Gout and the Holidays: Tips, Tricks, and Prevention
The guide to gout you never knew you wanted for the holidays.
See what I did there? Okay okay, no more Dr. Seuss.
So what is gout?
Gout is a common form of inflammatory arthritis that is very painful. It usually affects one joint at a time (often the big toe joint- 90% of attacks). There are times when symptoms get worse, known as flares, and times when there are no symptoms, known as remission. Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis (2).
Unfortunately there is no cure for gout, but you can effectively treat and manage the condition with medication and self-management strategies that we will go over in this article.
Symptoms:
The signs and symptoms of gout almost always occur suddenly, and often at night. If you’re experiencing gout, you might wake to find the sensation that your big toe is on fire. Other symptoms include:
Intense joint pain. Gout usually affects the big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
Limited range of motion. As gout progresses, you may not be able to move your joints normally.
Risk factors
You're more likely to develop gout if you have high levels of uric acid in your body. Uric acid is created when your body breaks down purines, a compound found naturally in your body but also in some food and drink. When your levels of uric acid become unbalanced, your body reacts with inflammation.
There are many things we encounter during the holiday season and other times of the year that may increase the chance of having high levels of uric acid, including:
Diet. Eating a diet rich in red meat and shellfish and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
Weight. If you're overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.
Medical conditions. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases.
Certain medications. Low-dose aspirin and some medications used to control hypertension — including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers — also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
Family history of gout. If other members of your family have had gout, you're more likely to develop the disease.
Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women's uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
Recent surgery or trauma. Experiencing recent surgery or trauma can sometimes trigger a gout attack. Even minor repetitive strain like hiking, running. In some people, receiving a vaccination can trigger a gout flare.
When to see a doctor
Treatment
If you experience several gout attacks each year, or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications.
Gout medications are available in two types and focus on two different problems. The first type [drugs such as corticosteroids (prednisone) and colchicine (Colcrys, Gloperba, Mitigare)] helps reduce the inflammation and pain associated with gout attacks, while the second [drugs such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric)] works to prevent gout by lowering the amount of uric acid in your blood.
If you already have evidence of damage from gout on joint X-rays, or you have tophi, chronic kidney disease or kidney stones, medications to lower your body's level of uric acid may be recommended.
** There are side effects, sometimes significant, associated with each of these medications and you should consult your doctors to weigh the risks and benefits for your individual case.
If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage. Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.
Diagnosis
Doctors usually diagnose gout based on your symptoms and the appearance of the affected joint. Common tests to help diagnose gout may include:
Blood test. Your doctor may recommend a blood test to measure the levels of uric acid in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.
Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope.
X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation.
Preventing Gout
With holiday parties bringing plenty of opportunities to consume sugary drinks and foods, it’s important to be aware of what we are putting into our bodies. There are many ways to prevent gout, including:
Avoiding or limiting alcohol
Consuming alcohol inhibits the body’s ability to excrete uric acid, increasing the risk of hyperuricemia and a gout attack.
Drinking plenty of water
Increasing water intake will help keep the kidneys healthy and help them flush out uric acid from the body.
Losing excess weight or maintaining a healthy weight
Treating sleep apnea
While more research is needed, some evidence suggests that treating sleep apnea may significantly affect the frequency of gout episodes. Increased oxygen intake may lower uric acid production and reduce the risk of a gout attack.
Avoiding foods that can trigger a gout flare-up. Foods that may trigger a gout attack:
Sugary foods and beverages, particularly those made with high fructose corn syrup, such as sodas
Meat, particularly organ meat or “sweetmeats,” such as liver, and game meats.
Seafood, particularly scallops, anchovies, and herring
People who are prone to gout can prevent uric acid buildup in the bloodstream by avoiding these foods (1).
A gout prevention diet includes plenty of vegetables, fruits, and complex carbohydrates, including whole grains and beans. Such a diet may also include:
Low-fat dairy products, such as skim milk and yogurt, may decrease the levels of uric acid in the blood and thereby decrease their risk of gout attacks. High-fat dairy products do not have the same protective effect.
Cherries have long been thought to prevent gout flare-ups, and there is some scientific evidence to support this. Fresh or frozen tart cherries, 100% unsweetened tart cherry juice, or cherry extract may be beneficial. Avoid sweetened cherries, such as cherry pie filling (1).
Avoiding medications that trigger gout
People who take these medications and have gout may ask their health care providers if other medications or treatments might be appropriate.
And of course, taking prescription gout medication (5).
Because gout is such a common ailment, there are many resources to help aid and avoid the symptoms of gout. If you’re experiencing symptoms, don’t hesitate to contact your doctor with questions and concerns. But if you are prone to gout or are concerned you may develop it because of your current diet and lifestyle, please take the advice given in this article to heart and make the few changes necessary to ensure you spend this holiday season happy and gout-free.
Have a happy, safe holiday and as always,
Be well.
—Dr. D.
Sources:
(https://www.arthritis-health.com/types/gout/gout-prevention)
(https://creakyjoints.org/about-arthritis/gout/gout-diet/low-purine-diet-gout/)
(https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897)