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Gout

Updated: Apr 23

This is a guest post by rheumatologist Dr. Brittany Panico who practices in Phoenix, Az and has a special interest in gout. If you are in the Phoenix area and are looking for the best rheumatologist in Arizona, I highly recommend you make an appointment with Dr. Panico. More information at: https://summitrheumatology.com/about-us/



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Every year on May 22, the Arthritis Foundation and other rheumatologic organizations recognize National Gout Awareness Day. Gout is one of the most common forms of inflammatory arthritis and affects over 9 million people in the United States. But gout is still very much underdiagnosed and undertreated. As we learn more about the inflammatory affects of high levels of uric acid on the body, we are now recognizing that gout is a systemic condition that can cause significant damage to the joints and body tissues (like the kidneys, heart, blood vessel, and skin) if left untreated or undertreated.


What causes gout?

Gout is caused by high levels of uric acid in your blood and body. This is most often genetic and takes time to build up. Gout can also be caused from high cell turnover like psoriasis or chemotherapy which causes a rapid fluctuation of uric acid in the body. Certain medications like diuretics (water pills), transplant immunosuppressants, and even dialysis, can increase your risk for gout. Certain foods and alcohol can contribute to gout but are NOT the cause for gout.


Why do I need medication for gout?

Gout is a chronic and systemic (whole body) condition that occurs in cycles. Between cycles of flares, such as joint swelling or kidney stones, uric acid is still collecting in your body. Once the concentration of uric acid is high enough, gout can affect every organ in your body and lead to high blood pressure, chronic kidney disease, type 2 diabetes, kidney stones, joint damage and chronic pain.


What medications are used to treat gout?

Allopurinol, febuxostat (Uloric) and pegloticase (Krystexxa) lower the uric acid in your body to treat symptoms of gout. These medications should be adjusted to a dose that lowers your blood uric acid level to less than 5. Colchicine, steroids (prednisone), and NSAIDs (like ibuprofen or indomethacin) only help treat the symptoms of pain, they do not treat gout itself. If you have more than 2 gout flares in 6 months, visible collections of uric acid on your body called tophi, or uric acid kidney stones, you qualify for treatment with either allopurinol, febuxostat, or pegloticase.


Why do I have gout flares when I am on medication?

Gout flares occur when there are abrupt changes in the concentration of uric acid in your blood. This often happens at the beginning of starting medication, and can occur until your uric acid level is less than 5. Certain foods, airplane travel, or injuries can disrupt the uric acid concentration in your joints, triggering a flare to happen. If your uric acid level is higher than 5, you are likely to continue to have gout flares.


Are there natural ways to treat gout?

The symptoms of gout, like joint swelling and pain, can be relieved with supplements such as tart cherry juice or extract when taken at the onset and during a flare. Decreasing consumption of red meat, shellfish, high-fructose corn syrup, beer and other alcohol, and other high uric acid containing products can help decrease the risk of gout attacks and kidney stones. There are no known natural products that decrease uric acid from your body the way medications do. Natural methods do no treat the root cause for why gout happens in the first place.


The Link Between Gout and Kidney Disease

Gout can be a symptom of kidney disease, and if gone untreated can cause additional damage to the kidneys.


When there is excess uric acid in the blood, it’s possible that the kidneys won’t be able to filter enough of it out of the body through urine. Over time, the kidneys can become less efficient and ultimately progress through the stages of kidney disease and possibly kidney failure.

While there does appear to be a more established correlation between existing kidney disease and the onset of gout, gout itself can also decrease kidney function and the cycle goes on and on. By treating gout appropriately and controlling flares, this can also help in treating kidney disease and even high blood pressure.



Danger of Untreated Gout and Kidney Disease

Refractory gout is a rare form of severe gout that can lead to permanent joint damage, trouble with movement, and difficulty walking. In addition to buildup of uric acid in the joints, refractory gout can also create lumps in the hands and elbows, which are painful and disfiguring deposits called tophi.


Left untreated, gout can cause intense amounts of pain and can lead to severely decreased kidney function. Without this important filtering process, the entire body can be impacted. Blood flows to every body part, and if blood isn’t properly filtered, other body systems can start to fail, including memory and thinking clearly. Late-stage kidney disease can cause damage to the heart, lungs, central nervous system, and bones.


Thankfully, dietary and lifestyle changes, along with proper medication, can help prevent gout attacks and lower uric acid levels. There are times that this can even lead to lower blood pressure, better control over blood sugar, and possibly decreased need for multiple medications.


Gout and Heart Disease

Gout has also been recently linked to increased risk of coronary vascular disease and atrial fibrillation. These conditions affect the blood flow to the heart muscle and the electrical condition of the heart. When uric acid levels are increased in the blood, there are higher risks that uric acid crystals can form within the blood vessels or even within pre-existing cholesterol deposits or plaques that lead to the risk of heart attacks. Uric acid is also very irritating to the electrical conduction of heart muscle and has been associated with an increased risk of irregular heartbeat or atrial fibrillation. These associations give us a better understanding of just how significant gout is on organ function and that gout is so much more than just intermittent joint pain and swelling.


What can I do if I have Gout?

If you are experiencing more that 2 gout flares per year, it is recommended to be evaluated by a rheumatologist to ensure that you are on the best medication to treat your symptoms. When gout is adequately treated, flares should stop and uric acid should no longer build up in the body. This may also mean that blood pressure is better controlled, the risk for heart disease is lower, the risk of diabetes can be decreased, as well as improved kidney function. Joint pain and the risk of permanent joint damage will also be decreased. All of these things can lead to less pain and improved quality of life.


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