How can I manage a gout attack?

With over nine million people with gout, there’s no denying the importance of educating the community on its potential impact on your overall health. Although it can be extremely painful and sometimes crippling, it is a treatable condition. Understanding the condition, as well as treatment and prevention options, can help you avoid complications and lessen the pain you could experience.

What is gout?

Gout (also referred to as gouty arthritis) is a form of arthritis that occurs due to high levels of uric acid in the body. Uric acid is the chemical produced as a result of the body digesting and breaking down proteins. When there is too much uric acid in your system, deposits accumulate as needlelike crystals in the joints and soft tissues. These uric acid crystals build-up and cause episodes of pain and swelling that can last for as little as one day or as long as a few weeks. These generally sudden episodes can look and feel different depending on how far the condition has progressed and how it’s being treated.

There are four stages of progression:

Stage 1: High Uric Acid Levels (No symptoms)

Stage 2: Acute Gout

Stage 3: Intercritical Gout (No symptoms)

Stage 4: Chronic Gout

After your first attack, there can be a decent period of time where you don’t experience any symptoms (Intercritical Gout). As time progresses, and depending on how you are managing your health, your attacks can lengthen and become more severe, whereas the symptom free periods can grow shorter. This is why understanding and managing symptoms during the onset of the condition is extremely important.

What does gout look or feel like?

You may be wondering what to look for or notice as far as symptoms are concerned. There are common attack locations where symptoms will centralize (see image). Depending on the stage of the condition, the symptoms could present with little to no impact on your day to day life. 

Very often, acute forms of the condition may produce brief twinges of pain to the affected joint(s). Other symptoms of gout you could experience when the condition is active include (but are not limited to):

• Severe pain that feels like “crushing” at the joint, even with bearing little weight
• Swelling and warmth around the joint
• Red, shiny, tense skin that may peel
• Masses of uric acid on the joints, called tophi
• Kidney stones

DID YOU KNOW that most attacks appear first in the big toe?

Is gout hereditary? 

For a long time it was unclear if gout had a genetic or hereditary component. Recent studies have shown that genetics do have an impact on your uric acid levels and ultimately, the significance of attacks. In fact, Tanya Major, PhD. of the University of Otago completed a meta-analysis in 2018 comparing the impact of genetic factors and diet on uric acid levels.

Genetic factors accounted for 24% of elevated uric acid levels in participants, showing more significance than diet on impacting attacks and symptoms. Dr. Major commented that, “Our results challenge widely held community perceptions that hyperuricemia is primarily caused by diet, showing that genetic variants have a much greater contribution to hyperuricemia in the general population than dietary exposure.”

There are certain genetic tendencies and conditions that play a more significant role in determining your risk of gout. Your gender, for example, can impact your likelihood of having gout as well as what areas of your body are impacted by the condition. Men get gout more than women by about nine to one, and men are more likely to develop gout in their lower extremities. Things like age, ethnicity and previous injury also play a role.

What foods trigger gout?

There are foods that can help prolong the time between gout attacks and foods that can set off gout attacks. It is important to remember that at a certain point for certain types of patients, diet alone will not always prevent a gout attack.

Many studies, including Dr. Major's, have proven that red meat, meat gravies, shellfish and alcohol (especially beer) can increase uric acid levels. All alcohol causes uric acid to be reabsorbed by the kidneys, ultimately raising uric acid levels, but beer has its own high purine level. On the other hand, things like skimmed milk, brown bread, margarine, eggs and non-citrus fruits can help to reduce uric acid levels.

When should I see a doctor? How do I manage gout long term?

There are wide ranges of treatment for gout depending on the severity and frequency of the attacks. In essence, you are considering two separate things when you approach your (potential) gout diagnosis: treatment of an attack and prevention of future attacks. There are different ways to handle both scenarios, depending on what stage of gout you are experiencing. 

If you are experiencing what you believe to be a gout attack, it would be important to talk with a doctor. Getting the pain under control and avoiding further injury is important, so don’t avoid it. If you are in the initial stages of gout or in between attacks, diet, physical activity and/or medications can be used to help prolong another attack.

Dr. Scott Heyl handles many patients who are managing their gout. He works his patients to develop a long term plan to manage the pain during attacks and also assist in prevention of future attacks. Each approach is very specific to each patient's diagnosis and lifestyle.

Overall, there is no reason to manage the pain on your own. It’s a lifelong condition that, if managed correctly, doesn’t have to severely impact your daily life. If you’d like to meet with Dr. Scott Heyl to discuss questions about gout or the possibility of a definitive diagnosis, schedule an appointment today(opens in a new tab).

Web Resources:

Gout: Risk Factors, Diagnosis and Treatment(opens in a new tab)

Gout Alliance(opens in a new tab)

References:

Major T J, Topless R K, Dalbeth N, Merriman T R. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts BMJ 2018; 363 :k3951 doi:10.1136/bmj.k3951

Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020 Jul;16(7):380-390. doi: 10.1038/s41584-020-0441-1. Epub 2020 Jun 15. PMID: 32541923.