Got gout? You’re in good company given that it impacts over eight million Americans,[i] making it the most common form of inflammatory arthritis. Despite it being common, no one should have to live with gout because, today, we understand what causes it and how to treat it. Yet, despite these advances, many suffer from flares and live with avoidable pain in their joints.
Gout is not just diet driven
It’s true that diet is a factor in gout, and the public often thinks it’s the only important factor. It’s true that being overweight raises the blood uric acid level (which we call sUA or urate). It’s also true that when we eat protein, one of the products of its breakdown is urate. Foods that have been associated with gout flares include alcohol of all types (with beer possibly being the worst), red meat, high fructose corn syrup (as in regularly-sweetened sodas), shellfish and organ meats such as liver. However, although diet is important in gout, the real cause lies in urate itself and in a person’s genetic tendency to gout.
Urate is the key to understanding gout. When there is too much uric acid, crystals can form and settle in multiple places in the body, especially the joints. High blood urate levels, called hyperuricemia, precede a person’s first gout flare. Many people are naturally disposed to developing hyperuricemia on a genetic basis. People without a hereditary tendency to gout don’t get gout flares even if they eat or drink all the “wrong things.”
Other factors can cause or set off gout beyond genetics and diet. Abnormal kidney function can raise urate levels. Taking diuretics can likewise raise urate levels.
Gout is also complicated by the fact that it is almost always (over 90%) accompanied by at least one other of a group of medical problems, including obesity, heart disease, high cholesterol/triglycerides, diabetes and kidney disease.
With this in mind, rheumatologists treating gout consider both lifestyle changes, diet, and medication therapy, all of which contribute to getting urate levels below the goal of less than 6.0. If a patient can keep urate levels below 6.0, over time gout flares almost always stop happening. Diet and weight loss are usually not enough, and most people need medication. Patience and persistence with therapy are needed!
Gout is Out of Control
As was made clear in a survey of 1,000 gout patients and 500 caregivers conducted by the non-profit arthritis advocacy group CreakyJoints®, gout is a disease that is out of control. Patients surveyed experienced an average of eight painful gout attacks per year and more than fifty percent reported their attacks lasted three or more days.[ii] Half of all patients did not report symptoms they experienced to their doctor and nearly one third hid attacks from loved ones.
Having two or more gout attacks per year means that it’s time for a treatment change. Flares can cause patients to have difficulty walking, climbing stairs or sleeping. And a person can develop significant functional disability. [iii]
Caregivers are impacted as well. Of those surveyed, on average, they missed 4.5 days of work to care for their loved one during a flare and the vast majority worry about gout’s impact on their loved one’s physical and emotional health. Certainly, intimacy is impacted when your partner is having pain.
Get Educated About Gout
Rheumatologists, primary care providers, nurses and other healthcare professionals have an important role to play in educating people with gout and their loved ones about its causes and management. It starts with setting a target of lowering uric acid levels (sUA) to below 6mg/dl. That’s why it’s important to have the urate level tested in anyone suspected of having gout. Levels should be also it followed over time to make sure it’s kept below 6. Since most people with gout need medication to control urate level, the most important part of their treatment is to stay regularly on the medication and to follow up with their doctor to have the urate levels checked over time. In addition, people with gout can help reduce flares by:
- Staying hydrated and avoiding regularly-sweetened drinks (which are likely to have high-fructose corn syrup)
- Working towards or maintaining a healthy weight. Losing weight decreases can lower urate levels (but usually not enough to avoid medication)
- Limiting red meat, shellfish and organ meats such as liver
- Reducing alcohol intake (or avoiding it entirely). Men who drink beer seem to be at higher risk for gout symptoms, but all types of alcohol raise urate levels.[iv]
CreakyJoints recently published “Raising the Voice of Patients: The Patient’s Guide to Treating and Managing Gout.” Using easy-to-understand language, these guidelines provide comprehensive education for people living with gout. It’s a resource a family might consult in between appointments so that they know what questions to ask their doctor during the next visit. Written by patients and CreakyJoints staff and medically reviewed by rheumatologists (including myself), the patient guidelines provide an unbiased review of different management strategies, including the different medications, complementary therapies, and alternative therapies. It also suggests approaches to speaking with insurance companies and working with the larger arthritis community to advocate for patient-centered health policy and laws.
When a doctor and a person with gout work closely together, it is entirely possible to keep gout under control. Asking for support is vital. I advise my patients to talk openly about their disease with their family, friends, and employers so that those around them can help when there is a need. Online support is also available at CreakyJoints. Gout flares are not something a person needs to tolerate or expect from their diagnosis. It can often take a year or longer to get gout flares to stop, even with a perfect regimen of gout treatment. However, over the long run, a successful outcome is almost always reached. And a much better quality of life can be achieved.
About the gout survey and patient guidelines
The gout survey was conducted online among 1,000 gout patients and 500 caregivers of gout patients in March 2017 to gain insight into their perceptions of and experiences with gout. Edelman Intelligence conducted the survey, which was made possible by CreakyJoints, with funding from Ironwood Pharmaceuticals. “Raising the Voice of Patients: The Patient’s Guide to Treating and Managing Gout, is available for free at www.CreakyJoints.org/patientguidelines (among other volumes covering other forms of arthritis) and they were jointly sponsored by Horizon Pharma and Ironwood Pharmaceuticals.
[iii] Fu, t., Cao, H., Yin, R., “Associated factors with functional disability and health-related quality of life in Chinese patients with gout: a case-control study.” BMC Musculoskelet Disord. 2017 Nov 3;18(1):429. doi: 10.1186/s12891-017-1787-7. Accessed on May 23,2018 at https://www.ncbi.nlm.nih.gov/pubmed/29100504
[iv] Choi, HK, Karlson, EW, Willet, W. et. al, “Alcohol intake and risk of incident gout in men: a prospective study”, Lancet, Volume 363, Issue 9417, 17 April 2004, Pages 1277-1281. Accessed on May 23, 2018 at https://www.sciencedirect.com/science/article/pii/S0140673604160005
Theodore Fields, MD
Dr. Theodore Fields, MD, FACP is Professor of Clinical Medicine at Weill Cornell Medical College and Attending Physician at the Hospital for Special Surgery.