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Gout -- how it starts and how to decrease its risk

Ivan Lian

When an individual has their first encounter with gout, it can develop quite suddenly, over a period of hours.

This week on “Take Care,” Dr. Robert Shmerling talks about risk factors and how to reduce your likelihood of getting gout.  Shmerling is a Harvard Medical School professor and clinical chief of rheumatology at Beth-Israel Deaconess Medical Center in Boston.

Gout causes sudden inflammation in various joints and is a result of a normal waste product the body makes called uric acid.

In its beginning stages, gout usually affects the big toe, causing swelling and what Shmerling calls “horrible pain.”

“Through evolution we lost an enzyme that helped us get rid of uric acid so it tends to build up in everyone, to some extent,” Shmerling says. “But, for a variety of reasons some people have more of it developed, or collect, in the body than other people.”

When high concentrations of uric acid exist in the body, blood levels increase which will cause uric acid to deposit into the joints. The crystals of uric acid that are formed can cause sudden inflammation and terrible pain.

“It can be quite excruciating,” Shmerling says.

Some risk factors for gout include age and dietary lifestyles. Age is a risk factor for gout because kidney function decreases with age.

“Declining kidney function is a risk factor for gout because uric acid is removed from the body largely through the kidneys,” Shmerling says.

Dietary components like high fructose corn syrup, alcohol, sea food and red meat can also increase the risk of developing gout.

Even medications can be considered a risk.

“A number of medications that are used to treat high blood pressure especially the diuretic-type medicine also contribute,” Shmerling says. “So, for a variety of reasons, the prevalence of gout is increasing, affecting up to a three or four percent of the adult population.”

Gout can run in families, but most people with gout have no family history of the disease.

“There have been a number of enzymes identified with genetic mutations which makes the enzymes either more active or less active depending on the enzyme involved but lead to higher uric acid and higher risk of gout,” Shmerling says.

Gout can often be diagnosed without a lot of tests.

“The symptoms, perhaps the physical exams, the assessment of all the risk factors that might be present, is often, altogether, good enough, to make the diagnosis,” Shmerling says.

However, the best way to find out if somebody has gout in a joint is to remove fluid from that area and look at it under a microscope.

“So, that’s the gold standard but, as you might imagine, if somebody awakens with a terribly swollen painful toe joint, the last thing they want is to have a needle put in there. So even though we use numbing medicine, it can be an uncomfortable procedure. Sometimes you can’t get much fluid out of every small joint so we often forego the joint fluid testing and make the diagnosis clinically.”

A blood test can also be done but it’s not always accurate.

The first choice in treating gout is an anti-inflammatory drug like ibuprofen or naproxen. Another option would be to inject cortisone steroids into the joint. Cortisone steroids are usually reserved for larger areas like the knee or the ankle.

Shmerling recommends that people decrease their red meat intake and moderate their alcohol consumption since beer and wine are probable risk factors.

But, Shmerling notes, a diet change won’t be that impactful, unless you’re eating the foods that are most likely to contribute to gout -- high-purine foods.

“Purines are the proteins that are in foods that are broken down into uric acid and a very high purine might include a lot of organ meat,” Shmerling says. 

If your diet consists of a lot of liver, pancreas and yeast, “you might have a very high-purine diet and be more at risk for gout,” Shmerling says.

He also suggests increasing coffee and diary consumption because they decrease risk.