All About Gout: 10 Questions You Had to Ask
Gout is misunderstood by many. So, what is it? If you've been diagnosed with gout, you know that it's very real. Notables such as King Henry VIII of England and Benjamin Franklin reportedly suffered from gout, and today, gout affects approximately 8 million Americans. We talked to gout expert Brian Mandell, M.D., Merck Manuals author and professor, and chairman of Academic Medicine at the Cleveland Clinic, to get answers to the most-asked questions about gout. Here’s what he had to say.
How did gout get its name?
It’s a goofy name — we can blame the French or the Latin speakers of the past. It comes from the Latin and French root, gutta, meaning "drop" — as in the term "dropsy." No, not dropping a sledgehammer on your toe, but the dropping of fluid and evil "humors" into a part of the body, causing striking swelling. The four humors were blood, yellow bile, black bile, and phlegm. In old literature, dropsy might refer to the edema or swelling of heart failure — another swelling we now know can be linked to gout.
How do we define gout and its symptoms now?
It is a common and painful disorder resulting from deposits of uric acid crystals that build up in joints. The cause is high levels of uric acid in the blood, or hyperuricemia. Crystals accumulate, causing flare-ups or attacks of painful inflammation in the joints. Gout symptoms can include sudden, severe pain in one or more of any of your joints, often at night. That joint will become inflamed and red, and a simple touch will hurt badly.
What's the importance of purine?
It’s a necessary building block for DNA and RNA, two main types of nucleic acids — they both carry genetic information. Our bodies get rid of unneeded purines by converting them into uric acid. That can be a problem if levels get too high. A number above 6.8 in the blood means it is likely to deposit in places around the body.
What is the most "misunderstood" thing about gout?
The disease of gout, also called hyperuricemia, is the deposition of the uric acid deposits in and around joints. It is not, as most people think, the actual attacks of gout. The gout attacks are a symptom of the disease. So while symptoms obviously should be treated, to ultimately stop the symptoms from occurring, the disease should also be treated.
Why do more men than women get the disease?
It's probably because of higher levels of uric acid in their blood. Estrogen lowers the blood uric acid level. Having higher blood levels of uric acid for longer lengths of time predisposes someone to acid deposition around joints. That predisposes them to getting gout attacks. Gout usually develops during middle age in men and after menopause in women, but young men can also get the disease. Certain behaviors may favor men getting attacks, such as drinking beer, including non-alcoholic beer.
What foods and drinks should be avoided?
We make most of the uric acid in our body — it doesn’t come from diet. That said, certain foods increase the amount of uric acid more than others, and some foods seem to predispose us to attacks. The worst offenders that I would avoid, in addition to beer, include anything with high-fructose corn syrup, anchovies, mussels, sardines, all organ meats, and cheap wines — which usually aren't that good anyway! Low dairy intake is also a risk factor.
Why do we tend to think of the big toe as the first joint to be affected?
Gout can occur in any spot where uric acid has been deposited — in any joint, tendon or bursa, or fluid-filled sac. However, uric acid tends to deposit in cooler areas towards the periphery of the body. Microtrauma or a minor injury tends to predispose areas of the body to uric acid deposition, and then to having an attack where it's deposited. The base of the great or big toe fits both of these criteria. Gout can affect multiple joints at the same time, called a polyarticular gout attack.
What are the implications of having gout?
Gout and hyperuricemia are both associated with a number of metabolic issues including diabetes, kidney disease, heart disease including cardiac death and heart failure, and hypertension. There is a complex interplay between all of these metabolic disorders, but in general, I would say that the appropriate management of gout and hyperuricemia can only help and really is probably beneficial.
What are the best medications to treat gout?
For most patients, Allopurinol is cheap and effective to lower the uric acid level and treat the disease. Alternatives are available. Multiple options exist to treat gout attacks, and are based on a patient’s other medical problems. We want to pick the safest option. The major issue in treating the disease is using enough medication to lower the uric acid level to below 6, so deposits dissolve — curing the disease and stopping attacks. Uric acid levels must be monitored and medication adjusted.
Why is it important to treat and manage gout?
Uric acid can cause other problems in people with gout, with approximately 20 percent of them developing kidney stones. Sometimes people with gout also have other chronic conditions that negatively impact the kidneys. These can include diabetes or high blood pressure. With these, the rate of uric acid excretion can worsen gout and joint damage. Having chronic gout also increases osteoarthritis risk.