Gout: Disease of the Kings

Hand surgeon John M. Erickson, MD answers your questions about the disease called Gout.

Gout is a common type of inflammatory arthritis typically presenting with a red, hot, swollen, extremely painful joint. Gout frequently affects joints in the big toe, ankle or knee but can happen elsewhere. Gout can also involve the fingers, wrist and elbow. A “gout attack” usually starts suddenly and the pain increases rapidly.  Because of the skin redness, warmth, and pain intensity, gout attacks can be difficult to distinguish from infection.

What is gout?

A gout attack is caused when uric acid normally circulating in the blood deposits in joints or soft tissues and forms crystals.  When the body reacts to the crystals it creates a painful inflammatory reaction. Uric acid is naturally produced in the body. It is a normal breakdown product of a chemical in many foods called purines. Our bodies remove uric acid through the urine. Gout occurs when there is either too much uric acid produced in the body or too little being removed by the kidneys. Gout attacks can cause joint damage over time. Bumps or nodules of uric acid can develop around the joints in long-term gout; these nodules are called tophi.

Doctors have known about gout for many centuries. Historically, gout was thought to be a disease of only the wealthy or royal class, and it was called the “disease of the kings.” Overindulgence in diets rich in meats, seafood, and alcohol has long been associated with gout, and the people who could afford such a lifestyle were the people typically affected. We now know that this is because animal proteins such as red meat, pork, oily fish, and shellfish are high in purines.  Additionally, alcohol reduces the metabolism of uric acid and can make problems with gout more significant.

What are the risk factors for gout?

Gout occurs more often in males than females. Other risk factors for gout are family history, purine-rich diets, alcoholism, kidney disease, obesity, diabetes, dehydration, use of chemotherapy drugs, and use of some diuretic medications (water pills). Food products with added fructose and sugary drinks can also increase the risk of gout. Occasionally, trauma and surgery can bring on a gout attack.

How is gout treated?

Treatment of acute gout attacks typically involves rest, splinting, and anti-inflammatory medications. Naproxen and ibuprofen are examples of common over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) used in the treatment of gout. Indomethacin and prednisone are stronger prescription anti-inflammatory medications. Colchicine is another commonly prescribed medicine for gout attacks. A corticosteroid injection into the joint (cortisone shot) can also be used to reduce the inflammation from gout. Gout attacks usually last for a few days, and prompt treatment can make the symptoms go away sooner.

How is gout prevented?

Attacks of gout can lead to joint damage over time, therefore prevention of gout attacks is important. Treatment of gout involves decreasing the uric acid level in the diet and/or increasing the excretion of uric acid in urine. There are several lifestyle changes which can reduce the risk of a gout attack, including:

  1. Stay hydrated and drink adequate amounts of water to flush the uric acid through the kidneys.
  2. Limit the intake of animal meats high in purines such as beef, pork, oily fish, and shellfish to reduce the production of uric acid. Organ meats such as liver, kidneys, and sweetbreads are especially high in purines.
  3. Limit the intake of alcohol.
  4. Limit the intake of processed foods such as refined flour, sugary drinks, and food products with added fructose. Instead, choose foods with complex carbohydrates such as whole grains, fresh fruits and vegetables. Choose dairy products such as low-fat milk and yogurt.

If diet and lifestyle changes are not enough to control the gout attacks, preventative medications may be needed. Most doctors recommend starting a medication to reduce uric acid in the blood if patients have more than two gout attacks in a year. These medications include allopurinol, probenacid, and febuxostat. Primary care physicians often prescribe these medications and monitor the uric acid level with blood tests. These medications are meant to treat an acute gout attack and  are designed to prevent gout attacks long-term. Please talk to your doctor if you have questions about gout.

Dr. John M. Erickson is a hand and upper extremity specialist at the Raleigh Hand Center. He trained in orthopedic surgery at the University of Michigan and completed a hand surgery fellowship at Vanderbilt University. He19 is an active member of the American Society for Surgery of the Hand (ASSH).

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