Gout – What You Need To Know About Causes, Treatment, and Prevention

Why is gout more common now? There are three reasons this is true: we are living longer, we have higher rates of obesity and other chronic diseases like diabetes, and we have higher rates of uncontrolled high blood pressure.

More on these risk factors, how to treat gout and how to prevent flare ups below.

Causes of gout

Gout is a problem of too much uric acid in the bloodstream. That excess uric acid forms into crystals of monosodium urate, which deposits in the joints and causes the inflammation and intense pain that comes with a gout attack.

Risk factors for gout

Your chances of getting gout increase if you have high uric acid levels. Certain medications, health factors, and dietary choices may affect your risk.

• Older age. Gout happens more often in older people, disproportionately affecting those over the age of 65.
• Male gender. Gout is generally more common in men. However, uric acid levels in women start to catch up to those in men after menopause, so the risk for gout in both genders becomes more comparable later in life.
• Medications. Popular medications like aspirin and diuretics that treat high blood pressure can increase your risk for gout.
• Health conditions. Medical conditions like uncontrolled blood pressure, diabetes, obesity, and kidney disease can increase your risk for gout.
• Diet. A diet rich in carbohydrates, alcohol (especially beer), meat and seafoods, and drinks sweetened with fructose can contribute to gout.  

Diagnosing gout

Laboratory tests from your doctor can help diagnose gout and distinguish it from osteoarthritis (“wear and tear” arthritis). These are the two recommended methods for diagnosing gout:

• Synovial (joint) fluid analysis. If there is fluid in the joint, your doctor may take a sample by putting a needle into the joint and then test the fluid for crystals. This is the gold standard for diagnosing gout.
• Blood tests. Blood tests that can indicate whether or not you have gout include measurements for white blood cell count, ESR (erythrocyte sedimentation rate), C-reactive protein, and uric acid.

Treatments for gout attacks

NSAIDs, steroids, and colchicine can help relieve pain and inflammation during a gout attack. Remember, the faster you treat the attack, the faster the episode goes away. 

• NSAIDs (non-steroidal anti-inflammatory drugs). Over-the-counter NSAIDs like naproxen (Naprosyn) and ibuprofen (Motrin) and prescription-only NSAIDs like indomethacin (Indocin) and celecoxib (Celebrex) all work for the pain and inflammation during an acute attack. 200 mg of Celebrex twice a day has been found to be just as effective as 50 mg of indomethacin three times a day for a gout flare up. You can stop the NSAID two to three days after your symptoms resolve.
• Steroids. Steroids like prednisone are sometimes used to treat pain and inflammation during acute gout attacks, but they aren’t a great option for many reasons—including the fact that when you stop taking them, you may have rebound symptoms and another gout attack.
• Colchicine (Colcrys). Colchicine is another option as effective as NSAIDS and steroids. Take 0.6 mg of colchicine three times on the first day of a gout flare up, then once or twice daily until your flare resolves.  

Prevention, the key to success

60% of patients who have an attack of gout will get another one in a year, 78% in two years and 84% in three years. If you’ve had a gout flare up, odds are you will have another one—so be ready. 

Dietary changes

Just decreasing intake of shellfish, beer and red meat can lower the uric acid in your bloodstream. Adding more low-fat and nonfat dairy products will help prevent attacks as well.

Medications

If you have recurrent attacks of gout, your doctor may place you on a daily medication for prevention. There are two medications to know about when it comes to prevention, both from the class of drugs known as xanthine oxidase inhibitors, which limit how much uric acid the body makes:

• Allopurinol. Allopurinol is the first-choice medication for preventing gout attacks. Its recommended dosage is 100 mg a day. If you already started taking allopurinol and have a gout flare up, continue taking it unless your doctor says otherwise.
• Uloric. Uloric (febuxostat) is a newer alternative to allopurinol, but safety concerns raised by the FDA about possible increased cardiovascular risk mean that Uloric should be avoided or used with caution in patients with a higher risk for heart disease. Uloric can help lower uric acid levels when allopurinol hasn’t worked and given all else equal, it’s safer in folks with kidney disease. But, Uloric will cost you; at a cash price of $400 for a month’s supply, it can be very expensive.

Supplements

A Cochrane review of two clinical trials found no good evidence for dietary supplements to help reduce pain from gout or lower uric acid levels. Neither skim milk powder nor vitamin C, supplements widely used for gout, showed any significant impact in the studies.

Hope this helps.

Dr O.

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