Ask the Expert: Dr. Theodore Fields, Rheumatologist, Answers Your Questions About Gout

by Dr. Theodore Fields
Dr. Theodore Fields, Rheumatologist

Q1: Is gout a form of arthritis? What triggers gout attacks other than red meat/alcohol/rich foods?

Gout is a form of arthritis which can be extremely painful. It’s true that alcohol and certain foods, such as shellfish and red meat, can set off gout attacks. This happens for a variety of reasons:

· Some foods have a lot of protein which gets broken down to purines, and purines get broken down to uric acid, and uric acid crystals cause the inflammation of gout.

· Alcohol also decreases the body’s ability to get rid of uric acid in the urine, so the level rises in the blood, which can cause a gout attack.

· However, many attacks happen in people who have eaten nothing that is especially likely to set off gout. This is because gout is a genetic disease which leads to high uric acid levels in the body.  This is why most patients with gout, especially once they are getting two or more attacks in a year, need to be treated with medication to lower the uric acid.

For the very great majority of patients with severe gout, diet control alone is not enough.

Q2: My grandmother periodically battles with bouts of gout. Is there anything she can do for the pain? Due to some other conditions, she has to be careful with pain meds.

It’s common for people with gout to have other conditions, such as hypertension, ulcer or diabetes, which make it more difficult for the doctor to pick a drug that can safely control their gout. Your grandmother should work with her doctor to find a medication that is best and safest for her. Some people have so many other medical problems that the safest thing for them when they get a gout attack is to have a local steroid injection in the joint.

Q3: What can women do to prevent gout? Are these things different for men?

The prevention issues for gout are similar for men and women. If a patient is overweight, a major weight loss can reduce the uric acid level and reduce gout risk. It is worthwhile to watch your diet, especially regarding things like red meat and shellfish, and to keep alcohol consumption down. If gout attacks continue despite these precautions, as is often the case, medications such as allopurinol are extremely successful in preventing gout attacks.

Q4; Are there certain diseases or conditions that predispose people to gout?

Yes, for example, people taking diuretics for hypertension or ankle swelling have an increase in uric acid level that could cause gout attacks. Obesity increases uric acid levels. People who develop kidney disease can have increased uric acid levels and gout attacks.

Q5: Can gout do any long term damage or have any other related side effects?

Yes, long term joint damage is common in patients with severe gout. This is an important reason that patients with recurrent gout attacks don’t just “tough it out” but instead take medication to lower the uric acid. Lowering the uric acid is extremely effective in preventing joint damage.

Q6: What age does gout usually set in? Is gout genetic?

Gout most commonly starts in men in their 40’s, but can occur in the 20’s in some, and in some doesn’t start until the 80’s and beyond. Women don’t have nearly as much gout as men until they reach the menopause. Gout is most definitely a genetic disease, and many gout patients will find that a number of their relatives share the problem.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Luna Plante says:

I am 54 and was diagnosed with gout about a year ago. I am not on meds. Any info on gout treatment and especially on foods to avoid and foods that might help would be appreciated.

HSS on the Move says:

Hi Luna: thanks for writing and we’re sorry to hear about your diagnosis. You can find a good overview of gout treatment on our website here: http://www.hss.edu/conditions_gout-in-depth-overview.asp and a post about diet and gout here: http://hss.edu/onthemove/preventing-treating-gout-through-diet/. The best thing for you to do is to consult with your doctor. If you would like to come to see us, contact Physician Referral Service at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp.

Marcus Tingstrom says:

Gout can present in a number of ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint).

Kit Zinser says:

In past two years have had 6 gout attacks. Uric acid level was 9. I am a female, 70, in good shape and don’t drink. Am confused because attacks happen only when I bump one foot or other, dog steps on my foot or some seemingly related trauma occurs; and pain is localized at instep of foot. Colcrys taken and pain lessons in 4-5 days. Could it be something other than gout?

HSS on the Move says:

Hi Kit, thank you for reaching out. Dr. Theodore Fields, Rheumatologist, says: “The story you give does sound very much like gout, but of course you should be examined by a physician to make sure nothing else is going on. With multiple attacks, a high uric acid, involvement of the foot and response to colchicine (Colcrys), everything would fit for gout. Gout can be set off by trauma, so that part of your story fits for gout also. Gout is a genetic disease, and comes out at an older age in women, and can certainly happen in people who don’t drink (or even people who don’t eat red meat or shellfish.) If you have gout and are having so many attacks, you should discuss with your doctor taking medication to lower uric acid. Once you have been on the medication for 6 months or so, gout attacks generally dramatically decrease. Often for the first 6 months of treatment to lower uric acid, your doctor may suggest taking daily colchicine to prevent gout flares. After that, you could likely stop the colchicine (Colcrys) and just continue the medicine to keep the uric acid low.” It is best that you consult with your treating physician. If you are interested in care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

Kevin says:

Hello doctor, I have high uric acid levels but no gout, am regular at the gym. Am planning to build muscles and want to take whey protein as supplements. Is it okay? Please advice

HSS on the Move says:

Hi Kevin, thank you for reaching out. Dr. Theodore Fields, Rheumatologist, says: “In general, it’s good for people with very high uric acid to avoid especially high protein diets. It’s possible that very high protein diet can set off gout. Most likely, you will tolerate it, but as a rule we advise people with high uric acid to be moderate in alcohol, red meat, shellfish and high-fructose corn syrup (as in regularly sweetened sodas) in their diet, and to avoid very high protein diets. Again, most people with high uric acid without gout don’t get gout just from their short-term diet, but it’s good to be aware that dietary issues such as very high protein diet could set things off. Perhaps moderate supplementation is your best bet.” For more information on gout, click here: http://www.hss.edu/conditions_gout-in-depth-overview.asp#.U48lzHJdXTo.

SYAMLAL says:

Hello doctor
two months before i have joint pain and burning heat like in my legs hands and neck
in hospital check my blood samples uric acid level is 7.6 last two moths medicine continued now in hands joins a small pain but burning like heat in hand joints knee and foot, neck and shoulders actually this is high uric acid problem or any Neurological disease. I have 30 year old. I am working in computer related profession. daily 8-10hr sitting infront of computer. Its a working related disease or high uric acid problem.
through medicine it is curable or not.
Sir please give me a detailed replay.

HSS on the Move says:

Hi Syamlal, thank you for reaching out. Dr. Theodore Fields, Rheumatologist, says: “Your question is important since it gets at the point that not everyone with a high uric acid has gout. Many people have a high uric acid, but have joint pain due to a different reason. On the other hand, it’s important to know if you have gout, since gout is very effectively treated, and prevented, with medication. Shoulder pain is actually uncommon with gout, so I wouldn’t want to assume that gout is what you have. Gout often gives swollen, tender and warm joints, and if you don’t have those, it makes gout less likely. Since your pain has now spread to the shoulders, feet and knees, it sounds like it would be a good idea to get a medical re-evaluation. A rheumatologist might be a good choice, or start with your internist. A more complete exam, which will include a complete physical exam and may include x-rays and more detailed blood testing, should help to narrow down what is causing your problem.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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