By Dr. Grismer, Rheumatologist, Baylor Scott & White
Gout is a type of arthritis that attacks abruptly with severe pain and swelling, usually in one or two joints. The joint and surrounding area are exquisitely painful with swelling and redness due to inflammation. Even touching it lightly, such as the weight of a bedsheet, can be painful. It usually occurs in the big toe joint but ankle and midfoot also can be affected. It can also occur in the elbow or knee, sometimes even in hand joints.
Gout is caused by elevated uric acid. This can occur when the kidney does not excrete uric acid well enough to keep the level low, or if the person consumes too much of certain foods and drinks that are high in purines (which then produce uric acid.) Once the uric acid is too high, it precipitates in a joint, and this elicits an inflammatory response.
Gout is diagnosed by having a characteristic painful, swollen red joint and elevated uric acid in the blood. Ideally, finding uric acid crystals within a white blood cell in the joint confirms gout. Radiology images such as X-ray and ultrasound also can be helpful. Gout is becoming more common because obesity is more common. High blood pressure is also associated with gout and high blood pressure is becoming more common.
Certain foods should be avoided. Alcohol (especially beer), red meat, organ meats, shellfish, soda and other high-sugar items, and dried fava and garbanzo beans contain high amounts of purines.
Problems associated with gout include obesity, hypertension, elevated cholesterol, and insulin resistance. These symptoms comprise metabolic syndrome, which has been shown to increase risk of cardiovascular disease and diabetes. Blood pressure and cholesterol need to be controlled. If obese, losing weight is of the utmost importance, and monitoring and managing blood sugar also is extremely important.
Genetics and dietary habits contribute to the risk of gout. Historically, a lifestyle of indulgence in fatty foods and beer and other alcoholic drinks were associated with painful gout flares. You can lower the risk of gout by avoiding certain food and drinks and eating less sugar and fat, rarely drinking alcohol, and achieving ideal body weight.
Well-known people with gout include Laurence Olivier, Jim Belushi, Ben Franklin, Charles Spurgeon, and many others. Gout is more common in men younger than 60 because estrogen in women keeps their uric acid lower.
