4 ways to prevent a gout attack
The nation’s obesity epidemic may be contributing to the rise in a painful joint condition that has been around for centuries, if not longer – gout. The ailment was first identified by the Egyptians in 2640 BC, who called it podagra.
Gout is a form of arthritis and is caused by the buildup of uric crystals in a joint and surrounding tissue resulting in inflammation and pain, according to the Journal of American Medical Association (JAMA). The disease affects 9.2 million people in the United States and is more common in men and older adults.
“Gout occurs suddenly and presents with a red, swollen, painful joint,” said Krzysztof Rosadzinski, MD, a rheumatologist with the Cape Cod Rheumatology Center in Hyannis. “Most people associate gout with high-fat meat, seafood, and beer, but in 2008, scientists also found a correlation between high fructose sugar and gout. Many foods are sweetened with high fructose sugar and, when your body metabolizes it, the by-product is uric acid.
Diuretics and Cyclosporin can also raise the level of uric acid in the blood.
The incidence of gout is rising in the United States, according to Harvard Medical School. While it mostly occurs in middle-age and older men, postmenopausal women can be affected when they lose the protective value of estrogen.
Diagnosis and Treatment
“The symptoms of a red, swollen joint and elevated blood uric acid level are hallmarks of diagnosis,” said Dr. Rosadzinski. “Uric acid levels may be lower during an attack because it is going to the affected joint and so we have to repeat the test. We can also drain the fluid from the joint, send it to the lab, and check for uric crystals, or we can do an ultrasound that will show changes suggesting uric acid crystals presence in the affected joint.”
The first attack is treated with NSAIDs, like Ibuprofen, or Naproxen. If there are contraindications for a patient to take these medications, there are also Colchicine, Prednisone, and steroid injections.
“Compared to other arthritis conditions, this one is easier to treat because you have a clear target,” Dr. Rosadzinski said. “We lower the blood uric acid level below six and that starts to dissolve uric acid crystals and prevents another attack from happening.”
Recurrences are treated with Allopurinol or a newer medication called Febuxostat (Uloric), Probenecid or Krystexxa, which is an injectable medication, Dr. Rosadzinski noted. Once you start on one of these medications, you will need to continue it and doses are adjusted based on the uric acid level.
Prevention
Dr. Rosadzinski recommends the following to prevent recurring gout attacks:
- Losing weight, if you are overweight.
- Stay away from alcohol, especially beer.
- Try to stick to a low-purine diet.
- Avoid high-fructose foods, such as juices, apples, grapes, watermelon, peas, and zucchini; red meats such as beef, pork, and lamb; as well as food products containing high fructose corn syrup.
“While gout can happen at any age, we see it mostly in older adults, said Dr. Rosadzinski. “There is some genetic predisposition that can also affect patients at younger age, including teenagers.”
