Understanding Gout Symptoms & Treatment

Gout is a term that is derived from the Latin word “gutta” which translates to “a drop”. In the 13^th century, it was believed that gout resulted from a drop of evil humor or spirits affecting a vulnerable joint.

Gout is the most common form of inflammatory arthritis in the United States, affecting nearly 8.3 million individuals. It appears to be more prevalent in men (5.9%) than women (2%) and occurs due to the deposition of monosodium urate (MSU) crystals into tissue within the body and this occurs because of high uric acid levels (hyperuricemia). The risk of gout increases with advancing age, and this is also associated with increased uric acid levels. The frequency of gout in individuals above the age of 80 years is 30-fold higher than in individuals aged 20-29 years. The risk of gout also increases with obesity and metabolic syndrome.

In this blog post, we’ll discuss some of the common symptoms and treatments for individuals living with gout.

Symptoms

Gout can involve almost any joint in the body, but the most common initial joint involved in 50% of cases is the first metatarsal (“the big toe”) – termed, “podagra”. In Greek mythology, Podagra was the foot torturous born of the seduction of Venus by Bacchus. Other joints commonly involved include joints of the foot and ankle, knees, wrist, fingers, and elbows. Joints involving the spine can occur but are much rarer. Typically, gout flares occur in one joint and begin abruptly within the hours of the night or early morning. There will be warmth and redness with swelling of the joint. It can often appear to look like an infection.

Like many forms of inflammatory arthritis, gout can present itself in ways in addition to joint pain. Gout can develop tophi, which are aggregated deposits of MSU in different parts of the body such as elbows, knees, the cartilage around the ears, and other areas. It can also develop as uric acid kidney stones. Additionally, individuals with gout can have an increased risk of heart disease and kidney disease.

Managing Your Disease

Gout can be managed with medications and lifestyle changes that lower uric acid levels. From a lifestyle perspective, avoiding purine rich foods such as red meats, seafood (shellfish, sardine, anchovies, shrimp, trout, tuna, halibut, crab, lobster, salmon), excessive fructose consumption (soda, fruit juice, energy drinks) can help reduce uric acid levels. Consumption of alcohol strongly correlates with the risk of developing gout. Consuming 30-50 grams of alcohol a day (nearly three to four beers, glasses of wine, or liquor shots) increases the risk of gout by 2-2.5-fold compared to a non-alcohol consumer. Consumption of purine-rich vegetables and nuts such as asparagus, spinach, cauliflower, and mushrooms are not associated with increased gout attacks. Reduced-fat dairy intake and tart cherries may lead to modest reductions in gout attacks.

Various medications can be used in conjunction with lifestyle changes to help reduce uric acid levels and thereby reduce gout. Medications such as colchicine, allopurinol, febuxostat, probenecid, non-steroidal anti-inflammatories (NSAIDs), steroids, and others can be used under the guidance of your rheumatology and primary care teams. In rare cases, biologics such as pegloticase and anakinra can also be used to help manage gout. Additionally, medications for blood pressure, heart failure, Parkinson’s syndrome, chemotherapy, and others can worsen gout attacks. Patients should discuss all possible risk factors with their healthcare team to optimize care.

Overall, gout is a form of arthritis that is very much treatable and individuals with this can preserve their joints and reduce sources of inflammation with compliance to diet, medication, and open communication with their healthcare provider.