10/18/2019

Gout: New Treatments and Recommendations for Prevention

Gout: New Treatments and Recommendations for Prevention

Gout commonly presents with a sudden onset of redness, swelling and excruciating pain of the great toe joint during the night. Gout is a painful joint condition brought on by hyperuricemia (high levels of uric acid in the blood) resulting in the particular precipitation of needle-like crystals in the joints. The prevalence of gout has been steadily increasing over the past two decades is now estimated to be 1-2% of the U.S. population. Gout is more common in men, but in recent years, the incidence of gout has doubled in women (1,2).

The common causes of gout are diet, overproduction of uric acid and renal disease. Common risk factors include family history, male gender, a high protein diet, heavy alcohol consumption usage, high blood pressure, kidney disease, metabolic syndrome, diuretic utilize and obesity. Hyperuricemia has been suspected to increase the risk of heart disease by increasing inflammatory factors that damage bloodstream (3).

Treatment Varies Regarding Acute and Chronic Gout

For acute gout flares, the standard treatment is a course of anti-inflammatory medications, steroid injections and/or joint aspiration. Allopurinol is commonly used for treatment of chronic gout and prevention of acute gout attacks. Febuxostat is a new treatment recently approved by the Food and drug administration. In long term studies over a 5-year period, febuxostat has been shown to reduce uric acid levels and also substantially decrease or eliminate acute gout assaults (4). A study last year in the Archives of Internal Medicine showed 500 mg of Vitamin c each day reduced the incidence of gout by 15% (2). Researchers at the Arthritis Research Centre of Canada in Vancouver found long-term coffee consumption is associated with a lower incidence of gout. Those who drank four + cups of coffee per day had the least risk of developing gout (5). The authors did not recommend starting to drink coffee for those people who do not currently drink coffee.

The relationship between heart disease and gout has been suspected to be able to be more coincidental than causative, till not too long ago. Recent research suggests uric acid may be a causative factor in heart disease. Uric acid activates the immune response and the inflammatory process. This reaction can be seen in an acute gout flare involving an unpleasant, red, hot, swollen great toe joint. Uric acid is both an antioxidant and a pro-oxidant. This means that even though uric acid may quench free radicals and reduce oxidative cell damage, it also increases mediators which affect blood vessels and increase the risk of heart disease (6).

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The Most Effective Prevention of Gout is the Modification of Diet and Lifestyle

Specific foods and beverages, which includes red meat and alcohol, can trigger a serious gout attack. Being overweight increases the risk of gout and other conditions which increase the risk of gout, such as hypertension as well as metabolic syndrome. Weight reduction and also daily exercise are both appropriate protective treatment options for gout. Other recommendations include limiting intake of sugary beverages and foods with added sugar, consuming whole grain products, nuts, legumes, many fruits, vegetables, moderate amounts of lean white meats and also low fat milk and oily fish (7). You may want to talk to your doctor about adding a vitamin c supplement or increasing your coffee intake.

Arthritis Rheum. 2010 Jan 21.

Arch Intern Med. 2009;169(5):502-507.

Curr Rheumatol Rep. 2010 Apr;12(2):118-24

Pharmacotherapy. 2010 Jun;30(6):594-608.

Arthritis Rheum. 2007 Jun;56(6):2049-55.

Rheumatology (Oxford). 2010 Jul;49(7):1229-38.

Curr Opin Rheumatol. 2010 Mar;22(2):165-72.

Christine Dobrowolski is a podiatrist and owner of Northcoast Footcare, Inc, an online resource for foot information and also physician recommended foot care products.

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