Gout info

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

More information is available from the Arthritis Foundation and the American College of Rheumatology

Gout is a metabolic disease that leads to an excessive amount of uric acid in the blood and other tissues. The excessive uric acid causes a common type of arthritis that occurs when sodium urate crystallizes in the joints.

Gout can also appear in an ear, small hand joints, ankles, knees, elbows, or wrists with inflammation, swelling and intense pain from build-up of uric acid crystals. Uric acid is the end product of the metabolism of food substances known as purines. Human beings lack the enzyme, uricase, which is responsible for the breakdown of uric acid. As a result, uric acid builds up and crystallizes. Excessive excretion of uric acid in the urine can lead to the development of kidney stones, kidney disease, and even kidney failure.

People who have gouty arthritis have the following clinical course… an attack usually comes on suddenly, and can last from a few hours to several days. It frequently manifests as painful inflammation of the big toe. This is called "podagra".

Gout is associated with high blood pressure, kidney disease, diabetes, hyperlipidemia, atherosclerosis, and obesity.

Between 75-90% of gout sufferers are middle-aged males and 25% have family members with it. In women, uric acid starts accumulating after menopause, quite possibly due to the drop in estrogen. Addition of diuretics for hypertension also are an aggravating factor for gout.

Traditional treatment of the acute attack are non-steroidal anti-inflammatory medicines (NSAIDS), steroids, or colchicine.

To lower serum usic acid, drugs such as allopurinol, febuxostat (Uloric), and probenecid are used.

Allopurinol and febuxostat inhibit the enzyme that causes the conversion of purines to uric acid. Allopurinol, however, has some serious side effects, such as skin eruptions, liver toxicity, inflammation of the blood vessels, bone marrow toxicity, and kidney damage. Febuxostat may increase cardiovascular risk.

Probenecid is another drug used in gout treatment. It makes the kidneys excrete uric acid. It is not effective in patients who don’t have normal kidney function. It also is not advised in patients who already are putting out too much uric acid in the urine since that can lead to kidney damage and kidney stones.

Dietary indiscretions that lead to gout are excessive amounts of alcohol, protein, heavy foods, coffee and soft drinks in the diet. Other foods that increase uric acid are anchovies, asparagus, legumes, mushrooms, meat, organ meat, and shellfish. Reduction in consumption of these foods is often helpful in reducing or eliminating gout.

Gout is more common in obese people. Nearly half of the people with gout are at least 15% above their recommended weight. As mentioned below, rapid dieting can trigger gout attacks.

Some other causes of gout attacks:

• Stress
• Surgery
• Injury
• Certain antibiotics
• Chemotherapy - uric acid is released in extreme amounts due to the cellular destruction.
• Hypothyroidism
• Diseases such as leukemia, multiple myeloma and psoriasis are associated with gout.
• Drugs such as cyclosporine and diuretics

Lead poisoning may be another possible cause of gout.

Diuretics may also increase uric acid levels, triggering gout. This effect is especially important for people who use diuretics continually for either dieting or hypertension.

When kidneys are not functioning at optimum levels, they lose their ability to excrete uric acid from the body.

Severe dieting or fasting can cause excess lactic acid, which hinders uric acid excretion by the kidneys.

Certain foods contain high levels of purine which can cause uric acid levels to rise. Purine is a protein substance that is transformed into uric acid during digestion.

Foods to Avoid

• Meat: organ meats, offal, meat extracts, veal, bacon, sweetbreads, meat gravies and broths, consumme/bullion
• Poultry: turkey, goose
• Seafood: salmon, mackerel, trout, cod, herring, sardines, anchovies, mussels, crab, shrimp
• Vegetables: peas, beans, lentils, asparagus, mushrooms, cooked spinach, rhubarb, cauliflower
• Yeast products: baked goods, beer
• Alcohol - increases the production of uric acid and inhibits its excretion by the kidneys

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