Newswise — Gout, a painful form of arthritis, is a highly treatable disease. The problem is that many patients stop taking their medication when they feel better, leaving themselves susceptible to painful flare-ups, according to Theodore Fields, MD, an attending rheumatologist at Hospital for Special Surgery (HSS).
“Studies show that not adhering to treatment is a major issue among gout patients. Many people simply aren’t fully aware that ongoing treatment and dietary changes are necessary to keep gout in check,” Dr. Fields notes. “At Hospital for Special Surgery, patient education is an essential part of the program for individuals who have gout. We want them to know why sticking to their medication regime is important, even if they feel better; how their diet can affect the disease; and that controlling gout is in their hands.”
A form of arthritis, gout is caused by a buildup of uric acid in the body that causes needle-like crystals to form in the joints. Most often, gout affects the base of the big toe, but it can also strike the ankle, foot, knee and other joints. A painful attack almost always occurs suddenly without warning, often at night. Patients say it feels like their toe is on fire or like they stepped on broken glass. The affected joint becomes swollen, tender, warm and red.
A Centuries-Old Disease, Now on the Rise
Gout has been around for centuries. Historically known as "the disease of kings,” it was believed to affect wealthy people who could afford to consume large quantities of food and wine. Henry VIII famously suffered from gout in the 16th century.
The disease has become more common in recent years and now affects more than 8 million people in the United States. “Gout cases are likely on the rise due to increasing rates of obesity, which elevates risk, although you don’t need to be overweight or wealthy to get gout. It affects men more often than women,” Dr. Fields explains. Gout tends to run in families, and many patients have relatives who share the problem.
Diet Plays a Role
Purines, chemical compounds found in common foods, can raise uric acid levels and trigger an attack of gout in susceptible individuals. Foods high in purines include meat, shellfish, gravy, beer and other alcoholic beverages, and drinks sweetened with high fructose corn syrup.
Sometimes an injury can set off an attack of gout. A stubbed toe can lead to a flare-up if enough uric acid crystals are in the joint. “Imagine that the crystals are like matches. They can sit quietly or they can be ignited,” Dr. Fields explains. “Crystals can be present for years in a joint without causing inflammation. Then, at some point, due to an increased number of crystals or another factor such as an injury, the matches are lit and inflammation begins.” People who have an attack of gout may also experience fever, chills, fatigue and general malaise.
Anyone who feels sudden, intense pain in a joint is advised to see a doctor, especially if it happens more than once, Dr. Fields says. People should not try to tough it out. Left untreated, gout can lead to worsening pain and even joint damage as time goes on. Individuals with advanced disease can develop lumps, bumps and other joint deformities.
Fortunately, gout is highly treatable, and the earlier it’s diagnosed, the better, according to Dr. Fields. Patients may first see a primary care physician, but more complicated cases are often referred to a rheumatologist.
“Lowering levels of uric acid is key to gout management,” Dr. Fields explains. “Weight control and a strict diet limiting offending foods may be sufficient for patients with mildly elevated uric acid levels, but the great majority of patients will need medication.”
Importance of Patient Education
A number of drugs are available to treat gout and prevent a recurrence of symptoms. It’s vital that patients stick to their medication regimen, even if their symptoms subside, according to Dr. Fields, and that’s where patient education comes in.
“We believe it’s important for patients to know their uric acid level and have a goal to keep gout in check, just like a patient with diabetes has a blood glucose goal, or an individual with hypertension has a blood pressure goal,” he says. “When gout patients stick with their medication, follow a healthy diet and control their weight, there’s a good chance flare-ups will disappear completely over time.”
Hospital for Special Surgery will host a Facebook Live Q&A with Dr. Fields on Monday, May 22 at 4 pm ET on the HSS Facebook page: https://www.facebook.com/hspecialsurgery/ He will provide the latest information on gout and answer questions from the viewing audience.