Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe) but also in other joints. Treatments are now available to control most cases of gout, but diagnosing this disorder can be difficult. Treatment plans often have to be tailored for each person.
Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and crystals deposit in the joints. This may happen either because uric acid production increases or, more often, because the kidneys are unable to adequately remove uric acid from the body. Certain foods, such as shellfish and alcohol, may increase uric acid levels and lead to gout attacks. With time, increased uric acid levels in the blood may lead to deposits of monosodium urate crystals in and around the joints. These crystals attract white blood cells, leading to severe gout attacks. Uric acid may also deposit in the urinary tract, causing kidney stones.
Gout and its complications occur more often in men, in women after menopause, and in people with kidney disease. Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes. Because of genetics, gout tends to run in some families.
Several other kinds of arthritis can mimic gout, so proper diagnosis is essential. Gout is suspected when a patient experiences joint swelling and intense pain followed, at least at first, by pain-free periods between attacks. Initial gout attacks often occur at night. A correct diagnosis may depend on finding the characteristic crystals. The physician will use a needle to extract fluid from an affected joint and examine them under a microscope to determine whether monosodium urate crystals are present. Crystals can also be found in deposits that occur under the skin (called tophi) that occur in advanced gout. Uric acid levels in the blood can be misleading, as these may be temporarily normal or even low during attacks. Uric acid levels are also often elevated in people who do not have gout.
Non-steroidal anti-inflammatory drugs (NSAIDS) are “aspirin like” medications that can decrease inflammation and pain in joints and other tissues. NSAIDs -- such as indomethacin ( Indocin) and naproxen ( Naprosyn) -- have become the treatment choice for most acute attacks of gout. There is no evidence that any one NSAID is better than others. High doses of short acting NSAIDS provide fastest relief of symptoms. NSAIDS may cause stomach irritation, ulcers, or diarrhea, but if used for the short term, are generally well tolerated. Resting the affected joint and applying cold compresses to the area may also help alleviate pain. Efforts to normalize blood uric acid levels should be considered for patients who experience several gout attacks or who develop tophi or kidney stones.
What works well for one person may not work as well for another, so decisions about when to start treatment and what drugs to use have to be tailored for each patient, and depend on kidney function and other factors. Drinking alcohol should be reduced or stopped. Diets that restrict foods rich in purines (substances found in meat and certain types of seafood) may help in difficult cases. In almost all cases, it is possible to successfully treat gout so that the patient experiences a gradual ending of attacks and decreases in the number and size of tophi.
Lifestyle changes can't cure gout, but may make it easier to manage this lifetime disease. The following measures may help relieve symptoms:
Foods considered high in purine content include:
Foods considered moderate in purine content include:
Smaller amounts of purines are found in all meats, fish and poultry. For this reason, limit animal protein in your diet to no more than 6 ounces of lean meat, poultry or fish a day.
Food Categories |
Food Recommended |
Tips |
Breads, Cereals, Rice, & Pasta 6 – 11 servings each day Serving Size = 1 slice bread 1 cup dry cereal ½ cup cooked cereal, rice or pasta |
All Whole grain breads & cereals, brown rice, whole wheat pastas |
Avoid high fat breads like muffins, French toast, and biscuits. Use tomato based sauces instead of cream or cheese sauces |
Fruits 2 – 4 servings each day Serving size = 1 medium size ½ cup canned ¾ cup juice |
All fruits and 100% fruit juices |
Fruits canned in heavy or light syrup |
Vegetables 3 – 5 servings each day Serving size = 1 cup raw leafy or ½ cup cooked |
All except those in moderation In moderate amounts: Asparagus, cauliflower, green peas, mushrooms, and spinach |
Limit those that are fried, au gratin, or prepared with cream such as French fries or creamed potatoes.
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Meats, Poultry, Fish, Dry Beans & Peas, Eggs, & Nuts 2 servings each day Serving size = 3 ounces of meat at each meat. Count 1 egg, ½ cup cooked beans or 2 T peanut butter as 1 ounce of meat
|
In moderate amounts: Beef, lamb, veal, pork, poultry, fish, shellfish, and eel Dry beans & peas, peanut butter, and nuts Limit egg yolks to 3 – 4 per week |
Avoid the following high-purine protein foods: sweetbreads, anchovies, sardines, liver, beef kidneys, brains, meat extracts, herring, mackerel, and scallops.
Limit meat, poultry or fish that is fried or served with gravy or cream sauce. |
Milk, Yogurt, & Cheese 2 – 3 servings each day Serving size = 1 cup milk or yogurt or 1 ½ ounces cheese |
Skim and 1% milk, low-fat yogurt, and low-fat cheeses ( less than 5 grams of fat per ounce) |
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Fats, Snacks, Sweets, Condiments, & Beverages |
Creamed soups made with low fat milk and vegetable broth-based soups Flavored gelatine, ice me ilk, plain cookies, and angel food cake Herbs & spices Sugar-free carbonated drinks and beverages In moderate amounts: Meat gravies and soups made with meat stock Baker’s & brewer’s yeast |
Use fats & oils like butter, margarine, cream, and salad dressings sparingly. Limit high-fat snack chips and sweets such as doughnuts, sweet rolls, pies, cakes, cookies, and ice cream. Check with your doctor is you may drink alcohol. If you drink alcohol, make sure you drink it with a meal. |
It is always best to talk with your rheumatologist for more information and before making any decisions about your care.
For more information:
The Arthritis Foundation
www.arthritis.org
National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
www.niams.nih.gov