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Gout Can Be a Royal-sized Pain

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Sometimes referred to as the “disease of kings,” gout has a long history of being linked to the kind of over-indulgence in food and drink that only the wealthy could afford. However, gout can affect anyone, and diet is only one contributing factor for the condition.

According to the American College of Rheumatology, gout occurs in approximately 9.2 million Americans, most commonly men, although women, especially after menopause, are also susceptible.

“Gout is a fairly common form of inflammatory arthritis that is caused by a build-up of uric acid in the blood and body,” said Somphone “Sam” Beasley, FNP, with SamCare Mobile Medicine.  “A gout attack can come on very suddenly with often severe, needle-like pain. The pain can be so intense it can require a trip to the emergency room.”

A gout attack often effects the joint in the big toe, but can also flare in ankles, knees, elbows, wrists and fingers, and in addition to the pain, is characterized by swelling, redness and a hyper-sensitivity to touch.

“I’ve heard people say that even the weight of a bedsheet on the toe can be painful,” Beasley noted.

What Causes Gout?

The body produces uric acid during the process of breaking down chemical compounds called purines, substances that are naturally found in the body and in certain foods and beverages, such as animal proteins, sugary drinks and alcohol.

“When everything is running optimally, uric acid dissolves in the blood and passes through the kidneys into the urine. If the body produces too much uric acid or cannot process it thoroughly, it accumulates in joints and surrounding tissue, causing crystals to form,” Beasley explained. “The crystals cause the sharp pain, swelling and inflammation.”

Gout affects everyone differently. Some will have gout attacks regularly, while others can go months or years without having another episode.

Diagnosing Gout

“While the intense pain of gout will pass, it is still important to see your health care provider if you have a gout flare-up. They’ll want to rule out something else like a possible infection in the joint, but also, if gout is left untreated, it can lead to permanent joint damage,” said Beasley.

“Your health care provider may recommend a basic blood test to check uric acid levels, and a joint fluid test. A joint fluid test uses a needle to extract fluid from the joint to test for crystals,” Beasley noted. “Your medical clinician may also order an imaging test to verify that there are no other problems in the joint or surrounding tissue.”

Treatment of Gout

Once diagnosed, treatments for gout vary depending on kidney function and your condition.

“During the gout attack, there are medications, such as nonsteroidal anti‐inflammatory drugs (NSAIDs), which can help to minimize pain and swelling,” said Beasley.

“After the pain has resolved, and depending on your individual situation, your health care provider may recommend a medication for longer-term use that will work to lower the uric acid level over time to prevent or lessen gout attacks,” Beasley said. 

While family history plays a role in causing gout, so do chronic conditions such as obesity, diabetes, hypertension and kidney disease.

“It’s important to work with your medical provider to manage any chronic issues you have. In addition, there are things you can do daily to manage gout, such as eating healthy, getting regular exercise and maintaining a healthy weight,” said Beasley.

Ways to Self-manage Gout

Although there is no cure for gout, these self-management strategies can help to minimize gout flares.

  • Limit foods high in purines, such as:
    • Red meat.
    • Organ meats, such as liver.
    • Wild game, such as venison.
    • Shellfish, anchovies, sardines and tuna.
    • Alcohol in excess, especially beer and grain liquors.
    • Sugary drinks with fructose, such as soda and fruit juice.
  • Maintain a healthy weight by eating plenty of vegetables and fruits, whole grains and lean protein, and by getting regular exercise. When overweight, the body produces more uric acid and the excess weight forces kidneys to work harder.
  • Some medications can raise uric acid levels in the body, such as diuretics, immunosuppressants and others. Work with your health care team to find the best solution for your situation.
  • Drink plenty of water throughout the day (8 to 10 glasses a day) to stay hydrated and help kidneys function at their best.

“While gout and related high levels of uric acid can be a lifelong condition, sticking with your treatment plan, maintaining a healthy diet and incorporating regular exercise into your day all can go a long way in minimizing the frequency of episodes and pain,” said Beasley.

Somphone “Sam” Beasley, FNP, serves patients at Samaritan Express clinics in Albany and Corvallis, as well as SamCare Mobile Medicine. She can be reached at 541-768-5166.