Obesity causes many other health issues such as high blood pressure, diabetes, strokes and some cancers. People can now add gout to the list.
Dr. Scott Neville, of the Foot and Ankle Center of Mooresville, and Dr. David Batt, service line leader of rheumatology for IU Health physicians, give the ins and outs of gout and why it is volatile and unpredictable.
What is gout?
Gout is a form of arthritis and is an inflammatory condition caused by too much uric acid in the body. Uric acid is a naturally occurring byproduct when we break down food and energy. There’s always uric acid in your system, but if that acid gets out of balance and gets too high, it causes inflammation. Typically this happens in joints, most commonly in the foot. It can also happen in the ankle, knee, finger, elbow, wrist or just the big toe.
“This can become very painful – so much so, that oftentimes, people can’t even let their bed sheets touch it,” said Neville.
What are the signs or symptoms?
Uric acid builds up in the system and strikes. Gout flares usually strike suddenly, typically at night, and without any warning. During the attack, the affected area becomes hot, red, swollen, and extremely tender.
What are the risk factors?
The kidneys need to clear uric acid, but sometimes the kidneys become overwhelmed and can’t clear it as well. Typically it’s because of certain medications; purine rich foods such as beer, anchovies, liver, peas, mushrooms, spinach or asparagus; or high fructose corn syrup. However, there’s no one thing that truly causes gout. There are certain risk factors that cause uric acid to elevate, but once it elevates it’s there.
Who gets gout?
Anyone can get it, no matter the race or gender, but it’s most common in men over age 50.
“There are younger people who have a family history of gout, they have an enzyme problem and make too much uric acid. Then there are older people, who because of kidney problems or certain medications their kidneys, don’t expel enough uric acid out of the body so it builds up. In most people it’s too much production or the inability to get rid of it in the kidneys,” said Batt.
Unfortunately, instances of gout are increasing and the severity of it is rising as well.
“It’s thought to be due to increases in obesity rates, high fructose corn syrup in the American diet and the aging of the population,” added Neville.
How do you treat gout?
The initial attack of gout is called an acute flair or acute gouty attack. This is treated by an injection or an oral medication. It’s typically very successful.
Following the first attack, there are what’s called inter-critical periods – maybe another attack doesn’t come for another few weeks, months or years later. For these patients, uric acid is treated by “urate lowering therapy.” There are various medications that can be used to treat subsequent attacks.
If the gout is either not managed well or isn’t responding to the medication, patients can get tophi (pronounced toe-phi) or uric acid tumors. Those can break through the skin, in which case surgery is required. A new medication now has the potential to resolve tophi without having to do surgery.
Currently, gout is considered to be a lifelong diagnosis with constant treatment and/or monitoring.
“It’s very controllable with the right medicines. If people take the medications properly it’s a good chance that someone with gout could go the rest of their life and not have an attack,” said Batt.
Can gout cause other health issues?
Neville said currently there are a few studies and a lot of research going on linking uric acid levels to high blood pressure. The thought is that high uric acid levels may be a predisposing factor to high blood pressure. The research is in its early stages and is not conclusive.
Ongoing research is also looking to find what else does high uric acid do. It used to be looked at as benign, but it’s become more popular with studies – physicians are beginning to learn more about gout.
How do you prevent gout?
The key is to watch the diet, particularly with high purine foods, and manage weight. However, people should note that even with diet and weight control, one can still get gout.
“The reason for that is the amount of uric acid in your system, 10 percent of that is made up from your diet. Ninety percent is made up from just the way your body produces and excretes uric acid,” said Batt.
