Gout,
who gets it and how do we deal with it?
Gout is a chronic disease with intermittent painful flare ups. This disease occurs when uric acid crystals in the blood get deposited in one or multiple joints of the body. Uric acid is produced from the breakdown of certain chemicals called purines. Purines are also found in certain foods.
Foods with high purines are red meat, sea food and some plant sources.
Causes:
1.Increasing the intake of foods with high uric acid can precipitate an attack of gout.
2. Decreased kidney function where the person is not able to excrete blood uric acid as it builds up in the body.
Let us look at foods which cause gout because of high uric acid
Foods with high purines cause elevated blood uric acid. The uric acid is then deposited in the joints as uric acid crystals. These crystals cause severe pain
Foods high in uric acid include:
• Red meat including beef and game meats
• Animal organs such as liver, spleen and heart
• Sardines
• Anchovies
• Trout
• Tuna
• Scallops and Mussels
• For people with severe sensitivities to purines, you might need to be careful with plant foods such as spinach, cauliflower, mushrooms, asparagus and green peas. These contain some amounts of purines and can tip a gout attack
Beverages that produce uric acid and hence gout attacks are:
• Beer
• Increased amounts of red wine
• Distilled alcohol as whisky, brandy and rum
• Soft drinks sweetened with high fructose corn syrup
• Fruit juices and sugar containing drinks
Symptoms of acute gout attack:
• Severe joint pain. Most notably at the bases of the big toe. It can however affect any joint
• The affected joints are swollen and red
• Painful restricted joint movement
• Icing can potentially cause more crystals to be formed in a joint.
Diagnosis
• History and physical exam
• Blood test to check uric acid levels
• Drawing Joint fluid for uric acid crystals evaluation
Risk Factors
• Diet with foods high in purines
• Obesity
• Medical conditions as diabetes, hypertension and kidney disease
• Certain medications as diuretics (that make us urinate a lot), some blood pressure medications such as the Angiotensin converting Enzyme examples are lisinopril, enalapril etc. They all end in -pril.
• Occurs more in men than women
• Family history of Gout
Complications of frequent gout attacks
• Joint destruction
• The formation of Tophi. These are soft usually non-painful nodules under the skin in joints of the hands, elbows and knees. It can actually be present in any joint
• Uric Acid kidney stones can form
• Recently it has been documented that tophi can occur in organs as the heart and kidneys leading to organ malfunction.
Treatment
Prevention of gout
• Watching what you eat and drink
• Weight loss
• Exercising
• Hydrating well with water
Medication treatment
1.Those used to prevent attacks as
allopurinol and febuxostat. These medications are taken daily to prevent gout attacks
2.These are used to help treat the attack
• Anti-inflammatory medications. These include ibuprofen and naproxen
• Colchicine which also acts as an anti-inflammatory
• Steroids to decrease inflammation
Francis Obeng MD