Gout: Symptoms, at Risk

Gout is an acute form of arthritis that frequently affects the joint of the big toe. The base of the toe becomes painfully red and swollen; the skin may become shiny and purplish in color. (Merck.com)

An acute attack often occurs at night. The patient may also develop chills and a fever which may reach 102 degrees, have a rapid heartbeat, and he will describe the joint-pain as excruciating. (Merck) An attack can last 5 to 10 days, with the pain subsiding after two weeks. The quicker treatment is begun, the sooner symptoms stop, which can be within 24 to 48 hours. A 2nd attack may occur but usually not for 6 months to 2 years and, in some cases, it doesn't reoccur. (Medcohealth.com)

Gout is caused by a build up of uric acid in the blood (hyperuricemia) which may form crystals that accumulate in joints like the base of the big toe, ankles, instep, knees, wrists, and elbows. But not all people with hyperuricemia develop gout. (Merck.com)

Those who are at the highest risk are: (sources: medcohealth.com and merck.com)

1) Genetically predisposed: one in 5 come from a family with a history of gout;

2) Lifestyle factors: Obese people who are more than 30 pounds overweight; People who overindulge in beer or alcohol (defined as daily consumption of one drink for women, two for men). Beer has yeast (with purines) in it and alcohol inhibits the excretion of uric acid;

3) Age and sex factors: Men between 40 and 50 years old; women after menopause, when their uric acid levels rise to equal that of men;

4) Medical conditions:

People with untreated hypertension (high blood pressure);
Diabetics;
People with high levels of fat and cholesterol in the blood;
People with a narrowing of the arteries (arteriosclerosis);
People with abnormal kidney function;
People with under-active thyroids (hypothyroidism); and
People with hemolytic anemia or lead poisoning.

5) Certain medications that increase uric acid levels: thiazide diuretics used to treat hypertension, which also reduce the amount of salt and water in the body;

low-doses of aspirin taken over long-periods of time, commonly recommended to prevent heart attacks, or extra-high doses of aspirin;

anti-rejection drugs given to transplant patients; TB medications like pyrazinamide and ethambutol;

cyclosporine given to suppress the immune system; niacin; and some medications used to treat cancer.

6) An acute gout attack can occur after the stress of surgery, sudden or severe illness or injury, and/or consumption of large amounts of alcohol or purine-rich foods. (Merck.com) An attack can also be brought on by dehydration or the use of diuretics ("water pills") which can increase the levels of uric acid. (Medcohealth.com)

An attack can occur without warning.

Certain foods are high in purines, which are transformed into uric acid. Thus, by avoiding those foods, one might prevent a second attack. A first attack is usually unavoidable because no one can predict a gout attack.

Foods to avoid: (sources: Medco; Merck; About.com)

Foods ranked very high in purines: beef, pork, lamb, liver, seafood, bacon, sweetbreads, alcohol,
anchovies, herring, mackerel, and yeast like that contained in beer and yeasty breads.

Foods that are moderately high in purines, but which may not raise the risk of gout (according to About.com) include: asparagus, cauliflower, mushrooms, peas, spinach, chicken, duck, turkey,
kidney and lima beans, whole grain breads and cereals.

Safe foods include: green vegetables and tomatoes, fruits and their juices, non whole grain breads and cereals, butter, buttermilk, cheese and eggs.
Also safe: coffee, tea, carbonated drinks, peanut butter and nuts.

Recommended foods: (About.com) Fresh cherries, strawberries, blueberries, and other red-blue berries;

Bananas; celery, tomatoes, vegetables like kale, cabbage, parsley, green leafy vegetables; foods high in bromelain (pineapple); foods high in Vitamin C; fruit juices and purified water; low-fat dairy products; complex carbs; chocolate and cocoa; essential fatty acids; and tofu.

Foods that might help lower the risk of a gout attack are dairy products like low-fat or skim milk and low-fat yogurt.

Diagnosis:

If your first, large toe-joint is inflamed;
the level of uric acid in your blood is high;
you're developing uric acid crystals (tophi) just under the skin;
your arthritis symptoms improve after taking the drug colchicine (an anti-inflammatory effective only in gouty-type arthritis);
and you have the tell-tale shiny, purplish skin, the diagnosis is almost apparent.

But a doctor can take a fluid sample from the joint and send it to the lab to look for uric acid. Some people have gouty arthritis even though they have normal uric acid levels. (Medcohealth.com)

Treatment involves three aspects: (1) pain relievers like acetaminophen in Tylenol; (2) anti-inflammatory drugs such as NSAIDS (non-steroidal anti-inflammatory drugs) like Advil, Motrin, or Aleve, colchicine (a plant substance) or corticosteroids like prednisone; (medcohealth.com ) and (3) medicine to manage the underlying cause of the excess uric acid in the body.

There are medications (allopurinol and probenecid), which slow the rate that uric acid is produced in the body or they help the body to eliminate the uric acid quicker. But those are metabolized by the kidneys, which some people can't handle, so a new drug, metabolized by the liver, is being tested, called Y700, also known as "Uloric" (generic = febuxostat). (http://www.uloric.com)

Gout is serious and can be disabling. Continued attacks of gout can lead to tissue destruction and deformity. About 1/5 of gout patients develop kidney stones.

Relief during an attack: A gout sufferer might use oxycodone for pain, along with immobilizing the joint with a splint, and applying ice to reduce the pain and swelling. (merck.com)

If you've had a few gout attacks, a long-term program to prevent uric acid build-up could be necessary for you. Ongoing research for new, less-toxic and more-effective medications is going on now.

Prevention is always better than the cure. If you are at high risk, take preventive measures. Proper fluid intake (8 glasses of water daily), losing weight, a change in diet, and drinking less alcohol could help you to avoid an acute gout attack. You might also ask your doctor to change a long-term medication known to add to your risk for gout.

An old folk remedy suggests eating cherries and drinking orange juice when a gout sufferer feels an attack coming on. Eating a half can of cherries and a glass of orange juice supposedly helps some people. If one "senses" an attack coming on, it probably couldn't hurt.

Sources:

http://arthritis.about.com. "Recommended foods to eat." "Gout foods: avoiding purine-rich foods." "Beneficial foods." By Carol and Richard Eustice, About.com. Updated June 3, 2006. Retrieved 7-31-09.

http://www.medcohealth.com. "What is gout?" "How is it diagnosed?" "How is it treated?" Developed by RelayHealth. Published by McKesson Health Solutions LLC. Updated January, 2009. Retrieved 7-31-09.

http://www.merck.com. "Gout and Pseudogout: Merck Manual Home Edition. "Gout, risk factors, causes, symptoms, diagnosis, treatment, preventing further attacks." Last full review/revision Feb., 2008 by Daniel McCarthy, MD. Retrieved 7-31-09.

http://www.uloric.com. Uloric (febuxostat) tablets for lowering blood uric acid levels. Licensed by Takeda Pharmaceuticals America, Inc.