Users Guide to Gout

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Not all big toe pain is gout—but you may have been hearing more about it recently. The prevalence of gout has increased greatly over the past 30 years.

So what is gout, why do we get it, and how can you get rid of it?

Why more gout? There is more gout for three main reasons: we live longer, more people have high blood pressure and diabetes, and common medications like aspirin and diuretics increase the risk of gout.

Did I do something wrong? Simply put, eating and drinking more carbohydrates, proteins, and drinks containing fructose contributes to gout. Avoid white bread, cakes, candy, sugar-sweetened beverages high-fructose corn syrup. Limit proteins from lean meat, fish and poultry.

Is the gout all my fault? Nope. Gout is a problem of too much uric acid in the bloodstream, which leads to crystal formation of monosodium urate crystals, which deposit in the joints. That causes the pain and inflammation. Also, men develop gout more often than women, though women are at risk for gout after menopause.

How do I know if the pain in my great toe or joint is gout? See your primary care doctor. But, you can presume you have gout if you have: development of severe pain, swelling and tenderness in a joint that reaches its maximum within 6-12 hours—especially with redness, and often in the big toe, knee or ankle. The most important things other than gout to “rule out” are an infected joint, pseudo gout and rheumatoid arthritis.

What can I do on my own to avoid a gout attack? Just decreasing intake of shellfish, beer and red meat can lower the uric acid in your blood stream. Between attacks, get your act together: changing your diet, weight loss, and reducing your alcohol intake can all help.

I’ve had gout. Will I get it again? Yes, probably. Sixty percent of patients who have an attack of gout will get another one in a year, 78% in two years and 84% in 3 years.

What medications can I take for an acute gout attack? If you have normal kidney function you can take NSAIDs. Either naproxen twice a day or indomethacin three times a day (then taper down) within 48 hours of your attack work the best. Use them for 5-7 days for relief of pain and inflammation.
If you can’t take NSAIDS, you can use colchicine instead. If more than 2 joints are involved and you can’t take NSAIDS or colchicine, a 7-10 day tapering course of corticosteroid prednisone is used. Know that recent studies show prednisone daily for 5 days was just as good as indomethacin three times a day for acute gouty attacks.

What medications can I take to PREVENT an attack? Folks with more than two gouty attacks per year who cannot prevent attacks through lifestyle measures (listed above) can take a urate-lowering medication to prevent attacks. First know this though: only 37% of patients taking medicines for gout are compliant with their meds, which (obviously) makes them less effective. Second, a common mistake is that symptoms of gout MUST RESOLVE before you start on allopurinol or Uloric (febuxostat) for prevention of your next attack.
A new intravenous medication, Krystexxa, is also now available for patients who have failed allopurinol or Uloric or have severe gout with tophi (deposits of uric acid crystals in the elbows, hips, etc resulting in bumps under the skin). At that point, you’ll want a rheumatologist taking care of you.

Dr O.

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