April 20th, 2023
By: Christopher Tracy, MD, FACP, FACR, board-certified rheumatologist
Gout is the most common form of inflammatory arthritis in the world, affecting an estimated 9.2 million adults in the United States. In fact, gout was one of the earliest diseases to be classified as a clinical entity identified by the Egyptians over 4,000 years ago.
This form of arthritis develops in those that have high levels of uric acid, a waste product found in the blood. Uric acid buildup can develop due to the kidneys not excreting properly or from consuming too much food containing purines, natural chemicals found in every cell of the body, including red meat, certain seafood, sugary beverages and beer.
These build-ups can form crystals that lodge into the joints and soft tissue, causing sudden and intense flare-ups of joint pain and swelling. These flare-ups occur over a span of a few hours and are associated with pain, redness, warmth and swelling of the affected joint. Typically, flare-ups affect a single area, usually the big toe, but symptoms can spread to several joints at the same time.
When someone experiences a gout flare-up, it can last several days and up to two weeks without medical intervention. If left untreated, the buildup of crystals may continue to grow causing significant joint damage and potential disability.
Men are three times more likely than women to develop gout. It tends to affect men older than 40 and women who have gone through menopause due to losing protection from estrogen. Medical conditions such as diabetes, obesity, heart and kidney disease, and specific high blood pressure medications can also increase one’s risk of developing gout.
Treatment of gout flare-ups includes taking anti-inflammatory medications or non-steroidal anti-inflammatory medication to help reduce the duration of joint pain and swelling. Medications help to reduce the duration of the flare-up and are taken for several days to weeks until it has subsided.
There are also treatments to help prevent future flare-ups, thus decreasing potential joint damage. Long-term medication may be prescribed to lower uric acid levels in the body. In severe cases of gout, biological infusion IV therapy may be used as a form of treatment.
Several lifestyle adjustments are recommended for those with gout. These include limiting purine-rich foods, and alcohol consumption, and avoiding high fructose corn syrup. Weight loss and weight management can also significantly help reduce flare-ups. Studies have shown that a 5% decrease in body mass index (BMI) can lead to a 60% greater chance of a flare-up, while a 5% decrease in BMI can lead to a 40% lesser chance of developing one.
Symptoms of gout can often be confused with other types of arthritis. Seeing a rheumatologist can help to avoid confusion and lead to proper treatment and prevention. Rheumatologists are specialists in the diagnosis and treatment of inflammatory joint conditions and are equipped to take the time needed to engage and educate patients about underlying causes and important treatment options available to them.
Christopher Tracy, MD, FACP, FACR, is board-certified in rheumatology and internal medicine and works at Pinehurst Medical Clinic. He is an Assistant Professor of Medicine at the Uniformed Service University of Health Science and is recognized as a Fellow in both the American College of Rheumatology and the American College of Physicians.