All about gout - Harvard Health (2022)

This old disease is becoming more common, but gout can be easily treated and then prevented — with the right care.

Unless you've experienced it firsthand or know someone who has, gout may seem like a museum piece of a disease — a condition that once afflicted corpulent men of means but doesn't get mentioned much these days. Even the name seems archaic and unscientific. Gout comes fromgutta, Latin for drop, a reference to the belief that it was caused by a drop-by-drop accumulation of humors in the joints.

But gout is still very much with us, and the number of Americans affected seems to be increasing, at least partly because of the obesity epidemic. Gout remains a disease that mainly affects middle-aged and older men, although postmenopausal women are vulnerable too, perhaps because they lack the protective effect of estrogen. The diuretics ("water pills") that many people take to control high blood pressure are another contributing factor. Gout can also be a problem for transplant recipients. There are several reasons for this but medications, such as cyclosporine, taken to reduce the chances of organ rejection and reduced kidney function are major contributors.

The encouraging news is that almost all gout cases are treatable. In fact, gout is one of the few treatable and preventable forms of arthritis, an umbrella term for dozens of conditions that cause inflammation in the joints. The challenge is making sure people get the gout care they need and follow through on taking medications.

What causes gout?

(Video) Gout | Causes, Pathophysiology, Risk Factors (ex. Diet), Symptoms, Diagnosis, Treatment

Purines are a group of chemicals present in all body tissues and in many foods. Our bodies are continually processing purines, breaking them down and recycling or removing the byproducts. Uric acid is one of the byproducts and, normally, any excess leaves in the urine. But in some people, the system for keeping levels in check falls out of kilter. Usually it's because the kidneys aren't keeping up and excreting enough uric acid, but sometimes it's a matter of too much uric acid being produced or it's a combination of both.

Gout occurs when surplus uric acid coalesces into crystals, which causes inflammation in the joints. Pain, swelling and loss of joint motion are typical. (Technically, the crystals consist of sodium urate, although for simplicity's sake they're often referred to as uric acid crystals.) The crystals appear most often in the joints, but they may also collect elsewhere, including the outer ear, in the skin near the joints, and the kidney.

High concentrations of uric acid levels in the blood — the medical term is hyperuricemia — are necessary for the crystals to form. Yet many people with hyperuricemia never develop gout, and even when they do, they often have had high levels of uric acid in their blood for years without any symptoms. People with hyperuricemia with no symptoms might be coached to make lifestyle changes — losing weight would often top the list — but hyperuricemia by itself is usually not treated.

Gout predisposing factors

Dr. Hyon K. Choi, now at the Massachusetts General Hospital in Boston, and epidemiologists at Harvard have used data from the Harvard-based, all-male Health Professionals Follow-up Study to make a series of comparisons between the 730 men in this study who developed gout during a 12-year period and the vast majority of those in the study who did not. The result is an impressive dossier on the risk factors for gout, at least as they pertain to men.

Dr. Choi's findings on weight weren't surprising and fit the stereotype: gout is, in fact, a heavy man's disease. Eating lots of meat and seafood and drinking lots of alcohol spells gouty trouble. And the Homer Simpsons of the world are gout candidates: two-or-more-a-day beer drinkers are more than twice as likely to get gout as nonbeer drinkers, which makes sense, because beer contains a lot of purines.

(Video) Uric acid and metabolic health with Dr David Perlmutter MD

Soft drink fanciers might be in the same gouty boat. High fructose intake was linked to gout in a Choi-led study published in 2008. Uric acid is one of the products of fructose metabolism, and there's good evidence from controlled feeding studies that fructose increases uric acid levels in the blood. Much of the fructose in today's American diet comes from the high-fructose corn syrup (which is about half fructose and half glucose) that's used to sweeten soft drinks and many other foods and drinks.

High blood pressure is another major risk factor for gout. It gets complicated, though, because the diuretics taken to lower high blood pressure increase uric acid levels, so the treatment as well as the disease is associated with gout.

Finally, gout does run in some families and we know that certain genes increase the risk of gout.

Gout symptoms and complications

Gout is not gout until symptoms occur. When they do, they usually come on suddenly and, at least initially, affect a single joint. Within hours, that joint becomes red, swollen, hot, and painful — they're called goutattacksfor a reason. It's easy to mistake a gout attack for a localized infection of a joint. The metatarsophalangeal joint at the base of the big toe (where the toe meets the foot) is often the site of the first attack, but the knees, ankles, and joints between the many small bones that form the foot are also common sites. People who already have osteoarthritis — the most common form of arthritis — often experience their gout attacks in the joints of the finger

All about gout - Harvard Health (1)

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Treating a gout attack

As is true for many painful conditions, the first-line treatment for a gout attack is taking one of the nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, ibuprofen, or indomethacin. For people who can't take NSAIDs, a drug called colchicine is an alternative. It's been used for centuries — maybe even longer — specifically for gout. The trouble with colchicine is its side effects, especially the copious diarrhea. If neither an NSAID nor colchicine is an option, then gout attacks can be treated with an oral corticosteroid, such as prednisone, or with corticosteroid injections into the joints.

Preventing gout attacks

For years, gout patients were told they had to follow a purine-restricted diet to stave off attacks, but those diets weren't very effective and people had a difficult time sticking to them. Now the easier-said-than-done advice is to lose weight, and also to cut back on alcohol, especially beer. Big meat and seafood eaters may be told to curb their appetites and instead eat more low-fat dairy foods. Diuretics tend to increase uric acid levels. If someone with gout is taking one, a doctor might explore lowering the dose or switching to a different medication.

But the most important fork in the road for gout sufferers is whether to start taking a drug that will lower their uric acid levels. Once people start taking these drugs, they usually must take them for the rest of their lives. Going on and off a uric acid–lowering medication can provoke gout attacks. Experts have differing opinions, but many agree that the criteria for starting therapy include frequent (say, two or three times a year) attacks, severe attacks that are difficult to control, gout with a history of kidney stones, or attacks that affect several joints at a time. Guidelines also recommend uric acid-lowering treatment if a person with gout also has kidney disease.

Allopurinol is the first-line uric acid–lowering drug. It needs to be taken only once a day and reduces uric acid levels regardless of whether the root problem is overproduction of uric acid or inadequate clearance by the kidneys. Sometimes people develop a mild rash when they start allopurinol, although rarely there's a dangerous allergic reaction. Old guidelines warned against prescribing allopurinol for people with kidney disease, but with proper dosing, the drug is usually well tolerated and effective even for people with kidney disease. Underdosing has long been a problem. The standard starting dose is 100 mg per day (or less if a person has kidney disease); many doctors do not increase it above 300 milligrams (mg), but that might not be enough to reach the commonly accepted target level for uric acid of 6 milligrams per deciliter (mg/dL). Most people can take doses of 400 mg or more (if needed) without any problems, although higher doses do mean taking extra pills.

A newer drug, febuxostat (Uloric), is similar to allopurinol in the way it works. In head-to-head trials, febuxostat looked to be more effective than allopurinol at controlling uric acid levels, although that was likely because the allopurinol dose in the study was too low. As a new, brand-name drug, febuxostat is far more expensive than allopurinol.

(Video) TOP 10 FOODS THAT REDUCE YOUR URIC ACID LEVELS

Probenecid is a third choice. Like allopurinol, it's been on the market for decades, so it has a long track record. Probenecid works by increasing uric acid excretion by the kidneys so it can trigger the development of kidney stones and is not a good option for people with kidney problems. Another drawback to probenecid is that it has to be taken twice a day.

Perhaps the biggest problem with the uric acid–lowering therapy is sticking with it. A number of studies have demonstrated that up to 80% of people prescribed allopurinol were taking it incorrectly or not at all. Poor adherence is understandable. Once people are taking an effective gout prevention medicine, there are usually no immediate symptoms to remind them to take the pills daily. And the memory of the last attack is bound to fade, no matter how excruciating it might have been.

Many types of arthritis cannot be prevented and lack medical treatments that reliably work. Gout is different - the treatment is usually straightforward and highly effective. So, if you have gout, ask your doctor about treatment options. Although gout is on the rise, there are now good treatment options for this ancient disease.

TheHealth Letterthanks Dr. Robert Shmerling for his help with this article. Dr. Shmerling is the clinical chief of the Division of Rheumatology at Beth Israel Deaconess Medical Center in Boston.

FAQs

What are the three 3 complication for gout? ›

Complications of gout include joint damage, kidney damage, and bone loss. This excess uric acid causes needle-shaped crystals to form around joints, leading to inflammation in and around the joints.

Can you reverse gout? ›

Gout is one of the most common inflammatory arthritides. The disease is due to the deposition of monosodium urate crystals. These deposits are reversible with proper treatment, suggesting that gout is a curable disease.

What is the number one cause of gout? ›

What causes gout? Gout is caused by a condition known as hyperuricemia, where there is too much uric acid in the body. The body makes uric acid when it breaks down purines, which are found in your body and the foods you eat.

What is the fastest way to get rid of gout? ›

Treatment
  1. Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin, Tivorbex) or celecoxib (Celebrex). ...
  2. Colchicine. ...
  3. Corticosteroids.

Which fruit is best for uric acid? ›

Grapefruit, oranges, pineapples, and strawberries are all great sources of vitamin C, which lowers your uric acid levels and helps prevent gout attacks.

Can gout lead to kidney failure? ›

This allows uric acid to build up, which may cause an attack of gout. Recent studies have found that compared with people who do not have gout, people with gout are: 29 percent more likely to suffer from advanced chronic kidney disease (CKD). 200 percent more likely to have kidney failure.

Is lemon good for uric acid? ›

Lemon juice may help balance uric acid levels because it helps make the body more alkaline. This means it slightly raises the pH level of blood and other fluids. Lemon juice also makes your urine more alkaline.

What food raises uric acid? ›

Meat (especially organ meats like liver and sweetbreads) and seafood (like fish and shellfish) can be high in chemicals called purines. When your body breaks them down, your level of uric acid goes up. Instead, go forprotein from low-fat dairy products, like skim milk, cheese, and yogurt.

What lifestyle causes gout? ›

Modifiable risk factors for gout include obesity, the use of certain medications, high purine intake, and consumption of purine-rich alcoholic beverages.

Which exercise is best for uric acid? ›

Exercises that work the body's cardiovascular system are best for managing uric acid levels and help to manage body weight ( 4 ). Examples of these types of exercises include walking, cycling, and swimming.

Which food reduce uric acid fast? ›

In fact, here are six foods that can reduce uric acid naturally:
  • Bananas. If you have developed gout because of high uric acid, then having a banana everyday can reduce lower uric acid in your blood, thereby reducing your risk of gout attacks. ...
  • Apples. ...
  • Cherries. ...
  • Coffee. ...
  • Citrus fruits. ...
  • Green tea.
28 Sept 2020

Is Ginger good for uric acid? ›

Ginger. Ginger is known to help with digestion and ease nausea, but it can also help with inflammation, including gout. One animal study, for example, found ginger lowered uric acid levels in subjects who consumed ginger internally.

What can I drink to flush out gout? ›

Drinking water can help flush the uric acid crystals that cause gout out of your system. “A well-hydrated patient should drink enough to urinate every two to three hours,” says Dr.

Do bananas trigger gout? ›

Bananas are low in purines and high in vitamin C, which makes them a good food to eat if you have gout. Changing your diet to include more low-purine foods, like bananas, can lower the amount of uric acid in your blood and reduce your risk of recurrent gout attacks.

What vegetables to avoid if you have gout? ›

Eat plenty of vegetables such as kailan, cabbage, squash, red bell pepper, beetroot, but limit the intake of vegetables with moderate purine content such as asparagus, spinach, cauliflower and mushrooms. Eat fruits high in vitamin C such as oranges, tangerines, papaya and cherries.

Is cheese OK for gout? ›

Dairy. Dairy products, such as milk, cheese, and yogurt, are low in purines, and they are a good fit for a diet to manage or prevent gout. They are good protein alternatives to meat, and reduced-fat dairy products are lower in saturated fat than full-fat ones.

Can apples Help gout? ›

Apples in a Gout Diet

As the old saying goes “An apple a day keeps the doctor away”. Truth is it really does since apples contain nutrients that can regulate blood sugar levels, metabolize bacteria and fight cancer but they are also an important food for your gout diet.

Is Egg good for uric acid? ›

Certain foods, such as red meat, are rich in purines. You should avoid such foods if you have gout or are at a high risk for it. This means you need to choose sources of protein that are low in purines. Eggs are a good option.

Is cucumber high in uric acid? ›

Due to their high fibre content, they are also helpful in expelling the uric acid content from the body. A cucumber is also a great option for those people with high uric acid in the blood. Vegetables help in reducing high uric acid level and also keep uric acid under control.

What organ is related to gout? ›

Health problem linked to gout go beyond the joints, however. Excess uric acid can also damage kidneys, blood vessels, and other organs, and gout raises the risk for several disorders. These include kidney and cardiovascular disease, as well as diabetes, depression and sleep apnea.

What happens if you let gout go untreated? ›

It's important to treat gout as soon as possible.

Over time, patients with untreated gout can develop a condition called tophi — hard and bulky uric acid deposits in the affected joint. Tophi are usually painless, but they can erode the bone and even pop open the overlying skin and start draining.

Can gout be caused by stress? ›

Gout attacks may be triggered by any of the following: Drinking alcohol. Eating a lot of protein-rich foods. Emotional stress.

Does tumeric help gout? ›

If you have gout, try turmeric as a home remedy. Its most active chemical, curcumin, has potent anti-inflammatory and antioxidant properties. This may help ease gout-related inflammation and pain. When eaten in foods, turmeric is generally safe.

Is pineapple good for uric acid? ›

Vitamin C in pineapple is very good for uric acid because vitamin C can help increase uric acid excretion through urine, also have ability to reduce uric acid levels in the body.

How do you beat gout? ›

Dietary changes

Medication is only one way to prevent gout attacks. Altering your lifestyle habits can add further protection. Besides reducing your intake of meat and shellfish, which can raise uric acid levels, limit your intake of alcohol as well as drinks with high-fructose corn syrup, like soft drinks, says Dr.

Does walking help gout? ›

It is safe for people to walk with gout. In fact, doing joint friendly activities such as walking can help improve gout-related pain. Gout is a form of arthritis that usually affects the big toe joint, but it can also affect the lesser toes, ankles, and knees. It normally affects one joint at a time.

Can losing weight stop gout? ›

Exercise and weight loss also bring down uric acid levels and help prevent gout flares. In one small trial, patients who lost 16 pounds dropped their uric acid levels by 3 points. “Lifestyle matters a lot in gout, like it does for diabetes. You can control gout if you really stick to good lifestyle choices,” Dr.

Can garlic heal gout? ›

Garlic. Garlic is an incredible herb for curing gout. It aids in eliminating excess uric acid from the system and reduces inflammation. Crush 1-2 clove of garlic and then consume it to get respite from joint pain.

Does eating cucumber reduce uric acid? ›

Due to their high fibre content, they are also helpful in expelling the uric acid content from the body. A cucumber is also a great option for those people with high uric acid in the blood. Vegetables help in reducing high uric acid level and also keep uric acid under control.

What are the main problem with gout? ›

Gout is caused by a build-up of a substance called uric acid in the blood. If you produce too much uric acid or your kidneys don't filter enough out, it can build up and cause tiny sharp crystals to form in and around joints. These crystals can cause the joint to become inflamed (red and swollen) and painful.

What are the three types of gout? ›

The four phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout.

What are the three levels of gout? ›

There are three main phases of gout: gout flare, intercritical gout, and tophaceous gout. Gout flare — Initial gout flares usually involve a single joint, most often the big toe or knee. Over time, flares can begin to involve multiple joints at once and may be accompanied by fever.

What organs do gout affect? ›

Health problem linked to gout go beyond the joints, however. Excess uric acid can also damage kidneys, blood vessels, and other organs, and gout raises the risk for several disorders. These include kidney and cardiovascular disease, as well as diabetes, depression and sleep apnea.

Does gout mean kidney problems? ›

Gout can be a warning sign for CKD or may mean you're at a higher risk for kidney disease. If you're experiencing symptoms of gout, talk to your doctor to determine the root cause and if kidney disease treatments are necessary.

Does gout ever go away completely? ›

There is no cure for gout. However, a combination of medications and home remedies may help to keep gout in remission. Gout is a form of inflammatory arthritis that causes pain and discomfort, often in the toes, ankles, and knees.

What is the best thing to drink if you have gout? ›

Drinking plenty of water is best if you have gout. Other beverages recommended for gout patients include milk, tart cherry juice, and coffee—all in moderation.

Does stress cause gout? ›

For some people, stress can trigger gout attacks. That's because high levels of stress and anxiety are associated with increased uric acid levels. 10 Taking action to manage your stress can also support a more calm state of mind and reduce the inflammation associated with stress.

Does gout worsen with age? ›

Some people have attacks of gout every few years, whereas others have them more frequently. The frequency of attacks tends to increase over time. Harry found that his attacks became more frequent and more severe as he got older.

What is red flag for gout? ›

Gout should be suspected in people presenting with any of the following: Rapid onset of severe pain together with redness and swelling in one or both metatarsophalangeal joints.

What is the life expectancy of gout? ›

If diagnosed early, most people with gout can live a normal life. If your disease has advanced, lowering your uric acid level can improve joint function and resolve tophi.

What is the final stage of gout? ›

Chronic tophaceous gout

This is the final stage of gout, which is a form of chronic arthritis characterized by permanent damage to the cartilage and bone in the joint.

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3. Preventing Gout Attacks with Diet
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