Gout

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Gout, an inflammatory joint disease causing acute pain and swelling, usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissue. If you have been diagnosed with gout, take steps to:

• Decrease the pain of an acute attack.
  • Rest the affected joint until the attack eases and for 24 hours after the attack.³
  • Elevate painful joints.
  • Relieve inflammation by taking nonsteroidal anti-inflammatory drugs (NSAIDs). Do not take aspirin, which may abruptly change uric acid levels and may make symptoms worse.
• Prevent recurrences.
  • Being overweight is a risk factor for gout. If you are overweight, a diet that is low in fat may help you lose weight. However, avoid fasting or very low-calorie diets. Very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Healthy Weight.
  • Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.⁴
  • Diets high in meat and seafood (high-purine foods) can raise uric acid levels.⁵
  • Certain medications that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin (81 mg to 650 mg) may raise the uric acid level. Since low-dose aspirin may be important for the prevention of stroke or heart attack, your doctor may want you to continue to take low-dose aspirin.
  • Cold hands and feet can precipitate an attack of gout. Try to keep your hands and feet warm, and take extra care to cover your hands and feet during cold winter months.
• Modify your risk factors.
  • Keep your weight within the normal range for your height.
  • Follow a moderate exercise program.
  • Avoid a diet rich in meat and seafood.⁵ Making changes in your diet may help with your gout. If you want to try an eating plan for gout, see:

    Gout: Changing your diet.

  • Have an evaluation for lead poisoning if you have been exposed to lead in your job or through hobbies.
• Continue to take any medications prescribed to you for gout. However, if you have not been taking medications that lower uric acid (such as probenecid or allopurinol) prior to the attack, do not begin taking it when the attack begins. These medications will not help relieve acute pain and may actually make it worse.

In the past, gout was thought to be due to drinking too much alcohol and eating too many rich foods. Although eating certain foods and drinking alcohol may trigger a rise in the level of uric acid in the body, these habits may not by themselves cause gout. Gout is most often caused by an overproduction of uric acid (due to metabolism problems) or decreased elimination of uric acid by the kidneys.

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Author:	Jan Nissl, RN, BS	Last Updated: July 24, 2006
Medical Review:	Martin Gabica, MD - Family Medicine Kathleen Romito, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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