Gout - Care Guide

Gout most commonly affects the big toe first. Subsequent attacks of gout, usually limited to a single joint at a time, can occur in the instep, ankles, heels of the feet and hands, knees, wrists, fingers, and elbows. Attacks of gout usually come on suddenly, stop after five to 10 days, and can keep recurring. While this problem is not life threatening, gout can be debilitating.

Diagnosing Gout

Usually, physicians can diagnose gout based on the physical examination and medical history (a person’s description of symptoms and other information). The diagnostic path includes X-rays of the affected joints and tests of the blood and urine to measure uric acid levels. Sometimes the doctor will numb the joint and use a needle and syringe to withdraw synovial fluid to examine for the presence of uric acid crystals. As gout progresses, often the uric acid crystals also form deposits, called tophi, under the skin. The development of a tophus can confirm the diagnosis of gout. The most definitive way to diagnose gout is to take a sample of fluid from the joint and test it for urate crystals.

Symptoms of Gout

Gout attacks often occur suddenly, affecting the big toe, heel, or ankle and then later progressing to the knees, wrists, elbows, and fingers. It begins with sudden and severe pain in the affected joint, usually the first joint of the big toe. The pain commonly arrives at night and wakes the person. The affected joint may be red, swollen, and warm to the touch. The pain and other symptoms typically go away within 10 days, and there can be an extended period before symptoms return.

Gout symptoms include intense pain, joint swelling, back pain, fever, red and warm joints and upset stomach.

Gout Risk Factors

You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include alcohol consumption (rye, beer, and wine), medications (antibiotics, aspirin, chemotherapy, diuretics, niacin), eating foods high in purines, elevated triglycerides, high blood pressure, stress (trauma, surgery, emotional stress), family history, gender: men are affected more frequently, age: those over 40 are at greater risk, kidney disease, lead exposure and carrying excess weight.

Treatment Options for Gout

Treatment during a gout attack focuses on relieving inflammation and pain. The goals of treatment for gout consist of alleviating pain, avoiding severe attacks in the future, and preventing long-term joint damage. In addition to taking pain medications as prescribed by their doctors, people having gout attacks are encouraged to rest and to increase the amount of fluids that they drink. Non-steroidal anti-inflammatory drugs or corticosteroid medications are generally the first line of medications to target these symptoms. Medications to reduce the risk for future gout attacks include colchicine, allopurinol, and probenecid, which slow the body’s production of uric acid. These medications do not prevent gout from progressing but can extend the time between attacks as well as reduce the permanent damage the inflammation can cause.

The alternative medicine approach to gout focuses on correcting hyperuricemia by losing weight and limiting the intake of alcohol and purine-rich foods. In addition, consuming garlic (Allium sativum) has been recommended to help prevent gout. Increasing fluid intake, especially by drinking water, is also recommended. During an acute attack, contrast hydrotherapy (alternating three-minute hot compresses with 30 second cold compresses) can help dissolve the crystals and quickly resolve pain.

Goat Prevention

For centuries, gout has been known as a rich man’s disease or a disease of overindulgence in food and drink. While this view is perhaps a little overstated and oversimplified, lifestyle factors clearly influence a person’s risk of developing gout. Since obesity and excessive alcohol intake are associated with hyperuricemia and gout, losing weight and limiting alcohol intake can help ward off gout. Dehydration may also promote the formation of urate crystals, so people taking diuretics or water pills may be better off switching to another type of blood pressure medication. All people are advised to drink at least six to eight glasses of water each day. Since purine is broken down in the body into urate, it may also be helpful to avoid foods high in purine, such as organ meats, sardines, anchovies, red meat, gravies, beans, beer, and wine.

Dietary Recommendations

The main benefit of a gout diet is a decrease in the pain, tenderness, swelling, redness, warmth, and inflammation of joints associated with the condition, and prevention of joint damage and disability. It also improves the quality of life in gout sufferers by helping prevent repeat attacks.

A gout diet is a nutritional routine that includes eating foods low in purines to help reduce the occurrence and severity of gout attacks. General dietary guidelines for people with gout include:

• It is important to stay hydrated by drinking eight to ten eight-ounce glasses of fluids, preferably water, every day.
• Limit protein consumption from meat and replace it with low-fat or non-fat dairy products and soy products, such as soybeans and tofu.
• Alcohol, especially beer, should be avoided.
• Consume dairy products low in fat rather than those high in fat.
• Since carbohydrates help increase the excretion of uric acid, carbohydrates should be about 50% of total calories consumed. To accomplish this, persons should eat six to ten servings a day of breads, pasta, cereals, and other starchy foods, and five servings of fruits and vegetables daily.
• Fat consumption should be limited to 30% of total calories consumed.
• Cholesterol intake should be limited to 300 milligrams (mg) per day.
• Maintaining a healthy body weight is essential.

Foods to include:

Cherries (fresh, canned, or juice) help to reduce uric acid levels. Strawberries, blueberries, and celery also seem to help.  Flaxseed provides essential fatty acids, which help reduce inflammation. Foods high in vitamin C (red peppers, tangerines, mandarins, oranges, and red cabbage) reduce uric acid. Pineapple is high in bromelain, a digestive enzyme that may help reduce inflammation. Whole grains and flax seed are high in fiber and help with elimination of uric acid.

Foods to avoid:

Organ meats (heart), sardines, herring, mackerel, mussels, and sweetbreads contain very high amounts of purines, which can substantially increase uric acid levels. Minimize (once weekly) anchovies, veal, bacon, liver, kidneys, goose, scallops, salmon, crab, lobster, turkey, and haddock, which contain high amounts of purines. Limit consumption (four times weekly) of legumes (dried beans, peas, and soybeans), asparagus, gravy, mushrooms, oysters, tongue, spinach, and tuna. Refined flour (white bread, pasta) and sugar should be minimized as these foods can raise uric acid levels and are also unhealthy. Reduce consumption of alcohol, especially beer, as it interferes with uric acid elimination. Drink plenty of water (2–3 L per day) to help flush uric acid through the kidneys. However, if you have heart or kidney disease and are on fluid restriction, consult your doctor before changing fluid intake.