News is Out About Gout

Although more than two million people in the United States currently have gout, an astonishing 40 percent of the general public doesn't even realize gout is one of the most painful forms of arthritis, let alone that it's the most common type of inflammatory arthritis in men older than 40, according to the newly formed Gout & Uric Acid Education Society (www.gouteducation.org). They have partnered with the Arthritis Foundation (www.arthritis.org) with hopes of changing that statistic by raising awareness today during the first-ever National Gout Awareness Day.

Gout is caused by an accumulation of uric acid in the joints. The excess uric acid (called hyperuricemia) can come from overeating foods high in purines – during digestion, purines are broken down into uric acid that your body either cannot excrete fast enough, or your body may make too much uric acid. But the condition, which causes burning, stabbing pain and swelling, can be tamed. "Hyperuricemia can be managed and controlled with medication and through adjustments to diet and lifestyle," says N. Lawrence Edwards, MD, chairman and CEO of the Gout & Uric Acid Education Society and Professor and Vice-Chair of the Department of Medicine at the University of Florida in Gainesville. "We formed the Gout & Uric Acid Education Society to educate the public and the health care community about gout and the related health care consequences of high uric acid levels, with the aim of improving the quality of care and minimizing the burden of gout," he says.

Dr. Edwards is the expert who reviews the gout information in Arthritis Today's annual Drug Guide (www.arthritis.org/ArthritisToday). I've had the opportunity to discuss gout with him over the past several years, as we've updated the information in the Drug Guide. We're still waiting to see whether the new gout drug febuxostat will be approved by the FDA, but in the meantime, gout can be controlled by allopurinol (Lopurin, Zyloprim), if your body produces too much uric acid, or by probenecid (Benemid, Probalan), if you don't excrete uric acid fast enough. Colchicine can be prescribed to help reduce the pain and inflammation of gout attacks, too, as can NSAIDs or corticosteroids.

If you have gout, though, you can't just take the uric acid-controlling medication when an attack occurs – the medication must be taken for life to keep uric acid levels in balance. You must also follow the diet recommended by your doctor to keep uric acid levels from getting too high. Rich foods and beer aren't the only culprits in gout attacks; sometimes perfectly healthy foods such as certain types of fish or vegetables can be high in purines and raise uric acid levels. Exercise also helps reduce gout attacks by improving circulation and metabolism, to help the body remove uric acid, and getting body weight into a normal range – obesity quadruples the risk of developing gout. And having gout means more than the ocassional painful attack. The uric acid crystals depositing joints can lead to destruction of joints, along with kidney problems.

Also important, especially in these summer months, is staying well hydrated by drinking water. (Look for news on water's role in decreasing gout attacks in the July-August issue of Arthritis Today.)

In the November-December 2005 issue of Arthritis Today, we reported that gout is not just a disease of men who overindulge. Women get gout, too, although usually after menopause. When estrogen levels decline, uric acid levels increase, but it takes several years until the levels increase to the point where crystals form. From 40 to 60, more men than women have gout. Around age 60, men and women are about even, as far as gout is concerned. But after age 80, more women than men have it.

If you already have a form of arthritis, such as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, or one of 100 other types, you may still develop gout. Although you might not be able to tell whether the joint pain and swelling you experience is caused by a new case of gout or your existing arthritis, your doctor can by doing a blood test to measure your uric acid levels and by examining your joints. To read about one man's quest to find out the cause of the pain in his feet and knees, go to www.arthritis.org/arthritistoday/oncall/archives/qa/oncall-gout.asp. And if you have any questions about gout, feel free to e-mail them to me directly at www.arthritis.org. I'll try to get them answered as we prepare for the second annual National Gout Awareness Day in 2008.