Gout happens when extra uric acid creates sharp crystals in the joint that cause pain, swelling and other symptoms. Medications and changes in diet can help prevent gout flare-ups.
Over-the-counter NSAIDs, like ibuprofen, can reduce pain and inflammation during a flare. People who experience frequent gout flare-ups should talk to their doctor about prescription medications, like colchicine or pegloticase, to lower uric acid levels.
Eat a Low-Purine Diet
Uric acid is a chemical in the body that forms when the body breaks down purines. It normally dissolves in the blood and goes through the kidneys to leave the body as urine. But when uric acid levels are too high for too long, it can form sharp crystals in and around joints, causing pain and swelling (a gout attack). Dietary changes aren’t a cure for gout, but they can lower the risk of new attacks and slow joint damage. A doctor or registered dietitian will recommend an eating plan that limits foods that contain a lot of purines, such as seafood and certain meats, alcohol, and sugary beverages.
A gout diet should also include plenty of vegetables, fruits, whole grains, nuts, seeds, and legumes. It may be necessary to reduce the amount of red meat, pork, and lamb in the diet to cut back on animal proteins, which can raise uric acid levels more than other types of protein. A dietitian can help people develop an individualized eating plan that limits high-purine foods and allows for variety in the diet.
A low-purine diet is not only important for managing gout but also to prevent diabetes, heart disease, and obesity. It is a long-term lifestyle change that may require some sacrifices, but it can be an effective way to manage hyperuricemia and reduce the need for medication.
Exercise Regularly
Gout is an inflammatory arthritis that causes sudden attacks of pain, swelling and redness in the joints. These attacks (flares) last a few days or weeks and may be followed by periods without symptoms (called remissions). Symptoms of gout usually occur in the big toe, but can affect other joints, such as the ankles, knees and hands. The disease is caused by a buildup of uric acid in the blood. Uric acid is made when your body breaks down purines, which are found in many foods. Certain foods and drinks can raise uric acid levels, such as organ meats, seafood, alcoholic beverages and high fructose corn syrup. Some medicines can also increase uric acid, including diuretics and low-dose aspirin.
Regular exercise can help prevent gout flares by decreasing the amount of uric acid in the blood. But it’s important to talk to your doctor before starting a new workout program. In general, exercise should be light to moderate and done on a regular basis.
Some exercises are easier on your joints than others. For example, cycling and walking are good aerobic activities that don’t put much pressure on your joints. Yoga can also be helpful, as it can improve flexibility and balance. Other exercises to avoid include burpees and jump roping, as they can be hard on your joints.
Get Rid of Stress
Stress and certain medical conditions can trigger gout. For example, it’s common for gout to flare up following surgery or after hospitalization for other serious medical problems such as heart disease, cancer or a stroke. Medications that lower blood pressure, such as diuretics, can also cause a gout attack in some people. Other precipitating factors for gout include alcohol binges, rapid weight gain or loss, and taking steroids such as prednisolone.
A gout diagnosis is made with the help of a patient history and physical exam, and x-rays of the affected joint. The medical professional will test a sample of fluid from the swollen joint for uric acid crystals. You may also have a blood test for uric acid levels and an ultrasound or special CT scan of the affected joint.
The doctor will prescribe a medication to lower uric acid levels. Uric acid can build up because your kidneys can’t excrete enough or because you eat too many foods high in purines, such as red meat, organ meats, shellfish and sugary sodas. Other medical conditions increase your risk of gout, including untreated high blood pressure, diabetes and obesity, as well as a family history of the disease. Allopurinol (Zyloric) is the drug of choice to lower uric acid, but febuxostat (Uloric) can be used for those who can’t take allopurinol.
Take Medications
Gout flare-ups are caused by an accumulation of uric acid crystals. These trigger the release of inflammatory mediators and cause pain in a single joint, most commonly at the base of the big toe (podagra).
In addition to diet and exercise, doctors usually prescribe medication to treat gout flare-ups. Medications include anti-inflammatory medications, corticosteroids and colchicine. NSAIDs, such as ibuprofen or naproxen, are available in low doses without a prescription and are effective at relieving pain during a gout attack. A higher-strength NSAID, such as celecoxib or indomethacin, is also sometimes prescribed to prevent future attacks. Often a doctor will also prescribe corticosteroids, which are powerful anti-inflammatories that can reduce swelling in the affected joint.
The goal of long-term therapy is to lower uric acid levels over time to prevent future flare-ups and reduce the likelihood of kidney stones. This approach is referred to as urate (uric acid)-lowering therapy, or ULT. ULT medications include allopurinol (Zyloprim) and a group of drugs called xanthine oxidase inhibitors, which decrease the body’s production of uric acid. Another option is pegloticase, which converts poorly soluable uric acid into the more easily excreted allantoin.
Your doctor will diagnose gout with a physical exam and a review of your symptoms and medical history. The doctor will also examine the affected joint and will take a sample of the fluid that is in the joint capsule to test for uric acid.