Gout Awareness Day

"The king of diseases and the disease of kings." This is how gout has been known for centuries, having been documented since antiquity. It's a common disease, but over half of gout patients have reported feeling too embarrassed to discuss their condition. A significant number report feeling judged for having it, thanks to a perception of gout as caused exclusively by being overweight or consuming too much alcohol. But in truth, gout is a form of arthritis.

The Facts of Gout

That's right, gout is a form of inflammatory arthritis, one that's particularly painful but usually affects one joint at a time. Although obesity and excessive alcohol consumption may play a part in developing gout, it has many potential causes and triggers. It also affects many people of different ages and lifestyles:

• 8 million Americans have gout - 6 million men and 2 million women.
• 4 percent of American adults are affected by gout.
• Gout patients accumulate 4.5 more days of missed work than those without.
• 93 percent of people don't know that gout is a form of arthritis.

Symptoms

Gout is usually characterized by flareups of intense pain in a joint that can last for days or weeks, followed by remission periods that can last for weeks, months, or years. It typically exists in one joint at a time, and around 50 percent of the time it starts in the big toe. It's also frequently found in other toes, the ankle, or the knee.

Symptoms include:

• Pain, often intense.
• Swelling.
• Redness.
• Heat: area is hot to the touch.

Causes and Triggers

Gout proceeds from a condition called hyperuricemia, the build-up of excessive uric acid in the body. This is usually a byproduct of breaking down natural compounds called purines, substances that form DNA and which are found in many foods. Too much uric acid can form into crystals that build up in joints, tissues, and fluids around the body, causing inflammation and pain.

Hyperuricemia without symptoms may not necessarily lead to gout, which has both underlying causes and flareup triggers. Medical or genetic risk factors for gout include:

• Being male.
• Genetic predisposition.
• Joint injury.
• Other medical stress: surgery; sudden, severe illness; infection.
• Other health conditions: including hypertension, congestive heart failure, diabetes, insulin resistance, poor kidney function, and metabolic syndrome.
• Certain medications or medical care: cyclosporine, diuretics, chemotherapy.

Lifestyle risk factors for gout include:

• Obesity.
• Alcohol consumption: risk of gout increases with increased intake.
• High fructose foods and beverages: sugary sodas or juices with added sweetener.
• High purine foods: red meat, organ meat, shellfish.
• Crash diets or fasting.

Treating Gout

Gout has no cure, but can be managed to help a patient avoid or reduce the impact of flareup triggers. A major part of this is adopting healthy lifestyle habits:

• Knowing your triggers: different patients have different flareup vulnerabilities. Learning yours over time is key to adjusting your lifestyle.
• Weight management: weight loss can reduce the amount of uric acid in the body, and reduces risk of heart disease or stroke, both often found in gout patients.
• Physical activity: can contribute to weight management, but be careful not to worsen inflammation in the joint or to get dehydrated, which can trigger a flareup.
• Medication: uric acid reducers as well as anti-inflammatory medications (corticosteroids, NSAIDs) and pain relievers.

A proper diet is an important way to reduce uric acid or prevent too many high-purine foods. A heart-healthy diet is a good guideline for gout prevention. These foods and drinks are recommended:

• Low fat dairy products: such as skim milk.
• Plant oils: olive, canola, sunflower.
• Some fruits: ones that are less sweet.
• Vegetables.
• Vitamin C supplements: 500 mg to 1000 mg daily.
• Water.
• Whole grain foods.

We mentioned earlier that while obesity may be a factor in gout, it's not the central cause. Dietary choices may be as much a factor in developing gout as being overweight. A physically active person may also be at risk because of genetic predisposition or excessive alcohol consumption. The causes of gout are a complicated mix of lifestyle factors and genetics.