Gout is one of the earliest diseases recognized by humankind. Sometimes referenced as the ‘disease of the kings’ because only the rich and powerful could afford a diet that was decadent enough to trigger gout pain. “Fifty-two million people in the US suffer from some form of arthritis and gout accounts for 16% of arthritis in the country. Gout is usually more predominant in men, until women go through menopause; after that, the distribution is much more equal,” says Dr. John Heydt, University of California’s Riverside School of Medicine.
What is gout? “Gout is a type of inflammatory arthritis,” says Dr. Nathan Wei, founder of the Arthritis Treatment Center. “It’s due to an accumulation of uric acid which may result from either over production by the body or under-excretion by the kidneys. When uric acid accumulates, it deposits out in both joints as well as internal organs such as the kidneys. In fact, in the old days, the most common cause of death in gout patients was kidney failure.”
Before menopause, estrogen helps the kidneys excrete uric acid; after menopause, when estrogen dips, uric acid levels tend to creep up. It can take several years for them to build to the point where the painful crystals form, according to the Arthritis Foundation, but by about age 60, the number of cases of gout in women and men are about equal; after age 80, more women than men have gout.
What are the signs and symptoms of gout? “If you think about gout as putting sugar in hot coffee, the sugar dissolves but as the coffee cools the sugar crystalizes again in the bottom of the cup,” says Dr. Heydt. “Gout is somewhat similar; the gout crystals accumulate in the joint and cause inflammation which causes redness, swelling, pain and limitations of motion.” Symptoms include extreme joint tenderness, red or purplish skin around the affected joint with limited movement.
Why does someone get gout? “Gout is a result of genetics, diet, alcohol consumption,” says Dr. Heydt. “Diet accounts for approximately 12% of gout flares and is linked to high protein content from meat and seafood, alcohol particularly beer and fructose drinks. Trauma and cooling of the joints or cold weather can trigger a gout attack.
What is the role of diet in reducing symptoms? Medications can control symptoms, but you can help by limiting foods that hike uric acid production, including bacon, haddock, liver, scallops, turkey, veal, and venison. “Foods high in purines, the substances that are metabolized into uric acid, need to be avoided,” says Dr. Wei. “The foods include red meats, shellfish, gravies, beer, and a few others. It’s been in shown in a few studies that cherries can abort acute gout attacks. The mechanism is unclear.”
“Although OTC medications can be helpful, gout is best treated by reducing the uric acid levels,” says Dr. Heydt. “This can be done with medications such as Allopurinol, which decreases production by the liver, or Probenecid, which allows greater excretion or elimination by the kidneys. “Other medications helpful in an acute gout attack are NSAIDs like Indocin. Naprosyn or ibuprofen can be helpful as well as corticosteroids such as prednisone or a joint injection with a corticosteroid. Colchicine is also useful particularly in people who cannot take NSAIDs.”
“For gout, heating the joint is helpful compared to most other kinds of arthritis or injuries where ice is used,” says Dr. Heydt. “To go back to the coffee/sugar example, heat helps the crystals dissolve.”
Some gout sufferers turn to Salonpas® Pain Relieving GEL-Patch Hot which features capsaicin, which is derived from chili peppers, which creates a warming sensation which can provide long-lasting relief.
“OTC anti-inflammatories may be useful in treating mild attacks as they are for treating other forms of arthritis pain,” says Dr. Wei. “However, this is a symptom treatment. It doesn’t treat the underlying cause of gout. Patients will require more aggressive intervention to reduce the amount of uric acid in the system.”