Men’s Health Month: Gout Awareness

by Dr. Theodore Fields
6.11 blog

For Men’s Health Month, gout is an important topic for men to think about. Gout is the most common form of inflammatory arthritis, with over 8.3 million Americans suffering from gout. A number of studies have shown that the frequency of gout is increasing over the last 20 years worldwide. Men develop gout much more than women, especially at younger ages. It’s rare for gout to develop in a woman before menopause, but men in their 20’s and 30’s develop gout frequently.

It’s really important for men to understand how gout develops and how important it is to treat it effectively. Gout is generally agreed to be the most “curable” of all types of chronic arthritis. “Curable” is in quotes because to have gout disappear from your life, you, in the great majority of cases, need to take medication to lower your uric acid indefinitely. However, if you do take the medication, it’s almost certain that over several years, your gout will eventually disappear. Most people with gout can’t control their condition just with diet, although diet is very important.

The reason diet is often not enough to control gout is that gout is a genetic disease. Gout is due to the buildup of uric acid in the body, which then deposits in many areas, especially the joints. Diet can make the buildup of uric acid even worse, but if you have a genetic tendency to build up uric acid, you will do so even if you eat the right diet.

Image of Gout

The right diet for gout is one in which you have as little alcohol as possible (since alcohol has an effect on the kidney that keeps uric acid from coming out in the urine). The right diet also limits red meat, shellfish, and high fructose corn syrup (as in regularly sweetened sodas). There are many other foods that can increase uric acid, but we focus on these because a large study showed that these are the foods people ate a lot of prior to their first attack of gout.

Unfortunately, even the absolutely strictest diet for gout can only bring the uric acid down about 1 point and most people with gout need more than that. Also, the diet that could drop the uric acid a full point is so strict that most people would have great trouble following it. Thus, most gout patients will need medication to lower the uric acid, such as allopurinol or febuxostat (Uloric ®). Good news is that these medications are extremely effective at lowering the uric acid, and well-tolerated in most people. Bad news is that many studies have shown that people who start these medications often don’t stay with them (and among medications studied, gout medications were the most likely to be given up).

Why do people often not stay with medication like allopurinol? One problem is that gout is intermittent, and in-between attacks, people can forget how painful the gout was. Another is that gout often comes along with other problems, such as hypertension, and people don’t like taking medications for lots of different ailments. Remember, gout is one of our most “curable” conditions if the medication is continued and are well-tolerated, so it’s an especially bad thing when gout medications are often stopped.

How can we get people to stay with their gout medication? One is education about why the treatment is so important- understanding that without treatment, the gout will just keep getting worse over the years, and can damage the joints. Another is education about how gout medication can generally be taken once a day and can usually be handled without side-effects.

Men’s Health Month is a great time for men with gout to decide that it’s time to end this problem forever. This is a realistic goal, although it can take 6-12 months of treatment, sometimes even longer, for the attacks to stop. This waiting period is well worth it, as gout can be one of our most painful conditions. The more a man knows about his gout, the more likely he is to never have to suffer from it again!

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. 

Topics: Rheumatology
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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

Eugene J. Puleo says:

Dr. Theodore P. Fields, sir, I have been taking ULORIC 80mg/once daily and COLCHICINE 0.6 mg/once daily for 10 months. Also INDOMETHACIN 50MG as needed for 6 years. i am under the care of a Rheumatologist for the last 10 months, previously i was under the care of a Internal Medicine Primary Care M. D. for 4-5 years, he only prescribed the anti-inflammatory. I have hypertension which is under good control. BMI 25-28 seasonally.

I suffer frequent gout attacks in nearly all joints of the body on a monthly(sometimes more frequently) basis. the attacks are severe enough to render the affected joint to be debilitated.

I do used red wine, 2-4/ 750 ml bottles a week and craft beers, 2-3/ 12oz. bottles a week. no soft drinks or fruit juices. Also 6+ liters of spring water per week. Moderate meat and fish simply prepared and a lot of daily fresh vegetables, often plain steamed. 95% of my diet is home prepared of whole ingredients.

Doctor, any comments, suggestions or recommendations you would care to make will be greatly appreciated. Thank you in advance.

Sincerely,

Eugene J. Puleo

HSS on the Move says:

Hi Eugene, thank you for reaching out. Dr. Theodore Fields, Rheumatologist, says: “To have your gout do well in the future, the most important piece of information is your uric acid level. We need to have that be less than 6. If you have a history of tophi (bumps which are collections of uric acid on the skin or over a joint) then you need to have a uric acid less than 5. If you can keep the uric acid at that level over time, the gout will ultimately do well. However, even if you are at that level, people with severe gout will sometimes have flares for some time after starting a drug like allopurinol or Uloric (febuxostat). So, question one for you is whether your uric acid is where it needs to be. If it isn’t, then there are a number of possible approaches. Your rheumatologist might consider adding a medication such as probenecid. You could decrease your intake of all types of alcohol. Being at a lower weight can lower uric acid somewhat. In some cases, higher doses of Uloric can be used, but that is “off label” since the FDA has approved it only to 80mg. One way or another, you need to get to the goal uric acid. If you are already at the goal uric acid, and it’s a matter of waiting for enough uric acid to be pulled out of the joints so that the attacks stop—then Question #2 is whether the indomethacin is the optimal medication for your attacks. Depending on any other medical conditions you have, options for treating attacks include oral prednisone, injected steroids and colchicine. Question #3 is whether you are taking colchicine prophylaxis, one or two a day. If there is no medical reason you can’t take colchicine, then you should be taking it until your attacks stop. Colchicine can significantly decrease the number and intensity of attacks while you are waiting for the Uloric to lower the uric acid in your joints enough to stop attacks from happening. If you attend to all 3 questions mentioned, the prognosis for gout is spectacularly good in the long term. People who keep their uric acid in the right range long-term almost always stop having attacks, but in severe cases the risk of attacks can continue, even for a year or two after starting uric acid-lowering therapy.”

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