Gout is a painful disease of the joints that can occur in individuals who have high levels of uric acid in their blood. Uric acid can irritate and damage the joints, as well as the kidneys, urinary tract, and other areas of the body.
The majority of cases occur when the kidneys are not able to remove excess uric acid from the body, most commonly in patients with chronic kidney disease. The remaining cases occur when too much uric acid is produced in the body, as may occur in cases of psoriasis, leukemia, and other disorders.
Symptoms include joint pain and swelling, most commonly in the big toe, knee, ankle, or wrist. Another common occurrence is kidney stones, which may result in severe abdominal pain, painful urination, and bloody urine.
Risk Factors
- Age: Risk increases with age.
- Gender: Gout is more common in males, possibly because estrogen in women promotes the passage of uric acid in the urine.
- Family history
- Dietary factors: See Nutritional Considerations.
- Obesity
- Medications, including diuretics, cyclosporine, aspirin, and niacin
- Stress, trauma, or surgery may increase the risks of flare-ups.
Gout: Diagnosis and Treatment
Diagnosis
- A medical history and a physical examination can suggest the diagnosis. However, laboratory testing is required for a definitive diagnosis.
- Blood and urine tests usually show high levels of uric acid.
- A joint aspiration may be necessary. In this test, a small needle is placed into the affected joint, and some joint fluid is removed. This fluid is examined under a microscope to assess for crystals of uric acid or other signs of gout.
- In longstanding cases, X-rays of the joints may reveal abnormalities consistent with gout.
Treatment
- Prevention of flare-ups may include dietary changes (see Nutritional Considerations, below) and medications (e.g., allopurinol or probenicid).
- Flare-ups are most commonly treated with bed rest and nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen or indomethacin). Steroids may be used in cases of severe disease or in individuals who cannot take NSAIDs (e.g., patients with a history of stomach ulcers or kidney disease).
- Surgery is reserved for severe cases that cannot be treated with the above measures.
Nutritional Considerations
The following factors are associated with decreased risk of gout:
- Reducing or avoiding meat: Studies have found that individuals who eat the most red meat, poultry, and fish have higher uric acid levels and a greater risk of developing gout, compared with those who eat the least.
- Weight control: Being overweight is a strong risk factor. Compared with men at or near their ideal weight, overweight men (BMI of 25 to 29.9) have almost double the risk for developing gout. Risk is nearly tripled for those with a BMI of 35 or greater.
- Avoidance of alcohol: Higher uric acid levels are associated with alcohol intake in men.
In addition, the following diet and lifestyle considerations should be noted:
- Elevated lead levels: Elevated lead levels increase uric acid and may increase the risk for gout. However, a definite relationship has not yet been established.
- Kidney stones: The strategies that are used to prevent kidney stones, such as drinking two liters or more of water and water-based beverages per day, may reduce the risk of uric acid kidney stones in gout patients.
- Cherry consumption: An intriguing but unconfirmed report found that consuming roughly 9 ounces of bing cherries (280 grams, or 45 cherries) daily was associated with a significant reduction in uric acid levels. However, further study is necessary before this can be recommended as a preventive treatment.
