Gout is a particularly painful form of crystalline or inflammatory arthritis in which high levels of serum urate cause swollen, stiff joints. Often related to genetics, gout is not the lifestyle consequence it’s been portrayed as. Forget the stereotype of carousing, overindulgent men such as King Henry VIII ending up stricken with gout.
“That’s just victim-blaming, While it does affect men more than women, and can be exacerbated by obesity and diet, genetics are a more important factor,” says John Fitzgerald, MD, with the department of rheumatology at the UCLA Medical Center in Los Angeles, and coauthor on the American College of Rheumatology’s recent guidelines update.
Many Risk Factors May Contribute to Gout and Gout Flare-Ups
Women can develop gout too, especially later in life after menopause.
Other risk factors and conditions for developing gout include:
- Insulin resistance
- Congestive heart failure
- Metabolic syndrome
- High cholesterol
- High blood pressure,
- Kidney disease and the medications taken for it, because they increase uric acid levels.
Your 10-Point Plan: Easing a Gout Attack
During a gout attack, the affected joint becomes swollen, warm to the touch, and appears very red. Even the slightest pressure on the joint can be very painful. The attacks more often occur in the middle of the night; about 50 percent start in the big toe, according to the Alliance for Gout Awareness.
Want to get ahead of the intense pain? Make sure you have a plan:
1. Get a Diagnosis
If this is the first time you have had an attack, see your doctor immediately. “Gout is one of the most underdiagnosed diseases because data on how to treat high uric acid has been lacking. We have better information now. If you are experiencing a flare, you should have an action plan in place, created with your doctor,” says Payam Shakouri, MD, nephrologist with Advanced Kidney Care of Hudson Valley in New York, and medical advisor for gout to CreakyJoints. The sooner you start treatment and pain management, the more quickly you will be back on your feet.
2. Take the Right Anti-Inflammatory Medications
There are three different kinds that are effective: over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, or naproxen sodium; prescription steroids; or a prescription anti-inflammatory called colchicine, which influences the way your body reacts to uric acid crystals. “Your doctor will figure out which is the best for your unique needs. NSAIDs, for example, are not appropriate if you have renal disease, and steroids could make your blood sugars worse if you have diabetes,” points out Dr. Fitzgerald.
3. Free the Joint!
The least pressure on the affected area can be very painful. People report they can’t even bear to be under a bedsheet. Make sure there are no constraints on the joint when it is flaring up.
4. Rest and Elevate
Stay off the affected joint and keep it elevated as much as possible.
5. Apply Ice — if You Can Bear It
“Apply ice if you can do so comfortably without creating pain,” says Fitzgerald.
6. Watch Your Diet
You can lower uric acid levels by limiting foods high in purines (like red meat, organ meat, and seafood), and alcohol intake (particularly beer and hard liquor).
7. Stay Hydrated
Drinking water can help flush the uric acid crystals that cause gout out of your system. “A well-hydrated patient should drink enough to urinate every two to three hours,” says Dr. Shakouri.
8. Practice Mindfulness and Meditation
The good news: A gout attack is self-limited and will clear in time. In the meantime, according to the Arthritis Foundation, meditation, yoga breathing, mindfulness, and guided imagery can help you deal with the pain.
9. Create a Support Network
Many patients suffer in silence because of the stigma around gout. Let trusted friends and family know that you have this disease, and reach out for support when you are having a flare.
10. If You Are Having Repeated Attacks, See Your Doctor
Some patients can go a long time between attacks. In fact, for 62 percent of patients the next attack will be more than a year away, and some won't have another attack in the next 10 years. However, if you begin to have more frequent attacks, talk to your doctor about escalating treatment. “People think it’s normal to have flares every now and then, but it’s not. The gout can be doing damage to your joints. It means you still have too much uric acid,” says Shakouri. In particular, ask about allopurinol. It won’t help with an acute attack but will help prevent future attacks by reducing uric acid production.
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