acid in their bodies, but too much of it can put people at risk for gout. To avoid gout and other problems, uric acid levels should be 6.0 mg/dL or below. A person with a level above 6.8 mg/dL is considered to have a condition called hyperuricemia – which significantly increases risk for gout.

Knowing your uric acid level is as important as knowing your cholesterol level, as it may indicate which medications you should be taking. People who have gout, or who are at risk for gout, should have their uric acid levels checked every six months.


Don't

Do not assume you are safe from gout

Gout is most common among men over the age of 45, but because there are other risk factors for developing gout, it can affect anyone at any time. Women are also at risk for gout, but usually do not experience their first attack until a decade or more after menopause. Other risk factors for developing gout include hyperuricemia, or high levels of uric acid in the bloodstream; a family history of gout; health issues including obesity, high blood pressure, heart disease, diabetes and kidney disease and previous joint injuries. Certain ethnicities are also more likely to get gout because they are at higher risk for other comorbid conditions.

Do not take aspirin for pain unless directed

High-dose aspirin can abruptly change uric acid levels and make gout symptoms worse. Those who are taking aspirin for other medical conditions, such as heart disease prevention, should consult with their doctor to determine if the benefits outweigh the risks.

Do not stop medications, even if they trigger attacks

Gout flares are common when medications to lower uric acid levels are first prescribed. While it is an unfortunate side effect, it actually is a sign that the medication is working and is helping to flush out excess uric acid from the body. Unfortunately, many people who experience a gout flare are inclined to stop treatment immediately, paving the road for future attacks and long-term damage to joints and tissue. If you experience a gout flare after beginning a medication, talk to your doctor immediately before stopping treatment. Your doctor can work with you to create a plan for managing your pain.

Do not change your diet without consulting your doctor

Extreme diets, including crash diets and high-protein fad diets, can trigger gout attacks. Before making any changes to your diet and lifestyle, consult with your doctor to determine a treatment plan that is right for you. While there is not a specific gout diet, people who do have gout should limit foods such as red meat, seafood, alcohol, sweet fruit juices and soft drinks – and avoid them completely when they are experiencing an attack.

Do not try to push through the pain

The sooner a person begins taking medication for a gout flare, the quicker the pain will resolve. Patients who do not seek treatment are more likely to experience future attacks of gout and are also at greater risk for long-term joint damage and developing other comorbid health conditions.


Summary
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While gout is a very serious and painful disease, people with gout can lead a normal life by seeking immediate medical attention and following the right treatment plan. Once a person is diagnosed with gout, medications can help to manage pain and lower uric acid levels that trigger painful gout flares. Lifestyle changes – including avoiding foods that are high in purines and high-fructose corn syrup, and exercising regularly – are also important steps to manage gout and control future attacks.

If you suspect that you have gout, early diagnosis and treatment makes a difference. Talk to a medical professional immediately.


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N. Lawrence Edwards, M.D.Chairman

N. Lawrence Edwards is a specialist in internal medicine and rheumatology, and serves as professor of medicine in the Division of Clinical Immunology at the University of Florida in Gainesville, Florida. He is also program director of the Medici...

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