Gout is a type of arthritis caused by a build-up of uric acid in the blood, leading to the formation of monosodium urate crystals that subsequently collect in joint spaces. These crystals develop into larger deposits that irritate the joints and cause inflammation. This inflammation results in the common symptoms of gout, including swelling, heat, redness, and severe pain. It has been called the most painful type of arthritis that a person can experience. In the fifth century, the Greek physician Hippocrates called it "the unwalkable disease", given that the pain can be so intense as to keep a person from putting weight on his or her foot. So how does the uric acid level increase to cause this condition? There are essentially two ways this occurs - either uric acid is overproduced during the metabolism of purines that are found in our food, or it accumulates due to an inability to excrete enough of it in the urine. This state of elevated uric acid is called hyperuricemia. Studies seem to suggest that underexcretion causes 80-90% of cases, with a much smaller number due to overproduction of uric acid. It also appears that these variations are linked to genetics and are hereditary traits. Interestingly, not everyone with hyperuricemia will develop gout; only about 1 in 10 will actually be afflicted by the disease. It is not yet understood why this is, but the body's ability to respond to inflammation may play a part beyond the genetic factor. RISK FACTORS: family history of gout, obesity, high blood pressure, diabetes, injury to the joint, use of certain medications, recent surgery or trauma, dehydration, alcoholic beverage consumption, excessive fructose sugar intake, and consumption of purine-rich foods The drugs that may have a worsening effect on uric acid levels include aspirin, niacin (Vitamin B3), diuretics, cyclosporine, and some tuberculosis treatment drugs. In terms of diet, purine high foods include things like beef, pork, seafood (especially shellfish and scallops), lamb, and organ meats such as liver. Foods from yeast also increase uric acid levels, so bread and beer are likely to increase the chance of a gout flare. Beer actually packs a double dose of risk, as it is high in purines and the alcohol decreases excretion of uric acid. Foods with high fructose levels include soft drinks, certain juices, candy and sweets.
PREVENTION: 1. Drink plenty of fluids - a 2009 online study through Boston University showed that people with gout who drank 5 - 8 glasses of water per day were 40% less likely to have an attack than those who drank less than one glass per day; also, coffee and tart cherry juice may be beneficial 2. Limit alcohol consumption - especially beer and spirits 3. Eat a healthy, non-inflammatory diet - this also means be careful of high purine foods and excessive fructose intake 4. Weight loss - this ultimately helps reduce uric acid levels as well as chronic inflammation 5. Medications - for patients who experience many flares of gout, daily colchicine, NSAID's, and/or other drugs might be a beneficial preventive measure.
MEDICATION TREATMENTS: 1. NSAID's such as ibuprofen, naproxen, indomethacin - these help alleviate pain and are anti-inflammatory 2. Colchicine - this anti-gout drug helps to decrease the production of uric acid and/or helps to eliminate it via the kidneys 3. Corticosteroids, such as prednisone - can be helpful in controlling the inflammatory response, but are usually reserved for patients who cannot tolerate other therapies 4. Xanthine oxidase inhibitors, including allopurinol and febuxostat - these meds limit the production of uric acid in the body; unfortunately these drugs have more side effects than others and can even trigger gout attacks when first taken and even during the first few months of use 5. Uricosuric drugs, such as probenecid - this medication improves the kidneys' ability to remove uric acid.
NON-DRUG/DIET THERAPIES: 1. Cherry juice/supplements - concentrated tart cherry or black cherry juice seems to have an anti-inflammatory effect 2. Coffee - a 2007 study involving 46,000 men found that those who drank 4 to over 6 cups per day had a much lower risk of hyperuricemia 3. Water - fluids in general help to flush uric acid out through the kidneys 4. Avoid icing the afflicted joint - the intense cold can actually increase the amount of monosodium urate crystals in the joint.
As always, ask your doctor for recommendations specific to your case.