Gout has been written about since ancient times and was once nicknamed the “disease of kings,” because it was known to affect wealthy, middle-aged men, who often indulged in rich foods and alcohol.

Today, we know gout is a type of arthritis that affects people from all walks of life. “Although diet may play a role in this disease, it is by no means the only culprit,” says Scott Glickstein, MD, a rheumatologist with Park Nicollet Clinic Rheumatology.

Big toe often at risk
Gout occurs when uric acid crystals build up in a joint. This, in turn, triggers the immune system to produce proteins, resulting in white blood cells disposing crystals in the joints. This causes the joint to become red, hot, painful and swollen. Most often, the initial gout attack strikes the big toe. Although gout can affect any joint, it usually strikes those in the foot, ankle or knee.

Gout attacks can produce intense, debilitating pain. Without medication, they can last from several days to a couple of weeks before subsiding. The pattern of attacks can vary. Often, initial episodes are widely spaced over a period of months or even years. Over time, they can become more frequent, last longer and eventually lead to joint destruction. It is important to seek medical help to diagnose and treat the condition before joint damage occurs.

Causes of uric acid buildup
Uric acid is a natural byproduct of food metabolism and is created when the body breaks down purines. Foods that have among the highest concentration of purines and should be avoided by people who have gout include:

• organ meats, such as liver and sweet breads
• mackerel
• sardines
• anchovies
• herring

Alcohol may cause uric acid to crystallize in the joints, but at lower levels. Beer also contains high concentrations of purines. These beverages should be used only in moderation, or avoided altogether.

Although diet does influence uric acid levels, other factors are much more important in influencing uric acid metabolism and gout itself. Uric acid is naturally excreted from the body through the kidneys. Anything that affects the kidneys’ ability to eliminate uric acid, such as underlying kidney disease or medication use, may elevate uric acid levels. People also may have inherited tendencies to produce higher uric acid levels and, therefore, are more prone to gout.

Important factors that may elevate uric acid levels include:

• health conditions, including kidney disease, congestive heart failure and high blood pressure
• medications, including diuretics (water pills), aspirin (low doses) and some medicines to prevent organ transplant rejection
• genetics
• gender (men are three times more likely to develop gout than women, but over age 60 the risk becomes similar)
• age (incidences increase with age)
• high alcohol consumption (especially beer)
• excess weight
• a diet rich in purines

Diagnosis
“We suspect gout when people have recurrent bouts of acute, short lived arthritis, usually affecting one or several joints,” Dr. Glickstein says. “Various factors, besides the patient’s history, impact the diagnoses of gout, including blood uric-acid level and X-ray findings. But the most definitive way to diagnose the condition is to take fluid from a swollen joint and examine it under a microscope for uric acid crystals.” This procedure allows doctors to distinguish between gout and other illnesses with similar symptoms, such as pseudogout and forms of infection.

Two-fold treatment
“We treat the disease in two ways: First, we treat the acute attack; then, if necessary, we try to prevent future ones,” Dr. Glickstein explains. “Sometimes, people may have a pattern of gout that results in short- lived, less-intense and less-frequent attacks. Anti-inflammatory medications, such as indomethacin, ibuprofen or naproxen, may be sufficient to treat these attacks.”

People with more frequent and intense episodes may require medications, such as allopurinol, which lower uric acid levels. While medications are the most effective way to lower uric acid levels, other approaches, such as avoiding foods with high purine amounts, exercising, losing weight and avoiding excess alcohol can help manage the condition and improve general health and wellbeing.

“Although gout can be extremely painful, it is one of the most gratifying forms of arthritis to treat and control. When medications are taken at the first sign of pain or inflammation, symptoms usually improve quickly, and long-term management generally prevents permanent joint damage,” Dr. Glickstein says. “With proper treatment, even people who have had the condition for a decade or more can avoid ongoing pain and permanent joint damage.”

To find a doctor to help with gout or other rheumatic illnesses, call 952-993-5500, or visit parknicollet.com/rheumatology.