What is Gout?

Gout is a common form of inflammatory arthritis linked to high levels of uric acid in the body. Uric acid is made when purines—compounds that occur naturally in the body and are also found in some foods and beverages— are broken down. Typically, uric acid in the bloodstream is carried to the kidneys, where it exits the body in urine. If blood levels of uric acid are too high, the kidneys can’t keep up and the blood uric acid concentration rises (a condition called hyperuricemia). In people who are predisposed to gout, this can lead to the formation of uric acid crystals that get lodged in the joints, particularly the lower body joints like toes, ankles, and knees. The accumulation of these sharp-edged crystals sometimes triggers inflammation which can result in a painful gout attack, or flare-up. Not everyone with hyperuricemia will get gout, but once it develops it’s likely to return without treatment to lower uric acid levels.

Gout can affect anyone, regardless of lifestyle. “A lot of risk is hereditary, as gout very much runs in families,” says Steven Vlad, MD, PhD, a rheumatologist at Tufts Medical Center. Gout is more common in men, women after menopause, and people with diabetes, overweight, obesity, or kidney disease.

What to Do.

Managing uric acid levels can help prevent gout attacks and slow joint damage. “When attacks occur infrequently (once a year or less), we generally start with recommending dietary changes,” says Vlad. For people who suffer more frequent attacks— two to three times a year—uric acidlowering medications are used as well. Research shows that weight reduction through diet and exercise can reduce uric acid levels and risk of gout flares.

For people who have gout, avoiding or limiting purine-rich foods is recommended to reduce risk of flare-ups. High-purine foods include red meats (beef, lamb, and pork), organ meats (like liver), and some types of seafood (including anchovies, sardines, and shellfish). Note that the overall health benefits of consuming fish are thought to outweigh risks in people with gout. It’s also important to know that high-purine vegetables, including asparagus, spinach, peas, and mushrooms, have not been linked to raising uric acid in the blood. Consuming dairy products, particularly low-fat dairy, has been associated with lower levels of uric acid and a lower risk of gout flare-ups.

Added sugars are also associated with gout risk. It is advised that people with gout limit or avoid sugar-sweetened beverages and other sweetened foods, such as sugary cereals, baked goods, and candy, and limit consumption of naturally sweet fruit juices. Naturally sweet whole fruits are not restricted—these healthy foods contain protective nutrients like antioxidant vitamins, which research suggests may have an anti-gout mechanism.

Alcohol consumption is associated with increased risk of gout flare-ups. Swap out boozy beverages and hydrate with water, non-sweetened beverages, or coffee. Additionally, dehydration has been shown to increase uric acid levels and trigger gout because it makes it harder for the kidneys to filter uric acid from the blood.

Research has found that people with hyperuricemia tend to have an overall diet which is low in vegetables, lower than average in dairy intake, and higher in alcohol consumption. Work towards an overall healthy dietary pattern to reduce your risk for flare-ups of this painful and debilitating disease.

The post Keep Gout at Bay appeared first on University Health News.

Once you have had an attack of gout, you need to start treatment to prevent another attack, because gout often comes back. Without treatment, you can expect another attack within two years. People with frequent attacks can develop a type of long-term gout that does not go away. It can cause painful lumps in or near joints and can cause damaging deformity of a joint. The good news is that treatment works well. Gout is very controllable for most people. [1]

What Causes Gout?

Gout occurs when you have too much uric acid. Uric acid is formed when your body breaks down a type of building-block molecule called a purine. Purines are naturally found in your body and they also come from certain types of food. It’s normal to have some uric acid in your blood, but if you have too much, uric acid can travel from your blood to your joints. Inside your joints, uric acid forms needle-shaped crystals. [2]

Your body’s defense system reacts to the crystals and tries to get rid of them. This reaction causes swelling and irritation called inflammation. Inflammation makes your joint red, swollen, hot, and tender. That is the gout attack. About two percent of people will have a gout attack at some time. Why this happens remains a mystery, because most people can have high levels of uric acid in their blood without having an attack. [1,2]

You may be at higher risk if:

• You are a man aged 30 to 45.
• You are woman over age 55.
• You have a family history of gout.
• You have high blood pressure, diabetes, or kidney disease.
• You are overweight.
• You drink alcohol.
• You eat foods high in purines or drink beverages sweetened with high-fructose corn syrup, like sodas. [1,2]

What to Do for a Gout Attack

Medication may shorten a gout attack. Your doctor may prescribe medication that blocks inflammation called a nonsteroidal anti-inflammatory drug (NSAID), you may also take a drug called colchicine or a strong anti-inflammatory steroid drug. Over-the-counter NSAIDs include ibuprofen and naproxen. [1,2]

These drugs will reduce the pain and inflammation, but there are also home treatments that will help. Home treatment includes resting your joint, elevating your joint above the level of your heart, and using ice packs to reduce pain and swelling. [1,2]

Prevention

Although gout usually starts in your big toe it can also affect your fingers, knees, or hips. [2] Gout can lead to kidney stones and can cause permanent damage to joints and tissues that surround joints. Medication and home treatments do a good job of preventing future attacks and long-term damage. [1]

If your doctor does a blood test that shows you have high uric acid levels after a gout attack, you may be started on a medication to lower uric acid. Medications to prevent attacks may be used for people who have more than three attacks per year, have severe gout, or kidney stones from gout. [2]

Lifestyle changes for prevention are an important part of treatment. They include:

• Losing weight if you are overweight
• Getting regular exercise
• Limiting alcohol
• Drinking lots of water to help your kidneys flush out uric acid
• Limiting fructose-sweetened drinks
• Limiting foods high in purines like red meats, organ meats (kidney and liver), shellfish, sardines, and anchovies
• Eating a diet low in salt and saturated fat.
• Including lots of fruits vegetables and whole grains in your diet [1,2]

RECOMMENDED FOR YOU

• Gout Foods: Keep These 6 Foods in Your Diet
• Add the DASH Diet to the List of Gout Remedies
• What Is Gout?
• What Could Be Causing Your Gout Symptoms?
• Gout in Ankles, Knees, and Feet: More Common Among Men

SOURCES

1. NIH, Overview of Gout
2. AAOS, Gout

The post How Long Does Gout Last? appeared first on University Health News.

What is gout? It’s an inflammatory arthritis–some call it “gouty arthritis”—caused by the formation of needle-like uric acid crystals in the joint. Hyperuricemia (high blood urate levels) leads to crystal formation and severe episodes of acute pain, stiffness, tenderness, warmth, redness, and swelling, often striking along the base of the big toe.

In its chronic form, gout can cause irreversible damage to the joints, tendons, and other soft tissue.

The Pathology of Gout

Gout is primarily a metabolic disorder in which uric acid (also known as urate) accumulates in blood (hyperuricemia) and tissues. When tissue levels reach saturation, needle-like crystals form, causing inflammation. This occurs most commonly in the cooler joints, notably the metatarsophalangeal joint of the big toe.

Many people with hyperuricemia never develop gout, but those with the highest levels are most likely to suffer episodes. Hyperuricemia may also lead to kidney stones.

Gout in Foot: Causes and Risk Factors

In about 90 percent of hyperuricaemia cases, there is impaired renal excretion; in about 10 percent, there is a problem with overproduction.

• Urate overproduction can be linked to lifestyle factors and certain diseases such as bone marrow cancers, psoriasis, and hemolytic anemia. Lifestyle factors include being overweight and ingesting excess amount of fructose or alcohol.
• Renal impairment has multiple causes, including gene mutations, hypertension, diuretic drugs, lead exposure, and cyclosporine immunosuppressive therapy.
• Gender and age. Men are twice as likely to develop gout as women. In men, the risk rises with age. Gout is uncommon in younger women but the incidence increases dramatically after menopause, due to falling estrogen.
• Western diet. There is solid evidence from the Health Professional Follow-up Study (HPFS) of a link between gout and purine-rich foods. See gout diet.
• Medications. Diuretics, antihypertensives, niacin, aspirin, chemotherapy and immunosuppressive drugs increase the risk of gout.
• Other conditions. Certain conditions carry an increased risk of gout including: Recent joint injury or surgery, cardiovascular disease, chronic pulmonary disease, anemia, psoriasis, renal disease, blood cancers, and metabolic syndrome.

Symptoms and Signs of Gout in Foot

An attack of gout is often sudden. Symptoms:

• It may present with excruciatingly painful swelling of joints; in the big toe, it is known as Podagra. The joint may be stiff and appear red or purple, very swollen, and tender to even light touch. Other gout sites include the instep, wrist, ankle, fingers, and knee.
• Skin may peel and itch as healing begins.
• An attack often begins at night; the acute phase lasts up to 12 hours. If untreated, the inflammation may last up to two weeks. In 10 percent of people, acute episodes present in more than one joint.
• Kidney stones precede the onset of gout in 14 percent of patients.
• Chronic gout may develop, and it may affect more than one joint, mimicking rheumatoid arthritis.
• Tophi are soft tissue swellings caused by urate buildup in chronic gout. They may be found in the ear, fingers, toes, kneecap, and elbow.

Some people have a single attack of gout, others are affected intermittently, often when they have overindulged or experienced dehydration.

Diagnostic Evaluation of Gout in Foot

What goes into a gout diagnosis? These procedures are options:

• Joint aspiration. Fluid is withdrawn from the joint and inspected for crystals and bacteria.
• Blood tests. White blood cell count, ESR (erythrocyte sedimentation rate), triglycerides, and kidney function (urea and creatinine) may be elevated.
• X-ray. An x-ray of the affected joint is likely to appear normal during an initial acute episode, but in chronic gout, bone erosion and overhanging edges may be seen.

Treatment of Gout

Your doctor will determine the treatment for gout that you require, perhaps using the American College of Rheumatology (ACR) 2012 guidelines.

Initial treatment

• In an acute attack, a combination of NSAIDs (nonsteroidal anti-inflammatory drugs), corticosteroids, and colchicine may be needed. Steroids can be given orally or injected into the muscle or joint. Rest, elevation, ice packs, and increasing water intake may also help alleviate symptoms.
• Colchicine is a drug that decreases swelling and reduces the buildup of uric acid crystals. Side effects are common and include nausea, vomiting, and diarrhea. It may be used in the acute phase and to prevent further flare-ups.
• Urate-lowering-treatment (ULT) is usually commenced following an attack. These drugs may be considered if colchicine is not effective, if multiple joints are involved, or if there is a history of kidney stones. These include allopurinol (Aloprim), febuxostat (Uloric), and probenecid (Benemid).

Lifestyle change

• Regular exercise and eating a healthy diet will not only help you reach a healthy weight but may also reduce gout flare-ups. Purine-rich foods in particular should be restricted. See our article “Gout Foods: Keep These 6 Foods in Your Diet.”

RECOMMENDED FOR YOU

• Gout Foods: What Food Should I Avoid with Gout?
• How Long Does Gout Last?
• Gout: A Type of Arthritis That is Linked With Heart Disease

This post was originally published in 2017 and has been updated.

The post Gout in Foot? Here’s How It Happens—and How to Treat It appeared first on University Health News.

Gout is one of the few types of arthritis in which diet seems to play a genuine role. What food causes gout—or, we should say, may contribute to gout?

Some studies have found that drinking water or skim milk as your main beverages may help prevent gout attacks; consuming meat, seafood, and sugary drinks and fruits may increase gout risk. So if you have gout or are at increased risk of developing gout, your doctor likely will recommend a diet that limits purine-rich foods and beverages.

Our handy checklist of three basic gout relief dos and don’ts will help you avoid the condition or lessen its effect.

Uric acid deposits in joints create sometimes severe cases of gout. Feet are especially susceptible, but gout also strikes knuckles and hands.

Gout Relief Tip #1: Avoid High-Purine Foods and Beverages

• Meats: veal, turkey, gravy, broth, bouillon, and consommé
• Organ meats (liver, kidneys, hearts, sweetbreads, brains)
• Game meats, including venison
• Seafood: anchovies, fish eggs, sardines, herring, mackerel, trout, cod, haddock, scallops, and mussels
• Beer and distilled spirits

Gout Relief Tip #2: Limit Moderate-Purine Foods to Occasional Consumption

• Moderate-purine vegetables include asparagus, cauliflower, green peas, kidney beans, lima beans, spinach, and mushrooms.
• Moderate-purine meats include beef, ham, chicken, duck, and pork.
• Moderate-purine seafood includes crab, oysters, and shrimp.
• Oats and oatmeal, wheat germ and bran, and whole-grain breads and cereals are other moderate-purine foods to limit.

Gout Relief Tip #3: Get Your Vitamin C

Vitamin C may have a role in reducing the risk of gout. One study found that men with higher intakes of vitamin C through food and supplements had a reduced risk, while another found that vitamin C supplementation significantly reduced levels of uric acid, which can accumulate and form the crystals that cause gout pain.

Stay Informed…

One more important gout relief tip: Stay informed. University Health News offers a number of free posts that can help you deal with gout conditions:

• “What Could Be Causing Your Gout Symptoms?“
• “How Long Does Gout Last?“
• “Gout Foods: Keep These 6 Items in Your Diet“
• “Add the DASH Diet to the List of Gout Remedies“
• “Of Pain and Purines: Lower Your Uric Acid to Ward Off Gout Flare-Ups“

Originally published in May 2016 and updated.

The post What Is Gout? appeared first on University Health News.

You wake up feeling stiff and sore, a feeling that doesn’t quite leave you throughout the day. Over-the-counter pain relievers aren’t quite keeping up with the pain, and you’re not quite able to keep up with your grandkids when they ask you to play in the yard. Rather than suffering in silence, equip yourself with solid information so you can speak knowledgeably to your doctor. In this patient-empowered age, the two of you will be able to find a solution that helps.

First order of business: Determine what you have.

What Is Osteoarthritis?

Over time, cartilage loses much of its elasticity and strength and becomes more likely to tear and split when stressed. As a result, its cushioning properties diminish, leading to the most common form of arthritis: osteoarthritis (OA), or “wear and tear” arthritis.

About 60 percent of adults over age 60 have joint degeneration as revealed by X-rays. Though it most often occurs in weight-bearing joints such as the hips, knees, ankles, and spine, OA can affect the shoulders, hands, and feet as well.

What Are the Risk Factors for OA?

A combination of factors makes a person more likely to develop osteoarthritis:

• Obesity: The more you weigh, the more stress you put on your ankles, hips, knees, and spine. It’s estimated that each additional pound of body weight puts three extra pounds of stress on your knees as you walk. Losing weight lowers your risk for OA, and may help slow the development of the disease once you get it.
• Injury: Previous injury to a joint seems to put you at higher risk of developing post-traumatic arthritis in that joint later on.
• Overuse: If your daily behavior involves repeated, heavy use of a joint, especially accompanied by bending, then you are at higher risk of developing arthritis in that joint. This is especially true of the spine and the knee.
• Genetics: Some people are born with defects in the cells (chondrocytes) needed to make and maintain the collagen that is a key component of joint cartilage.
• Anatomy: Some studies suggest that certain abnormalities in your anatomy—including unequal leg lengths and flat feet—may lead to problems with OA.
• Smoking: Smoking has been linked to greater cartilage loss and more pain in people who already have OA.
• Diabetes: People with type 2 diabetes are at greater risk of OA, although obesity (a prime type 2 diabetes risk factor) may be more to blame than the diabetes itself.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease of the joint lining, or synovium, and is the most common form of inflammatory arthritis.

With RA, a faulty immune system engages in “friendly fire,” triggering a gradual destructive attack on the joints, as well as on organs throughout the body. The joint lining becomes inflamed and swollen, releasing enzymes into the joint capsule that, over time, eat away at the bone and cartilage. As the cartilage is destroyed, the cushion between bones is lost, and the bone rubbing against bone becomes increasingly painful.

What Are the Risk Factors for RA?

Though the precise causes of RA are unclear, several factors may increase your risk:

• Being female: Though it can affect anyone, including children, RA affects women twice as often as men.
• Getting older: The incidence of RA increases with age, with onset usually occurring between 30 and 50 years of age.
• Infection: There is some suggestion that exposure to an infection, such as a virus or bacterium, may cause an abnormal immune system reaction in those who are already susceptible to RA, thus triggering the disease.
• Obesity: Emerging evidence has identified a potential link between obesity and the development of RA. Like RA, obesity has been linked to inflammation, and fat tissues and cells produce substances involved in inflammation and immunity.
• Genetics: Inheriting specific genes may make you more likely to develop RA. For instance, HLA-DR4, a genetic marker associated with RA, is found in as many as 60 to 70 percent of Caucasians with the disease, compared to only 30 percent of the general population.
• Inflammatory pathways: Proteins known as cytokines are involved in inflammatory diseases such as RA.
• Smoking: Use of tobacco has been directly linked with an increased risk for developing RA, and with greater disease severity. On a positive note, some evidence suggests that compared to those who continue to smoke, RA patients who quit smoking may see improvements in joint tenderness, swelling, stiffness, and disease activity.
• Gum disease: Emerging research continues to uncover an association between gum (periodontal) disease and RA. Both conditions are characterized by damage from a wayward immune response and inflammation.

What Is Gout?

Another form of arthritis, gout, occurs when uric acid crystals are deposited in the joints. Uric acid forms when the body metabolizes substances called purines, which are found in a variety of foods.

Gout is one of the few types of arthritis in which diet seems to play a genuine role. Some studies have found that drinking water or skim milk may help prevent gout attacks, while consuming meat, seafood, and sugary drinks and fruits may increase gout risk. So if you have gout, your doctor likely will recommend a diet that limits purine-rich foods and beverages.

If you’re at increased risk of gout or already have it, consider the following steps.

• Avoid high-purine foods and beverages: Organ meats (liver, kidneys, hearts, sweetbreads, brains); game meats (venison); anchovies, fish eggs, sardines, herring, mackerel, trout, cod, haddock, scallops and mussels; veal, turkey, gravy, broth, bouillon, and consommé; and beer and distilled spirits.
• Limit moderate-purine foods to occasional consumption: Asparagus, cauliflower, green peas, kidney beans, lima beans, spinach, and mushrooms; beef, ham, chicken, duck, and pork; crab, oysters, and shrimp; oats and oatmeal, wheat germ and bran, and whole-grain breads and cereals.

Vitamin C may have a role in reducing the risk of gout. One study found that men with higher intakes of vitamin C through food and supplements had a reduced risk, while another found that vitamin C supplementation significantly reduced levels of uric acid, which can accumulate and form the crystals that cause gout pain. (See also our posts “Gout Foods: Keep These 6 Items in Your Diet” and “Foods to Avoid with Gout.”)

The post What Is Arthritis? It Could Be Gout, Rheumatoid Arthritis, or Osteoarthritis appeared first on University Health News.

But gout also can be a painful and chronic health issue for women, especially after menopause.

“Gout can be a serious problem in women, and they certainly should be more aware of it,” says Theodore Fields, MD, a rheumatologist at the Weill Cornell-affiliated Hospital for Special Surgery. “Gout is the most common type of inflammatory arthritis. An estimated 8.3 million people have gout in the U.S. Women should be aware of the warning signs of gout, such as a hot and red ‘bunion joint,’ and should seek attention for signs of joint inflammation.”

But gout awareness is about more than avoiding painful joints. Gout is associated with higher risks of heart attack, stroke, and heart disease.

What Is Gout?

Dr. Fields notes that gout’s most obvious symptom is usually isolated in the foot—in the large joint of the big toe, in particular. But some people feel the stinging pain of gout elsewhere in their feet or ankles, as well as their hands and knees. The pain usually subsides after a couple of days, though some minor pain and stiffness may linger.

Gout is caused by a buildup of uric acid. “In 90 percent of patients, the crystals build up because their kidneys don’t excrete uric acid normally; in 10 percent of patients, their bodies make too much uric acid,” says Dr. Fields. “Either way, uric acid builds up in the blood and then gets deposited, especially in the joints.”

Uric acid crystals

Potentially Serious Effects

When uric acid crystals are found in large amounts in the urine, they may cause kidney stones. Excess uric acid in your body also may make you more resistant to insulin, increasing the odds that you’ll develop diabetes.

But it is the cardiovascular risk associated with gout that may be the most alarming. “In studies, heart attack appears to be more common in patients with gout,” says Dr. Fields. “It is believed that, as in many inflammatory conditions such as rheumatoid arthritis and psoriatic arthritis, the inflammation in blood vessels caused by uric acid crystals may predispose you to develop hardening of the arteries. Gout patients also more commonly suffer from hypertension, high cholesterol, and obesity than the general population, which all increase cardiac risks.”

Treatment Options

While gout can’t be cured, for some patients, it may be managed fairly easily. “If someone has had only one gout attack, we can try dietary changes and weight loss,” says Dr. Fields. “Dietary strategies include limiting alcohol of all types, especially beer, limiting red meat and shellfish, and limiting high fructose corn syrup, which is typically found in soft drinks.”

Other patients may require medications that may include over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs), as well as colchicine, a pain reliever specifically designed to treat gout. Other medications include long-term uric acid-lowering medications, such as allopurinol (Zyloprim) or febuxostat (Uloric).

However, to keep symptoms under control, it’s important for gout patients to become educated about why they need long-term treatment and to commit to the treatment. “The success of long-term treatment of gout is spectacular, but only if people stick to the recommended diet and stay on medication if it’s been prescribed,” says Dr. Fields.

Your primary care physician may be able to handle your gout treatment, but Dr. Fields advises that patients with more serious cases consult a rheumatologist.

He adds that, since women are less likely than men to suffer from gout, women are often less aware of gout than men are. “After menopause, women are much more likely to develop gout than before menopause,” says Dr. Fields. “It appears that estrogen helps keep uric acid levels low by increasing the amount of uric acid eliminated in the urine.”

He also urges women who have gout symptoms to see a doctor immediately. When gout is diagnosed and treated early, symptoms often can be reduced, and a proactive treatment plan can be developed to prevent future episodes.

The post Gout: An Inflammatory Disease That Affects Women as Well as Men appeared first on University Health News.

Q. I?ve been on a low-carb, high-protein diet and I recently experienced an attack of gout. Could my diet be to blame?

A. Possibly. Diet is one of several factors linked to gout. Family history, age, gender, certain drugs, obesity, alcohol, high-purine foods and quick weight-loss diets may increase your chances of getting gout. Plus, there is growing concern that extremely low-carb diets, which are high in animal protein and fat, may exacerbate gout.

What Is Gout? Gout is a painful form of arthritis that occurs when the body produces too much uric acid or is unable to excrete it properly. Uric acid results from the breakdown of purines, substances found in all the body’s tissues and in certain foods, such as meat and seafood. Excessive uric acid builds up in the blood, which in itself is not a problem. But if uric acid crystals form in the joints, gout develops. An acute attack of gout most often first affects the big toe, causing redness, swelling and intense pain. Over time, uric acid crystals may also form in other joints, soft tissues and the kidneys.

   The prevalence of gout is on the rise. That fact should come as no surprise since it is associated with obesity, high blood pressure, abnormal blood lipids and diabetes, conditions which are also on the upswing. Gout is most likely to strike men over 30 and, less frequently, postmenopausal women. It is treated primarily with medications to control the pain and inflammation of acute attacks, to reduce high blood uric acid levels and to help prevent future attacks and complications. However, proper diet may complement drug therapy and aid in the management of gout.

The Diet Connection. A high-purine diet is known to increase blood uric acid levels, but whether eating a diet low in purine-rich foods, like meat, seafood, mushrooms, spinach, asparagus and beans, reduces the incidence of gout is unclear. In a 12-year study of more than 47,000 male health professionals with no prior history of gout, researchers found that the risk was greatest in men who ate the most seafood and meat and lowest in men who ate the most dairy products, especially low-fat dairy. Surprisingly, total protein intake did not affect the incidence of gout.

EN‘s Bottom Line.  EN, with the help of Robert Terkeltaub, M.D., chief of rheumatology at the VA Medical Center in San Diego, offers these tips to manage gout and keep blood uric levels in check:

?  Eat meat, seafood and alcohol in moderation; cut down on refined carbohydrates and foods high in saturated fat; cut back on portion sizes.

?  Drink plenty of fluids, especially water, to help flush out excess uric acid.

?  Maintain a healthy weight, but avoid extremely low-carb, ketogenic and rapid weight-loss diets, which may increase uric acid levels and worsen your gout.

?  Take the medications prescribed by your doctor’they?re your best defense against an attack of gout.

?Adrienne Forman, M.S., R.D.

The post Gout Is New Risk to Consider When You Opt for Low-Carb appeared first on University Health News.