Fight back against acute gout attacks

Gout is the most common type of inflammatory arthritis and affects more than eight million adults. If you ever have it, you will never confuse it with regular joint pain.

“It suddenly strikes like flicking on a light switch,” says rheumatologist Roy Altman, MD, a professor of medicine at UCLA Health. “The pain is severe with intense swelling and redness.”

In general, if you have one acute attack there is about a 70 percent chance you will have another within the next year. But even if you have avoided gout so far, the odds are you will suffer from it in the future.

“There is a direct relationship between age and gout,” says Dr. Altman. “Men tend to get it more than women, although a woman’s risk increases once she reaches menopause.” But in order to avoid possible attacks, you have to understand why it occurs so you can take the necessary protective steps.

Inside look at gout

Gout is triggered by the crystallization of uric acid within the joints. It happens like this: Your body produces uric acid from breaking down purines, a natural waste product of living cells. Uric acid is dissolved in your blood and passes through your kidneys into your urine.

However, sometimes your body produces too much uric acid or excretes too little. This causes uric acid to build up and form needle-like urate crystals in a joint or the surrounding tissue. The result: a sudden, hot, painful flare-up.

The large joint of your big toe is the most common affected area, followed by the side of the foot and ankle. Other potential hot spots include the knees, hands, and wrists. Episodes can last about seven to 10 days. “Anything longer may be a sign of osteoarthritis,” says Dr. Altman.

Attacks tend to strike at nighttime. Observational evidence has long shown gout attacks are more than two times higher during the night or early morning, but only recently has it been confirmed by research. The main reasons are believed to be lower body temperature and nighttime dehydration.

“Crystals are more likely to crystallize in lower temperatures, and dehydration can prevent excess uric acid from being flushed from the body,” says Dr. Altman.

Another reason is decreased circulation and hypoxia, a condition where oxygen levels fall in the body, both of which can occur when sleeping. “This can cause tissue damage and cell breakdown, and make uric acid levels rise,” says Dr. Altman.

Treating gout

Gout can be confirmed by a joint fluid test to reveal urate crystal levels. Your uric acid level can also be helpful to diagnose gout as the higher the level, the greater your risk. For sudden, acute attacks, the first line of treatment is medication. The most common include:

* Nonsteroidal anti-inflammatory drugs (NSAIDs): These include common over-the-counter options, such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), as well as prescription NSAIDs like indomethacin (Indocin) or celecoxib (Celebrex). “However, stronger prescription dosages are often needed, says Dr. Altman.

* Colchicine: This pain reliever reduces gout pain. After the pain resolves, your doctor may prescribe a low daily dose along with a urate-lowering medication to prevent future attacks.

* Corticosteroids: These may control gout inflammation and pain, and may be taken in pill form, or injected into your joint.

If you suffer chronic or frequent attacks, or more than one joint is affected, or you develop kidney stones or a tophus (large lumps of crystals), you may need medication to reduce your uric acid production. These drugs include allopurinol (Aloprim, Lopurin, Zyloprim), febuxostat (Uloric), and probenecid (Benemid). The usual goal here is to lower uric acid levels to less than six milligrams per deciliter (mg/dL).

Make dietary and lifestyle changes

Medication is only one way to prevent gout attacks. Altering your life-style habits is also another means of protection.

Besides reducing your intake of meat and shellfish, which can cause uric acid levels to climb, limit your alcohol intake as well as drinks with high fructose corn syrup like soft drinks. Stay well hydrated and adopt an exercise program to help lose excess weight.

You can also increase your intake of certain foods that have been shown to lower uric acid levels, like coffee (regular or decaf) and cherry juice, as well as getting more vitamin C through supplements or foods like bell peppers, broccoli, strawberries, and oranges.

But keep in mind that gout may be a sign of something more serious, says Dr. Altman. “High uric acid levels could be reflective of an underlying medical issue like cardiovascular disease, hypertension, and kidney disease.”