Introduction to Gout - Part 1

By Anna Hazard

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Part 2 - Gout Prevention Diet

Introduction

Gout is a type of inflammatory arthritis as well as a metabolic disease that revolves around the production and elimination of uric acid within the blood. Those people whose bodies overproduce uric acid or whose kidneys process it inefficiently are at much higher risk for developing gout.
 
Uric acid is a byproduct formed when the body breaks down nitrogen-containing proteins known as purines which are found within human cells and in many foods. Uric acid is found dissolved within the blood and is normally processed through the kidneys and excreted through urine. The high levels of uric acid in the body (also known as hyperuricemia) can cause the formation of hard needle-like crystals in the joints and surrounding tissues.
 
Gout is more common in older adults as it takes years for uric acid to build up within the joints and is also more typically found in men and in post-menopausal women or those with naturally low estrogen, About 4% of American adults (6 million men and 2 million women) suffer from gout.

Signs & Symptoms

The symptoms of gout include burning pain, swelling, redness, heat, stiffness, tenderness, or oversensitivity in the joint up to the point that any sort of touch, including the weight of a bed cover, could cause pain. Gout attacks can last from days to weeks, with the most common length being 1 - 1.5 weeks long, and can be sporadic, not re-occurring again for months or even years. Despite the lack of symptoms in the interval between bouts of gout, the  uric crystals within the joints are still present and if left untreated the frequency as well as duration of the flare-ups can worsen, even to the point where the pain will no longer go away.
 
A gout flare-up often starts overnight with increasing pain over the first 10-12 hours with generally the worst symptoms occurring in the first 4-14 hours for a mild or short bouts and within the first 36 hours for a longer ones. Mild flare-ups can dissipate within hours or up to 1 - 2 days later while severe attacks can last for weeks. Discomfort can linger for days up to weeks afterwards.
 
Gout is most commonly found at the base of the big toe or in other lower body joints such as the feet, ankle, and knees, but it can be found in any joints of the body including higher placed one such as the elbow or wrist. A flare-up usually affects one joint at a time, but if high uric acid levels remain present for many years, chronic gout can develop with more frequent attacks, lingering symptoms that affect multiple joints at once, as well as permanent limitations to joint mobility.
 
Gout can cause permanent damage and deformity to the joints as well as to the surrounding cartilage, bone, and tendons. This includes the formation of gritty/chalky nodules called tophi, which can develop under the skin in the cartilage and surrounding soft tissues around affected joints. High uric acid in the blood has also been linked to the development of kidney stones & kidney disease, as well as a higher risk of cardiovascular problems, plus certain cancers such as prostate cancer in men.

Sources & Causes

Gout is more likely to develop in those who have a genetic predisposition, especially for those who have other gout sufferers within their immediate family. It also has a higher probability with those who have certain pre-existing conditions such as obesity, high cholesterol or blood pressure, impaired glucose tolerance and diabetes, metabolic syndromes, chronic decreased kidney function, hyperlipidemia, or heart disease. Sleep apnea (or pauses in breathing during sleep) causes periods of oxygen deprivation which has been linked to triggering the overproduction of uric acid in the blood.
 
Flare-ups tend to triggered by a combination of weight as well as diet. People who are obese or otherwise overweight tend to produce more insulin with higher levels of insulin within the body tending to retard the processing & elimination of uric acid through the kidneys. In particular visceral fat (belly fat) has been linked to the development of both insulin resistance and gout.
 
Those eating high purine foods are five times more likely to have a gout flare-up within the short term (within days on ingesting the food) as well as a 50% higher chance of developing chronic gout in the long term. Foods high in purines that should be avoided include alcohol (particularly beer), red meat and certain types of seafood & shellfish. Very low calorie diets have also been linked to spikes in uric acid within the body.
 
Certain medicines can also help trigger a gout attack or worsen its symptoms including water pills and other diuretics that lower the level of salt in the body, drugs that suppress the immune system (such as those taken for arthritis or organ transplant), the vitamin niacin, as well as aspirin. Due to its tendency to raise the level of uric acid in the blood, other anti-inflammatory painkillers such as naproxen (Aleve) or ibuprofen (Advil) are recommended during gout flare-ups.
 
Other causes for an onset of a gout attack include dehydration, stress, very low calorie diets, physical jostling of the joint and the crystals positioned within it, surgery, and beginning medicinal treatments for lowering uric acid (which can temporarily displace the crystals already present in the joints)

Short Term & Long Term Treatments

Treatments for those who have experienced at least one gout attack usually include either over-the-counter (for use during acute attacks) or prescription medicines (for treatment of long term gout & to help prevent joint degeneration).
 
Medications that can help with managing gout pain during a flare-up include Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen ( Advil, Motrin) and naproxen sodium (Aleve) or more powerful prescription painkillers such as indomethacin (Indocin) or celecoxib (Celebrex). Other medicines that may be prescribed for use during acute attacks include colchicine (Colcrys, Mitigare) which tends to have heavier side effects as well as corticosteroids. Resting & icing the affected joint are also highly recommended as treatments.
 
To help manage long-term gout and prevent future flare-ups certain medicines can be prescribed which include xanthine oxidase inhibitors such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) which limit the amount of uric acid produced in the body. Another medicine often prescribed for chronic gout are uricosuric agents such as probenecid (Probalan) which help improve the kidney's ability to eliminate uric acid from blood. When beginning these longterm treatments, an acute flare-up may occur as the uric acid crystals begin shifting within the joints. If a person's gout is not responding to either xanthine oxidase inhibitors nor uricosuric agents, then injections of pegloticase (Krystexxa) can be used instead.
 
Besides the use of prescription medications, exercising and the gradual loss of weight (as sudden weight loss & low calorie diets can also trigger flare-ups) are also recommended for helping to prevent & manage gout as well as following certain dietary recommendations which will be discussed in further detail during the second part of our gout article series next week.