Treating Gout: Dietary restrictions are not the only main focus
Understanding the causes and treatment of gout

Osteoarthritis typically manifests in the hands and knees, causing mild to moderate pain that lasts for a relatively short duration. The pain usually persists for several minutes to a few hours, and it is often more pronounced in the morning. In contrast, rheumatoid arthritis appears symmetrically on both sides of the body, with longer-lasting and more severe pain. Gout, on the other hand, commonly affects a single joint, such as the toe joint. The area surrounding the joint becomes red, swollen, and painful, and individuals with gout may also experience mild fever.

Gout occurs when there is an excessive amount of uric acid in the blood. Uric acid is primarily produced through the breakdown of purines and is excreted from the bloodstream into the joints, triggering an inflammatory response. Purines can be obtained from dietary sources as well as from the body’s own metabolism. Uric acid is a natural substance found in everyone. It is filtered by the kidneys and eliminated from the body through urine and the intestines. However, when uric acid reaches a concentration where it cannot be fully dissolved in the blood, it forms crystals that accumulate in the joints, skin, or kidneys, resulting in gout and causing damage to the affected organs.

Impaired kidney function is the most common cause of excessive uric acid accumulation. This means that individuals with kidney disease or those experiencing a natural age-related decline in kidney function are more likely to develop gout. In some cases, younger individuals with gout may have a congenital deficiency of certain enzymes, leading to an overproduction of uric acid in the body and the subsequent onset of the condition.

If gout patients do not receive treatment, uric acid will continue to accumulate in the joints, forming uric acid crystals that gradually erode the joints, causing damage to the cartilage and bones and impairing normal joint function. Acute joint inflammation caused by gout most commonly affects the big toe, followed by the ankle, knee, wrist, and thumb joints. During a gout attack, the affected joint becomes red, swollen, and extremely painful. The pain typically subsides after several days. If uric acid in the blood is not adequately controlled, inflammation can spread to multiple joints and recur frequently. Additionally, high uric acid levels can lead to worsening kidney function and the formation of kidney stones, creating a vicious cycle.

Furthermore, studies have established a connection between high uric acid levels and metabolic disorders such as hypertension, diabetes, high cholesterol, and obesity. These conditions increase the risk of cardiovascular diseases, such as heart disease and stroke, in individuals with gout.

Gout is a chronic disease, and currently, there is no known cure. However, with appropriate treatment and management, the symptoms of gout can be controlled, and the frequency of recurrent episodes can be significantly reduced.

The primary objectives in treating gout are to reduce uric acid levels, manage pain and inflammation, and prevent further damage to the joints and cardiovascular system.

Medication treatment

Medications used for treating gout include nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and urate-lowering medication. NSAIDs and steroids are effective in relieving joint pain and inflammation. Urate-lowering medications like allopurinol and febuxostat help decrease uric acid levels in the bloodstream and minimize the formation of uric acid crystals.

Dietary modification

Gout patients are often advised to make dietary changes and avoid foods high in purines, such as beer and organ meats. This is because high-purine foods can trigger gout attacks and contribute to other issues like high cholesterol. However, suppose a patient’s uric acid levels have been successfully normalized through medication treatment. In that case, moderate-purine foods (including meats) may not need to be entirely eliminated since dietary modifications are not the sole focus of treatment. Uric acid primarily originates from metabolic processes, with diet accounting for only 10% to 15% of its formation. Patients should also prioritize adequate hydration, especially during periods that may lead to dehydration, as dehydration can increase uric acid concentration. Drinking plenty of water can help reduce the likelihood of gout attacks.

To prevent gout, you can take the following measures:

1. Maintain a healthy weight: Being overweight or obese increases the risk of gout, especially central obesity. Excess fat can lead to increased production of uric acid and insulin resistance, resulting in reduced uric acid excretion by the kidneys.
2. Limit excess alcohol intake: Alcohol can raise uric acid levels in the blood, triggering gout attacks. Beer, in particular, is a common trigger due to its high purine content from the hops used in its production.
3. Stay adequately hydrated: Drinking enough fluids helps dilute uric acid and facilitates its excretion through urine.
4. Follow a balanced diet: While dietary restrictions are not the sole focus in preventing gout, it is recommended to limit or avoid high-purine foods. These include organ meats, shellfish, red meat, and sugary beverages. Instead, opt for a diet rich in fruits, vegetables, whole grains, and low-fat dairy products.
5. Engage in regular exercise: Regular physical activity helps maintain a healthy weight, improve joint health, and reduce the risk of gout.
6. Manage chronic conditions: Certain chronic conditions, such as high blood pressure, diabetes, and kidney disease, can increase the risk of developing gout. It is important to manage these conditions effectively to lower the risk of gout.

Virtus Rheumatology Specialist