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Toggledrop summary
Gout is a rheumatic disease that usually affects the joints, especially the joint base of the big toe in 75% of cases. This often chronic condition is characterized by severe joint inflammation that often causes severe pain. The pain caused by this disease is often excruciating. Gout is a form of arthritis.
The main cause of gout is high levels of uric acid in the blood (above 6.8 mg/dL, without uric acid solubilization). This molecule travels through the bloodstream and then accumulates in the joints in the form of crystals, which trigger an inflammatory reaction and severe pain.
Other factors may explain this increase in cases, such as taking antihypertensive medications (these can promote gout by increasing uric acid).
The elevation of uric acid in the blood can be due to genetic defects that lead to an increase in its production. Another reason that keeps it high in the blood is the inability of the kidneys to excrete the substance. Other factors such as a diet rich in meat and seafood, abusive intake of alcohol and consumption of some medications can increase uric acid levels and trigger gouty arthritis.
If left untreated, gout can become complicated, causing kidney stones and deposits of calcium ureate crystals under the skin.
To make an accurate diagnosis, the doctor must make a puncture in the joint. The presence of uric acid crystals confirms the presence of gout.
It is often a chronic illness. When a person stops taking medication and/or stops maintaining an adequate diet (no alcohol, no meat, for example), they will often see gout attacks reappear.
Treatment can be curative for gout attacks, with drugs such as anti-inflammatories and colchicine, or preventive, with the use of allopurinol .
For the patient who already suffers from gout or is prone to developing the disease, some tips can help prevent it, such as reducing the intake of alcoholic beverages, reducing meat consumption, drinking plenty of fluids and controlling weight.
3 Good Tips for Properly Managing Gout
1. Have a healthy diet and lifestyle (exercise, balanced diet, etc.)
2. Eat foods that are healthy for you and low in purines (see also Good Tips below).
3. Take your medications.
Sources: American College of Rheumatology, 2015
Read also: Interview with a teacher about gout, a very painful disease
Definition
Gout is a rheumatological, inflammatory and metabolic disease that affects one or more joints. It is a type of arthritis. It is important to note that gout almost always starts at joint extremities, such as the toes, knees, elbows or ankles.
Gout is caused by a deposit of uric acid in the joint region, which forms crystals, causing a lot of pain (one of the worst pains, according to some patients).
Gout is a disease that evolves by incidences, so we speak of a gout crisis when the pain becomes very intense.
Finally, it should be noted that it is important to treat gout well, through medication and/or changes in lifestyle, as kidney complications such as joint deformations can occur if the disease is not well treated. Only a doctor will be able to prescribe the appropriate medications (do not self-medicate!).
Famous people like Isaac Newton and Leonardo da Vinci suffered from gout.
Gout has also been called the disease of kings, because at the time, royalty held parties rich in meat and alcohol, two important risk factors for gout. We know that King Henry VIII of England suffered from this disease.
Gout is a disease known for about 4000 years.
Foto: Consolation in the Gout – Rheumatology Research Foundation – Atlanta, EUA.
Epidemiology
– Gout mainly affects men (20 times more than women, in 95% of cases) from the age of fifty.
Another study showed that 6 patients (male) and 1 patient (female) out of 1000 general practitioners in the UK suffer from gout. In this case, the male-female ratio is not 20, but 6.
On the same subject, a study published in January 2014, still in the United Kingdom, showed that the male-female ratio was 4 men to 1 woman.
– It is estimated that 1% of men over 40 suffer from gout. When women are affected, it is mainly after menopause.
– The first attack of gout often occurs in men between 20 and 40 years old.
– In children, the disease is rare, but when it occurs in this age group, it is often associated with well-defined metabolic problems.
– In Brazil, the incidence is 0.2 to 0.35 per 100 inhabitants (source: Revista Brasileira de Reumatologia).
United States
– In the United States, it is estimated that around 4% of American adults (source: American College of Rheumatology ) suffer from gout. This number has increased strongly (about twice as much as in 1994, reference year 2014), but since 2015-2016 we have observed a stabilization in the number of cases. In fact, according to data from 5,467 adults in the United States under the National Health and Nutrition Examination Survey(NHANES) for the years 2007-2016, researchers found that the prevalence of gout and hyperuricemia remained at 3.9%, doubling between the years 1960 and 1990, or approximately 9.2 million adults with gout in 2015 -2016. In the US, half of people affected by gout have 3 attacks of gout or more per year. A gout crisis lasts an average of 4 days.
Epidemiology of hyperuricemia
It is estimated that, in the general population, up to 20% of people suffer from hyperuricemia, according to an article published in November 2017 in the internal journal of the ACR Congress in San Diego (USA). For comparison, about 4% of the American population suffers from gout. This means that most people with hyperuricemia will not develop gout.
– In France, around 600,000 people suffer from gout (Source: National Health Authority, April 2014).
– In the UK, 3.2% of adults suffer from gout, according to a study published in the scientific journal BMJ in 2017. This number was higher than in previous decades, according to the BMJ .
In this country, it is estimated that one in every 40 people suffers from gout (Source: Annals of the Rheumatic Disease Journal).
In the world
As gout is largely associated with lifestyle, it is observed that globalization and junk food are related to the increase in the number of cases of gout worldwide. In any case, this is a frequently cited hypothesis.
Causes
Gout is caused by elevated levels of uric acid in the blood (hyperuricemia) above 6.8 mg/dL, ie above the solubilization point for uric acid. That is, above 6.8 mg/dL, urate crystals can form and then be deposited in joints such as the big toe.
In the US, gout experts recommend a uric acid level below 6 mg/dL. In patients with gout, this rate should be less than 5 mg/dL to prevent future attacks.
The more the concentration of uric acid in the blood decreases (for example, below 5 mg/dL or less), the greater is its solubilization in the blood. In general, uric acid dissolves in the blood without forming crystals and then passes through the kidneys and is eliminated through the urine.
Uric acid crystals cause tissue inflammation. Then there is the production of molecules present in the inflammatory process, such as interleukins. Physiologically, inflammation is not directly related to the uric acid crystals, but to the immune cells that attack these uric acid crystals, which are considered by the cells of the immune system to be foreign bodies.
Many people have high levels of uric acid in their blood but do not develop gout. Elevated levels of uric acid in the blood are a necessary but not sufficient condition for triggering attacks. It’s not clear why some people develop the disease and others don’t. Many people who suffer from gout have had high levels of uric acid for years before they experience their first attack.
formation of uric acid
The origin of uric acid is multiple. This molecule can arise in particular from residues formed by the breakdown of purines at the cellular level:
DNA (from a dead cell, meat, after cancer treatment, etc) > Purines > uric acid > from uric acid crystals in joints (gout).
To learn more about the causes of increased uric acid
In 80 to 90% of cases of gout, the cause is poor excretion of uric acid by the kidneys, not over-ingestion. In the kidneys, uric acid is then reabsorbed into the bloodstream, leading to hyperuricemia (excess uric acid).
Gout can be primary or secondary.
Primary gout:
This form of gout is not well defined, it is estimated that genetic factors influence the high levels of uric acid in the blood. Primary gout is also known as idiopathic gout.
Secondary gout:
In this form, several factors can increase the levels of uric acid in the blood, it can be due to:
– A diet high in meat, alcohol, etc.
tomato and drop
A study by the University of New Zealand, in the city of Otago, showed that eating tomatoes can promote gout, as pointed out by scientists who observed a strong correlation between tomato consumption and this rheumatological disease. According to researchers, eating tomatoes increases the level of uric acid in the blood. This particular study involving over 2,000 New Zealanders who suffered from gout was published in the journal BMC Musculoskeletal Disorders in August 2015. Participants were asked how gout attacks were triggered, and 71% reported having one or more foods causing gout. Tomato was listed as a trigger in 20% of these foods. Other foods cited were alcohol, seafood, red meat and sugary drinks (eg soft drinks).
Gout: low influence of diet
Diet may be less important than previously thought in relation to the cause of gout. A study published October 10, 2018 in the scientific journal BMJ (DOI: 10.1136 / bmj.k3951), which used food questionnaires, genetic analysis and the uric acid levels of more than 16,000 people in the United States. The researchers found that dietary choices accounted for less than 0.5% of uric acid variation, while genetic factors accounted for about 24%. As gout is caused by high levels of uric acid, this study suggests that genetics are far more important than diet when it comes to gout risk.
– A hemolytic disease ( anemia )
– Tumors
– Kidney failure
– Obesity or overweight , obesity increases the risk of gout by a factor of 2 to 3.
Obesity and the risk of gout – bariatric surgery
According to a Swedish study from the University of Gothenburg, obese people who underwent bariatric surgery saw their risk factor for suffering from gout decrease by 34% during the 26-year follow-up of participants in this study. This study was published in October 2016 in the journal Annals of the Rheumatic Diseases.
– Use of certain medications: aspirin (even at low dosage, for example 100 mg, used to prevent cardiovascular diseases), diuretics such as hydrochlorothiazide, antihypertensives, some cytotoxic drugs used in the case of hematological malignancies, immunosuppressants such as cyclosporine or tacrolimus.
– Recent research has also shown that excessive consumption of soft drinks and sweetened processed juices increases the likelihood of developing gout, including in women. This could be due to increased insulin resistance and fat accumulation in the abdominal area. Taking certain medications ( aspirin , diuretics) can also favor the onset of gout.
– Diabetes : It is known that high levels of insulin in the blood can lead to high levels of uric acid, this being the link between diabetes and gout.
– Lymphoma
– Excess cholesterol
– Sleep apnea , a person suffering from sleep apnea has a 20% greater risk of suffering from gout.
– Hospitalization, including prolonged hospitalization.
In fact, the risk of suffering a gout attack during hospitalization increases by a factor of 10 and a long hospital stay has been directly associated with an increase in gout attacks, according to an American study published in the Journal of Rheumatology .(DOI: 10.3899/jrheum.171320) on July 1, 2018. A total of 429 people with an incidence of gout participated in this study. The study used a medical database (Rochester Epidemiology Project) in Olmsted County, Minnesota. According to the study authors, hospitalization is strongly associated with gout attacks in patients with pre-existing gout. The study authors note, however, that their research may have been limited by the retrospective nature of this work. Indeed, the incidence of gout may not have been considered in all cases because out-of-hospital attacks were based on patient self-report.
Pathophysiology of gout (inflammasome)
Studies on the pathophysiology of the attack of gout have revealed that crystals of monosodium urate ( English MSU ) or simply crystals of uric acid, the crystalline form of uric acid, are recognized by immune cells as a danger signal . These cells can initiate an inflammatory response, orchestrated by the pattern recognition receptor ( patternin English) intracellular called NLRP3. In case of exposure of uric acid crystals (MSU), NLRP3 forms a protein complex called inflammasome. Activation of the caspase 1 protein then follows. This protein then cleaves highly pro-inflammatory cytokines such as interleukin (IL)-1β and IL-18, which leads to secretion of their biologically active forms and causes a gout attack.
Symptoms
Gout, in its acute phase, is characterized by the famous crisis, with the following symptoms:
– Gout usually affects the joints, most of the time (in about 70% to 75% of cases) the joint at the base of the big toe of the foot is often the only joint affected by gout.
In gout, uric acid crystals are deposited mainly in the joint at the base of the big toe. Usually only one joint is affected.
In 90% of patients with gout, the joint base of the big toe will be affected at least once.
Why is the big toe joint most affected?
Several hypotheses have been exposed. First, the pH in this region of the body is more acidic than in other regions. The acidic environment is known to lower the solubilization point of uric acid, which increases the likelihood of uric acid crystal formation. Second, because of the state of the joint at one end of the body, the temperature is colder than other areas, and like acidity, cold reduces the solubility rate of uric acid. Third, some experts believe that pressure while walking promotes crystal formation.
Gout can also reach other joints, such as the foot, knee, fingers, elbow, etc. Other regions can also be affected such as the ears (known in this case as tophi) or the kidneys.
In general, joints in the lower limbs are more affected by gout than those in the upper limbs, mainly because they support more weight.
– The attack of gout is extremely painful and occurs suddenly. The pain is so unbearable that it is often impossible to put your foot down or even put on a shoe, coat or blanket when you sleep. The pain is so severe that gout can wake you up at night. The origin of the pain comes from thousands of uric acid crystals that act like shards of glass inside the joints.
Duration of a gout attack
This attack often occurs at night, periods when it is colder, which favors the crystallization of uric acid (cause of gout). In December 2014, researchers at the Boston University School of Medicine (USA) found in a clinical study of more than 700 people that patients with gout had a 2.4 times greater risk of suffering a crisis at night between midnight and 8 am than during 8 am and 4 pm.
In general, the crisis starts with a little pain and discomfort, but after a few hours the joint becomes completely inflamed.
A gout attack can last for several days, often 3 to 7 days (some sources speak of attacks lasting 3 to 10 days). In the United States, the average duration of a gout attack is 4 days.
Even without treatment, the crisis resolves within a few days, often less than a week. Joint pain is usually strongest in the first 12 hours after the onset of the gout attack.
– The joint affected by gout shows the classic signs of inflammation red, painful, warm and swollen skin. Joints may become so swollen and inflamed that the patient experiences fever and chills.
– Gout attacks can occur only once or repeat several times (we speak of chronic gout), for example, for several months or years after the first gout attack.
Diagnosis
The doctor uses the signs and symptoms of gout to diagnose the patient.
The doctor can make a puncture of the fluid from the affected joint, the presence of uric acid microcrystals confirms gout. The analysis of these crystals is done under the microscope in the doctor’s office. Some experts believe that this analysis of the crystals under the microscope is the only way to establish a correct diagnosis of gout.
The specialist may order blood tests to check the levels of uric acid in the patient’s plasma. However, the blood test alone is not accurate, as there are patients with high levels of uric acid in their blood who never develop the disease and patients with symptoms of gout even with normal levels of uric acid.
The doctor may also take an X-ray, especially to exclude other diagnoses, such as pseudogout (also called articular chondrocalcinosis), caused by deposition of calcium pyrophosphate in the joints.
Joint x-rays can also be helpful in chronic gout to find any bone or joint problems such as gouty tophi. Also read gout complications.
In chronic gout, the doctor may also check kidney function to identify possible kidney failure.
New diagnostic criteria for gout
In September 2015, the Association of American Rheumatologists, the American Association of Rheumatology (ACR) and the EULAR, the European equivalent, published new criteria for the diagnosis of gout according to specific symptoms, with different parameters.
The main criteria for the diagnosis of gout are:
– The required entry criterion in this new classification is that the patient has experienced at least one episode of swelling, tenderness, or pain in a peripheral joint or a painful synovial bursa.
– The presence of sodium urate crystals in a joint or synovial bursa, and also the presence of a tophus (uric acid crystal) are sufficient criteria to characterize gout.
– If the doctor does not find crystals of sodium urate, he should continue the questionnaire, including other clinical questions.
All these criteria and selection system can be viewed online at the website in English .
Complications
Gout, if not treated properly, can lead to complications such as:
– Recurring attacks of gouty arthritis.
– Kidney stones . According to a Swedish study published in July 2017, patients suffering from gout (men and women) are 60% more likely to suffer from kidney stones than the general population. This study was published on July 24, 2017 in the scientific journal Arthritis Research & Therapy.
– Kidney complications such as kidney failure (in this case, the loss of kidney function is often irreversible), It is estimated that people suffering from gout are 4 times more likely to die from kidney problems.
– Joint deformities (more unusual case these days, due to preventive treatment based on allopurinol ) due to the accumulation of ureate crystals.
– Deposits of calcium urate crystals are called gouty tophi, which are a white solid mass (nodule). The formation of gouty tophi comes from the accumulation of uric acid crystals in the blood, these nodules accumulate near the affected joint, such as the big toe, elbows, ear pinna, etc.
As can be seen, the gouty tophus can be deposited in the soft tissues forming a bulge, for example in the ear, and not necessarily only in the joints.
One operation can usually remove these gouty tophi.
This seems, however, exclusive to advanced cases, usually by reducing uric acid, if it reduces these nodules. Tophi can potentially destroy joints.
Note that it often takes several years of treatment to remove tophi.
– Increased risk of myocardial infarction and stroke . A study published in September 2013 in the British journal Rheumatology, showed that patients with gout were twice as likely to suffer a myocardial infarction and stroke than those who do not suffer from gout.
Another British study published at the end of August 2014 showed that gout increases the risk of cardiovascular disease, this study showed that women are particularly at risk.
– A study released in June 2014, at the EULAR Congress (European League Against Rheumatism – European League Against Rheumatism in Portuguese), which was held in Paris, showed that men with gout suffer more from erectile dysfunction . Another study presented at the 2017 EULAR congress in Madrid showed that gout is associated with a 29% increase in the risk of erectile dysfunction in patients taking medication to treat it. This last study was carried out by the Rutgers Robert Wood Johnson Medical School in New Brunswick of New Jersey (United States).
Treatments
To treat gout we can distinguish two types of treatment: the treatment of the gout crisis (1) and the treatment that prevents future attacks (2):
1. Gout Attack Treatments – Gout Attack Medications
To calm the painful gout attack, the doctor mainly has analgesic or anti-inflammatory drugs such as:
– non-steroidal anti-inflammatory drugs (NSAIDs) such as those based on diclofenac, naproxen and ibuprofen to be taken, for example, in tablet form. Avoid taking aspirin to treat gout, as it can influence uric acid and worsen gout symptoms. Some NSAIDs with a powerful effect like celecoxib or indomethacin are often also prescribed by doctors.
– colchicine (an anti-ugt), which acts against the inflammation caused by uric acid crystals. However, this drug must be carefully evaluated due to its adverse reactions, such as nausea, vomiting and diarrhea.
In France, the independent reference review known for its independence, Prescrire wrote in January 2021 that, in patients suffering from a gout attack, colchicine (trade name: Colchicine Opocalcium®) does not relieve pain better than a non-steroidal anti-inflammatory drug. steroid like naproxen (trade name: Naprosyne® or generics). Considering the risk of fatal overdose associated with colchicine, this should be the last resort to be chosen, according to Prescrire1.
– corticosteroids such as prednisone and cortisone can be used due to their anti-inflammatory action. They can be given in the form of pills or as injections into the joints. Corticosteroids are usually intended for people who cannot use NSAIDs.
Prednisolone , a synthetic corticosteroid, is also frequently used in cases of gout attacks . A study by researchers from Hong Kong, published in February 2016 in the specialized journal Annals of Internal Medicine, showed that this drug is safe (does not lead to serious side effects), effective and can be said to have the same analgesic effect as indomethacin , a non-steroidal anti-inflammatory drug (NSAID), in case of gout.
– canakinumab , an antibody directed against interleukin, used in some patients. It is prescribed when other medications such as NSAIDs and colchicine are ineffective or contraindicated.
Comparison between taking NSAIDs and corticosteroids
A review of studies involving 6 studies and 817 patients concluded that among patients with gout, there was no significant difference between taking corticosteroids (eg prednisone ) and non-steroidal anti-inflammatory drugs – NSAIDs (eg ibuprofen) for short-, medium-, and long-term pain, the duration of pain blockage, or the need to take other analgesics. Although there was no difference between corticosteroids and NSAIDs in terms of the primary outcome, in terms of safety, eg in relation to the rate of gastrointestinal bleeding, the incidence of gastrointestinal adverse events was lower in the corticosteroid group. Subgroup analyzes showed no differences in doses or routes of administration ( prednisoloneoral, intramuscular betamethasone, and triamcinolone) for corticosteroids. A similar analysis has not been performed for the various NSAIDs. This study shows that corticosteroids can be an effective alternative to NSAIDs in acute gout pain. This study was published on March 23, 2018 in the scientific journal Annals of Emergency Medicine (DOI: 10.1016/j.annemerged.2018.02.004).
– The anakinra (Kineret). Anakinra, an interleukin 1 (IL-1) inhibitor, may be used primarily in the United States during gout attacks if the patient cannot receive other treatments or if other treatments prove ineffective. This medication is typically reserved for hospitalized patients with multiple comorbidities (concurrent illnesses)2 . Anakinra is also indicated forrheumatoid arthritis.
2. Preventive treatments for gout attacks
Initially, it is advisable to follow certain advice, such as a change in lifestyle (reduction in alcohol, meat consumption, etc.), to treat gout and limit future crises. If the change in lifestyle does not have any effect, there is the possibility that the doctor will prescribe a very effective drug to prevent and limit new attacks of gout, allopurinol . Other medications can also help prevent gout flare-ups (see below).
– In general, the doctor will only start preventive drug treatment based on allopurinol if the patient has already had several attacks of gout. It is also important to know that this medicine decreases the concentration of uric acid in the blood, which reduces the probability of having a gout attack, but it will be necessary to take it regularly, because once the therapy is stopped, the probability of an attack can increase. It is therefore a treatment to be taken on a long-term basis.
It is worth noting that numerous people who are treated with allopurinol for a year and then, for example, in the second year or at least some time after, stop taking it. This is dangerous because it poses a risk to the patient’s health (gout, kidney complications, etc.). These will have to take the medicine every day and the doctor or pharmacist can help them to achieve this goal.
– Another drug that also blocks the production of uric acid is febuxostat . Both allopurinol and febuxostat can trigger a new attack of gout if taken before a recent attack has completely healed.
Clinical study on febuxostat:
According to a study published in 2017, febuxostat reduced gout attacks in a double-blind, placebo-controlled clinical study conducted in 314 adults with gout. Febuxostat also reduced synovitis, an inflammation of the lining of a healthy joint, over a 2-year period compared with placebo. The febuxostat dosage used per day was either 40 or 80 mg. This study was published on October 4, 2017 in the scientific journal Arthritis & Rheumatology (DOI: 10.1002 / art.40233).
In February 2019, the US Food and Drug Administration (FDA) reported that febuxostat had a higher risk of death than allopurinol. After an extensive safety study of febuxostat (in the US sold as Uloric) in a clinical trial, febuxostat was found to be associated with an increased risk of death from heart disease and other causes of death. Therefore, the FDA decided to place a warning in the drug’s package insert. The FDA recommends the use of febuxostat only if patients experience poor efficacy with allopurinol or severe side effects with allopurinol.
– Probenecid is a drug that increases the kidney’s ability to excrete uric acid. In this way, the concentrations of uric acid in the blood decrease which reduces the risk of developing gout.
– Lesinurad (200 mg) and allopurinol (300 mg or 200 mg) – compound drug, combination drug, sold in the USA in 2017 under the trade name Duzallo® , according to the press release from the laboratory that markets this drug (Ironwood Pharmaceuticals ). Duzallo® was approved by the drug regulatory agency in the United States, the FDA in August 2017, about a year later (August 2018), the European Medicines Agency EMA gave a positive opinion on its commercialization in the European market. This medicine is indicated for patients with uncontrolled gout, that is, those who do not respond well to medicines such as allopurinol in a single dose. The medicine has the pharmaceutical form of a tablet ( tabletin English). It is particularly contraindicated for people suffering from acute kidney failure (in the United States, the drug has a boxed warning about this disease, according to an August 2017 press release). As noted on the Swiss website Pharmavista.net which is based on the German Journal Pharmazeutische Zeitung , lesinurad prevents the reabsorption of uric acid by the kidneys through inhibition of the URAT1 transporter and the OAT4 anion transporter, which results in an increase in uric acid excretion. uric acid and decreased serum uric acid. According to the Pharmavista.net website, the most common adverse effects of Duzallo® are flu-like symptoms, gastroesophageal reflux, headache, and elevations in serum creatinine.
– Benzobromarone . In some countries, such as France and Brazil, benzobromarone is used for the prevention of gout alone or in combination (eg with allopurinol). Benzobromarone is a uricosuric agent that acts as a non-competitive inhibitor of xanthine oxidase. In some countries, such as Brazil, the molecule is little used. In general, benzobromarone is not used as a first-line treatment. In general, allopurinol is used in preference. Benzobromarone sometimes has a side effect of liver toxicity. Doctors usually prescribe benzobromarone when the glomerular filtration rate is normal and without urinary clots, as an alternative to allopurinol if the patient experiences, for example, side effects caused by allopurinol.
A study published on July 7, 2022 in Arthritis & Rheumatology (DOI: 10.1002/art.42266 ) reveals that low doses of benzbromarone may be a better option than other medications used to combat gout, such as febuxostat. In this prospective, open-label, single-center study, 196 men with gout and low urinary uric acid excretion were randomized to receive low-dose benzbromarone or low-dose febuxostat for 12 weeks. Participants in the benzbromarone group were more likely to achieve the <6 mg/dL blood uric acid goal than those in the febuxostat group (61% versus 32%). Side effects did not differ significantly between groups.
Note on gout treatments:
– It is estimated that a large proportion of people with gout, 80% of patients according to some sources, do not correctly take their medications to treat and prevent gout flare-ups or do not benefit from proper treatment. This is often a serious public health problem, particularly in the West (Europe and North America).
– According to the American College of Rheumatology, preventative gout treatment may work for one patient and not another. Therefore, therapy must be individualized for each patient. The doctor will decide when to start this treatment and with which medication. The choice of treatment also depends on kidney function and other health problems.
– The goal of preventive treatments for gout is to achieve a blood uric acid concentration of less than or equal to 6 mg/dL (360 μmol/L). These treatment goals are recommended by the American Association of Rheumatologists (AAR) and the European Association (EULAR).
Prevention
To prevent the appearance of new attacks of gout, it can be very useful to change your lifestyle and follow certain advice such as:
food for gout
– Limit your consumption of meat (meat is rich in purines, which are transformed into uric acid, the molecule responsible for gout). Other purine-rich foods are beans, chickpeas, and shellfish (shrimp, lobster, clams). Therefore, try to have a diet rich in fruits and dairy products, and low in foods rich in purines such as meat, legumes, etc.
One study showed that purines from animal sources (seafood, meat) were associated with a much higher risk of developing gout than purines from plants (legumes like beans, lentils).
A study published in August 2016 in the specialized journal Arthritis & Rheumatology showed that a diet used to combat high blood pressure, the DASH diet (in English: Dietary Approaches To Stop Hypertension), can reduce the level of uric acid in the blood, on average, at 0.35 mg/dL. In individuals with uric acid levels above 7 mg/dL, the most frequent rate in patients with gout, the DASH diet can lead to a decrease of more than 1 mg/dL. The DASH diet is particularly rich in fruits, vegetables and grains.
Oily fish such as salmon, rich in omega-3s, are not recommended. Give preference to lean fish. When it comes to meat, choose lean meats like chicken or lamb.
Read: Foods for Gout
– Limit or avoid alcohol consumption. Recent studies have shown that beer consumption increases the chances of developing gout, especially in men. In addition, alcohol reduces the excretion of uric acid.
– Drink plenty of fluids (2 to 3 liters of water a day), particularly if you have a gout attack. Avoid drinking sweetened juices or soft drinks, especially those using high fructose syrup or corn syrup. Do not hesitate to drink 500 ml of water in the morning, immediately after waking up. Dehydration is one of the causes of gout.
– Control your weight, as being overweight favors gout.
– Reduce the consumption of sugary drinks, such as soft drinks or industrialized juices, recent studies (2010 and 2013) have shown a negative influence on gout. fructose, often found in sugary drinks, increases the risk of gout, as shown by a study by the Boston University School of Medicine.
A genetic variant (called SLC2A9) in some people would explain the influence of sugary drinks on gout. In fact, according to a New Zealand study published in 2013, in individuals with this genetic variant, drinking sugary drinks increases the concentration of uric acid in the blood, which helps to have a gout attack.
– Practice physical exercises. In addition to helping with weight control, it prevents metabolic disorders that are associated with the onset of gout.
– Intake of vitamin C can reduce the levels of uric acid in the blood. However, the dose must be established by a doctor, since overdoses can increase the amount of uric acid in the blood.
– If you are obese, having bariatric surgery can reduce the risk of suffering from gout by up to 34% (more information about this study with its reference in Causes, and paragraph in Obesity).
– In the case of fasting (eg Lent, Ramadan, diet), it is important, if possible, to continue drinking water during the day and night, because dehydration increases the risk of gout. Uric acid is mainly eliminated by the kidneys, so drinking water favors its elimination.
Tips
– During gout attacks, avoid forcing the joints with weights or movements. Any pressure can increase the pain. Sometimes it is necessary to immobilize the joint to avoid pain.
Avoid excessive footwork, do not play soccer, as there is an accumulation of uric acid crystals in the joints, and in case of shock, it makes the pain amplify.
– Drink coffee. Studies have shown an association between coffee intake (regular or decaffeinated) and reduced levels of uric acid in the blood.
Drinking 3 cups of coffee a day was associated with a lower risk of suffering from gout, according to a large study (coverage study or umbrella review in English) published on November 22, 2017 in the British journal The BMJ (DOI : 10.1136 /bmj.j5024). This study also showed that drinking 3 or 4 cups of coffee a day reduced the risk of overall mortality and heart disease.
– Do not heat or cool the site of inflammation, as this can increase gout pain. However, some experts, such as the Arthritis Society of Canada, believe that it may be possible to heat and cool the inflammation temporarily to ease the pain. The NHS (National Health Service, UK) recommends not heating the joint affected by gout.
In the US, the American College of Rheumatology (ACR) recommends, in case of gout, resting the affected joint and applying ice packs or cold compresses to relieve pain and inflammation. As the information seems a little contradictory, ask your doctor for more personalized information. Try especially to observe what is best for you (nothing applied, cold or hot) to combat the pain.
– Drink plenty of fluids (2 to 3 liters of water a day), particularly if you have a gout attack. Avoid drinking sweetened juices or soft drinks, especially those using high fructose syrup or corn syrup. Do not hesitate to drink 500 ml of water in the morning, immediately after waking up. Dehydration is one of the causes of gout.
– Eat less tomato . According to a study published in 2015, tomatoes could promote gout (read under “Causes” for more details).
– Consume dietary fiber . A high intake of fiber from your diet can surprisingly help with gout.
Researchers have shown in an experiment with mice that a high-fiber diet decreases inflammation in cases of gout. Gout is an inflammatory disease that, as seen above, is mainly caused by the accumulation of sodium urate crystals. The effect of fiber on sodium urate is indirect. According to researchers, fibers favor the production of short chain fatty acids (short chain fatty acids or SCFAs) from intestinal microorganisms. The positive outcome for gout is that these fatty acids lead to apoptosis (death) of neutrophils and reduce inflammation at the joint level. This study carried out by the Federal University of the State of Minas Gerais, Brazil, was published in January 2017 in the printed version of the specialized magazineJournal of Leukocyte Biology . As this study was performed in rats, further studies are needed to verify whether these results are reproducible in humans.
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