Living With Gout
"Gout? What is that? Isn't that something rich people get?" In earlier centuries, this painful disease of the joints had a reputation of occurring only among the upper classes. Classic 18th century lithographs frequently depicted cartoon imps poking little pitchforks into the shoes of portly dukes who were sitting at tables laden with fatty gourmet fare and wine. Experts debate whether gout truly targeted the wealthy back then—but they do know that today, this debilitating condition occurs in people of all backgrounds and incomes. At present, more than 8 million Americans are living with the disease.
Gout is a form of arthritis that causes sudden attacks of intense pain in the joints. It occurs when uric acid, a bodily waste, builds up in the bloodstream and forms needle-like crystals that are deposited in the joints. The resulting inflammation causes swelling, redness, heat, pain and stiffness.
Gout most commonly strikes the joints of the big toe first. Other affected sites may include the ankles, instep of the foot, heels, knees, fingers and elbows. Gout also can cause lumpy white deposits, called tophi, visible under the skin of joints or on the outside of the ear.
A gout attack usually lasts from three to 10 days, and after the first incidence patients may not have another attack for a long time. But over the years, periods of gout may occur more frequently, eventually causing serious damage and disfigurement of the joints.
Who Is at Risk of Developing Gout?
Gout occurs more often in men than women, most commonly first appearing between the ages of 40 and 50. Women who are past menopause also are at higher risk. Genes are part of the story: As many as 80 percent of people suffering from gout have a family history of the disease. Certain medical conditions raise the risk; these include high blood pressure, kidney disease, diabetes, underactive thyroid and psoriasis. Some medications increase the level of uric acid in the body; these include diuretics, aspirin, cyclosporine and levodopa. And just as the 18th century doctors believed, being overweight and drinking too much alcohol also raise the risk.
How Is Gout Diagnosed?
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, gout can be challenging to diagnose. To confirm the diagnosis, a doctor may take a sample of fluid from an inflamed joint to look for uric acid crystals, or may look directly for crystals around a joint. The doctor will want to rule out other conditions that cause similar symptoms, such as infection of the affected joint, or pseudogout, a similar condition that is caused by calcium phosphate deposits and requires a different treatment.
How Is Gout Treated?
Most people with gout are able to control their symptoms and avoid long-term damage to the affected joints. Treatment consists of medications, including corticosteroid injections, NSAID drugs taken orally and other types of drugs.
The doctor also may recommend pain-relief treatments during an attack, including ice, elevation of the affected area and rest.
In severe cases, surgery is sometimes recommended to repair the damage caused by gout.
Lifestyle changes also can decrease the frequency and severity of gout attacks. If you have experienced gout attacks, take these steps to lower the risk of future occurrences:
- Have your medications reviewed to see if you are taking drugs that are known to increase the occurrence of gout attacks.
- Drink plenty of water and other fluids, but avoid drinking alcohol.
- Begin an exercise plan and maintain a healthy weight; avoid low-carbohydrate quick-weight-loss diets, which actually increase the risk.
- Eat a healthy diet and avoid foods that can lead to the production of uric acid. These foods include anchovies, asparagus, beef kidneys, dried beans and peas, gravies, liver and sardines. Consult your doctor about a diet that is right for you.
Gout can be kept under control, and promising research is underway to develop improved treatments. It is important to seek medical attention at the first sign of gout symptoms. Without treatment, the disease may reach the point where permanent damage to the joints and even the kidneys occurs. But with proper medication and diet, most patients avoid progressing to this serious stage.
While gout really isn't "the disease of kings," patients whose gout is successfully under control have every right to feel royally fortunate!
The National Institute of Arthritis and Musculoskeletal and Skin Diseases offers more information about the treatment of gout and how to prevent recurrences.
The Mayo Clinic’s dietitians have more information on the gout diet.
The information in this article is not intended to replace the advice of your healthcare provider. Speak to your doctor about your symptoms, and before taking any medications.