Gout: New Treatments and Recommendations for Prevention

Gout commonly presents with a sudden onset of redness

, swelling and excruciating pain of the great toe joint during the night. Gout is a painful joint condition caused by hyperuricemia (high levels of uric acid in the blood) resulting in the precipitation of needle-like crystals in the joints. The prevalence of gout has been steadily increasing over the past two decades is now estimated to be 1-2% of the U.S. population. Gout is more common in men, but in recent years, the incidence of gout has doubled in women (1,2). The common causes of gout are diet, overproduction of uric acid and renal disease. Common risk factors include family history, male gender, a high protein diet, heavy alcohol consumption, high blood pressure, kidney disease, metabolic syndrome, diuretic use and obesity. Hyperuricemia has been suspected to increase the risk of heart disease by increasing inflammatory factors that damage blood vessels (3).

Treatment varies for acute and chronic gout. For acute gout flares, the standard treatment is a course of anti-inflammatory medications, steroid injections and/or joint aspiration. Allopurinol is commonly used for treatment of chronic gout and prevention of acute gout attacks. Febuxostat is a new medication recently approved by the FDA. In long term studies over a 5-year period, febuxostat was shown to reduce uric acid levels and substantially decrease or eliminate acute gout attacks (4). A study last year in the Archives of Internal Medicine showed 500 mg of Vitamin C per day reduced the incidence of gout by 15% (2). Researchers at the Arthritis Research Centre of Canada in Vancouver found long-term coffee consumption is associated with a lower incidence of gout. Individuals who drank four + cups of coffee per day had the least risk of developing gout (5). The authors did not recommend starting to drink coffee for those individuals who do not already drink coffee.

The relationship between heart disease and gout has been suspected to be more coincidental than causative, until recently. Recent research suggests uric acid may be a causative factor in heart disease. Uric acid activates the immune response and the inflammatory process. This reaction can be seen in an acute gout flare involving a painful, red, hot, swollen great toe joint. Uric acid is both an antioxidant and a pro-oxidant. This means that although uric acid may quench free radicals and reduce oxidative cell damage, it also increases mediators which cause damage to blood vessels and increase the risk of heart disease (6).

The most effective prevention of gout is the modification of diet and lifestyle. Specific foods and beverages, including red meat and alcohol, can trigger an acute gout attack. Obesity increases the risk of gout and other conditions which increase the risk of gout, such as hypertension and metabolic syndrome. Weight reduction and daily exercise are both appropriate preventative treatments for gout. Other recommendations include limiting intake of sugary beverages and foods with added sugar, consuming whole grains, nuts, legumes, fruits, vegetables, moderate amounts of lean white meats and low fat dairy and oily fish (7). You may want to talk to your doctor about adding a vitamin C supplement or increasing your coffee intake.

1. Arthritis Rheum. 2010 Jan 21.

2. Arch Intern Med. 2009;169(5):502-507.

3. Curr Rheumatol Rep. 2010 Apr;12(2):118-24

4. Pharmacotherapy. 2010 Jun;30(6):594-608.

5. Arthritis Rheum. 2007 Jun;56(6):2049-55.

6. Rheumatology (Oxford). 2010 Jul;49(7):1229-38.

7. Curr Opin Rheumatol. 2010 Mar;22(2):165-72.

Gout: New Treatments and Recommendations for Prevention

By: Christine Dobrowolski

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