For some patients, gout, a painful form of arthritis, is simply a manageable annoyance. For others, it can be a chronic and debilitating condition that requires ongoing medications and significant lifestyle changes.
There's no easy cure for gout. The disease can be managed, however, through weight maintenance, diet changes and cutting alcohol consumption.
And though the condition can be tricky to treat, numerous medication choices exist depending on the symptoms, which can vary from patient to patient.
"For most people it's just really an inconvenience," said Dr. Albert Gros, chief medical officer of St. David's South Austin Medical Center in Austin. "But some people can have trouble walking, and get deposits or uric acid under the skin. Unfortunately for people who have it, kidney damage can happen in the long term."
Defining Gout
Acute gout is a condition that usually involves inflammation of one joint, typically the big toe. Many, however, suffer from chronic gout in which there are multiple episodes, often involving several joints.
Acute gout, also known as gouty arthritis, is caused by elevated levels of uric acid. In some, the body makes too much uric acid, while in others the body simply has difficulty getting rid of the acid. While there is a large population with high uric acid levels, only about 10 percent suffer from gout.
"About 90 percent are under secreters," noted Dr. Gros, who said the disease is also linked to metabolic syndrome, a broad group of conditions that occur together and can increase the risk for heart disease, stroke and type 2 diabetes.
Uric acid can build up in the fluid surrounding joints, causing crystals to form. Those crystals can lead to swollen, inflammed joints and chronic pain. In a small percentage of sufferers, those crystals can create oozing sores. Complications include passing kidney stones and chronic kidney failure. Those with chronic gout may develop joint deformities or lose motion in affected joints.
Another complication is the development of tophi. It usually only develops after a patient has had gout for several years. Those with tophi develop painful lumps below the skin around joints.
Symptoms of gout can develop very suddenly. Other joints affected include those in the knees, ankles, hands and elbows. Often, the pain begins at night and is described by patients as a throbbing or excruciating sensation, according to the National Institutes of Health. The affected joint may feel hot and look red in appearance. A fever also may be present.
Gout is usually diagnosed with a blood test to check for uric acid, or a fluid sample from the site of the tender joint to check for the presence of crystals. Infrequently, a biopsy is needed because the disease also has similar symptoms to septic arthritis, a rare bloodstream infection that leads to joint inflammation, Dr. Gros said.
Gout attacks often last several days. For some, flare-ups could be months, or even years, apart while others struggle with it on a freqent basis.
Lifestyle Management
Medication is usually part of a gout patient's way of life, but lifestyle changes can play a significant role in decreasing attacks.
Staying well hydrated, avoiding alcohol and eating a healthy diet are key to managing gout, Dr. Gros said. Patients should try to limit the amount of food consumed at each meal, while making sure that what they eat is high in carbohydrates and low in fat. Maintaining a healthy weight is important since obesity is a major risk factor for the condition.
Gout sufferers should consume only a moderate amount of protein each day. They should also avoid certain foods that contain a chemical called purines, often found in certain meats and fish such as sardines, anchovies, herring and organ meat, including kidneys, gizzards, liver and tongue. Gout patients should pass on oils, dried beans and peas, gravy, mushrooms, spinach, asparagus, cauliflower and brewer's yeast.
Overweight patients with gout are advised to lose weight slowly as rapid weight loss could cause kidney stones.
"There is a genetic predisposition," said Dr. Gros, "but being male and being overweight tend to make you more susceptible. And alcohol is a major factor."
Dr. Gros also said that certain medications, such as diuretics, usually taken to manage high blood pressure, can put patients at an added risk for the condition. Before drugs are needed to manage blood pressure levels, incorporating a healthy diet and exercising to reduce hypertension can decrease the risk of developing gout.
The Mayo Clinic has suggested that alternative treatments, such as consuming cherries and dark colored fruit like blackberries and blueberries, as well as coffee and vitamin C supplements, may help lower uric acid. Why these foods help reduce acid levels, however, are not yet known.
Gout and Drugs
Taking medications — sometimes several — is usually a part of living with gout. The types of drugs prescribed are often as varied as the patient.
Those who suffer several gout attacks each year often take a daily dose of allopurinol (Zyloprim, Aloprim) or probenecid (Probalan). Allopurinal limits the amount of uric acid the body can make, while probenecid aids the kidneys in helping the body remove uric acid from the blood. Other medications include steroid injections, corticosteroids, non-steroidal anti-inflammatory drugs, the pain reliever Colchicine, and sometimes even narcotic pain relievers are prescribed.
A newer drug, Krystexxa (pegloticase), approved in 2010, is also used for patients who do not receive relief from traditional medications. It works by breaking down uric acid. Krystexxa is dispensed though monthly intravenous injections in a hospital.
A small percentage of gout patients are extremely difficult to treat because they are resistant to most drugs currently used to treat the disease, Dr. Gros said. But he noted that new drugs on the horizon might be helpful.
"They're doing a lot of development of new medications. They're developing more sophisticated treatments," Dr. Gros said. "Within the next 20 or 30 years we may learn the trigger that causes the over- or underproduction of uric acid. We should never give up hope for developing a cure, but right now our main goal is management."
