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Gout is one of the many different types of arthritis. It can cause a severe and sudden onset of pain and inflammation in a joint. Gout occurs when a build up of uric acid in the blood results in a collection of uric acid crystals depositing in the joints. This collection of uric acid can result in recurrent attacks of painful joint inflammation. Other complications of uric acid build up include the formation of tophi, or lumps of collected crystals under the skin or elsewhere, kidney stone and impaired kidney function (called gouty nephropathy or urate nephropathy).
Gout is a treatable disease and with proper treatment, may not lead to any long-term effects. Elevated levels of uric acid, or hyperuricemia, can occur in different ways. Uric acid is produced when the body breaks down the chemical compounds called purines. Purines come from foods we eat as well as well as our own bodies recycling of DNA and RNA. High uric acid production, low uric acid excretion or a combination of both can result in hyperuricemia and gout.
Acute attacks of gout occur after years of asymptomatic hyperuricemia. An acute attack is extremely painful, with redness, warmth and swelling. It commonly affects the base of the big toe. It can be very dramatic and one may think they have significantly injured their foot and present to their physician. The mechanism, by which an acute attack occurs, begins when a single white blood cell (WBC) happens upon a uric acid crystal. The WBC tries to eat the crystal as it thinks it is foreign. Unfortunately humans and Dalmatian dogs are the only mammals that evolved without the enzyme uricase, which breaks down uric acid. When the WBC cannot digest the uric acid crystal, the cell dies and releases all of its contents. These contents start a dramatic inflammatory reaction with more WBC’s coming to the scene to help eat the crystals. This results in a domino affect of inflammation in the joint.
There are many ways to treat gout. First, is treating the acute flare. This can be done with anti-inflammatory medications such as NSAID’s (non steroidal anti-inflammatories), colchicine or prednisone. These medications stop the inflammation, which causes pain and swelling. It is very important to let your doctor know about a flare right away as treatments are more effective early on during the flare. Next we try to prevent further flareups.
The only way to get rid of gout is to lower the uric acid. However, anytime we try to lower the uric acid, there is an increased risk of flare. Therefore, the medications used for an acute flare can be maintained by your physician to prevent flare-ups while lowering the uric acid. There are only two medications currently available to lower uric acid, probenacid and allopurinol. These medications are never initiated during a flare as they will worsen the symptoms. Once the uric acid level is effectively lowered, patients remain free of flare-ups as long as they stay on their uric acid lowering medication. Other methods of lowering uric acid include dietary modification, which can be effective, but sometimes only results in moderate uric acid lowering. The role of diet in gout: As mentioned earlier purines in the diet contribute to the overall uric acid burden in the body. These compounds are found in a variety of food and beverages including, but not limited to, organ meats, anchovies, seafood, and gravies. Alcohol should be avoided because it increases production of urate and impairs its excretion. Beer, in particular, is high in purines and is associated with gout.
Weight loss may reduce serum urate, but fasting and dehydration may make a gout attack more likely. Fructose found in soft drinks may elevate the uric acid level, whereas vitamin C intake may lower uric acid levels. In addition, increasing intake of dairy foods may be helpful in reducing acute attacks. Some medications also increase the risk of gout, particularly diuretics or water pills.
Gout is a common treatable form of arthritis. It is important to understand and work with your physician in treating and preventing painful attacks of arthritis. If left untreated it can progress to a debilitating and deforming condition. Dr. Janelle Laughlin is board certified in rheumatology. She specializes in treating patients with arthritis. She joined Longmont Clinic in August 2006. She can be reached at 720-494-3158.
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