Ask the Expert: Dr. Theodore Fields, Rheumatologist, Answers Your Questions About Gout
Q1: Is gout a form of arthritis? What triggers gout attacks other than red meat/alcohol/rich foods?
· 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.
Dr. Theodore P. Fields, Rheumatologist, specializes in the treatment of gout, rheumatoid arthritis, and osteoarthritis. Throughout his career, Dr. Fields has remained active in many professional organizations and has had his work recognized numerous times. Dr. Fields holds many professional appointments, including Director of the Rheumatology Faculty Practice Plan and Co-Chairman of the Hospital for Special Surgery Web Editorial Committee.