Family Medicine North  

Gout is a form of arthritis that is a painful inflammation and swelling of the joints caused by the buildup of uric acid in the body. Certain foods cause gout (see below) so diet plays a role. Treatment of gout can be achieved through medication and proper diet.

Gout symptoms
The most common gout symptom is sudden, severe attacks of pain, tenderness, redness, warmth and swelling in some joints. It usually affects one joint at a time, especially the joint of the big toe, but can also affect the knee, ankle, foot, hand, wrist and elbow. Deposits of uric acid, called tophi, can appear as lumps under the skin around the joints and at the rim of the ear. In addition, uric acid crystals can also collect in the kidneys and cause kidney stones.

Causes of gout
This is one of the few types of arthritis where the cause is known. It results from deposits of needle-like crystals of uric acid in the connective tissue, joint spaces, or both. Normally this is a byproduct of the breakdown of purines or waste products in the body. Normally uric acid breaks down in the blood and is eliminated in urine. When the body increases its production of uric acid or if the kidneys do not eliminate enough of it from the body, levels build up. This is called hyperuricemia. Hyperuricemia is not a disease and is not dangerous. However, if excess uric acid crystals form as a result of hyperuricemia, gout can develop.

Foods that cause gout
Some people may benefit from a reduction of purine rich foods. These include beer and other alcoholic beverages, anchovies, sardines (in oil), fish roes, herring, yeast, organ meats (e.g., liver, kidneys), legumes (e.g., dried beans, peas, and soybeans), meat extracts, consommé, gravies, mushrooms, spinach, asparagus, cauliflower, and poultry. A more complete list is below. Weight loss can help reduce uric acid levels in those people that are overweight.

Gout treatment
Although there is no cure, most people with gout can keep it under control and lead normal lives. Treatment may consist of one treatment or a combination of treatments.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) block prostaglandins, the substances that dilate blood vessels and cause inflammation and pain. They are taken orally at their highest safe dosage as long as symptoms persist and for three or four days after. There are dozens of NSAIDs. Indomethacin (Indocin) is the usual choice.
  • Colchicine, a derivative of the autumn crocus, has been used to treat gout for thousands of years. This drug relieves the pain and swelling and can help prevent future attacks. Although highly effective, it is no longer the first treatment choice due to the potential for unpleasant side effects.
  • Corticosteroids may be used if NSAIDs are not tolerated.
  • Allopurinol (Lopurin, Zyloprim) blocks uric acid production and is the drug most often used in long-term treatment for older patients and those with high levels of excreted uric acid.

Standard diagnostic tools for gout may include a medical history and physical examination, a blood test for hyperuricemia (high levels if uric acid in the blood), and a urine sample. For a definitive diagnosis, a sample of fluid from the affected joint is required. X-rays can provide helpful information in some cases.

Future research
Scientists are studying whether other NSAIDs are effective in treating gout and are analyzing new compounds to develop safe, effective medicines to treat gout and other rheumatic diseases. For example, researchers are testing to determine whether fish oil supplements reduce the risk of gout. They are also studying the structure of the enzymes that break down purines in the body, in hopes of achieving a better understanding of the enzyme defects that can cause gout.

Dietary guidelines to prevent gout flare-ups
Purines are compounds formed naturally in the body or found in certain foods. When purine is broken down in the body, uric acid (a waste product) is produced. When there's too much uric acid in the blood, the condition is known as hyperuricemia. Hyperuricemia can have many causes and may develop when there's an increased production of uric acid in the body or a reduction in the amount of uric acid excreted from the body. Food containing purines may also play a role.

Hyperuricemia may lead to gout and it may also contribute to other medical conditions, such as the formation of uric acid kidney stones.

Dietary changes
Although medication is the major treatment for gout, a purine-restricted diet may help you decrease the uric acid salts in your blood by up to 15 percent. A high-carbohydrate, low-fat diet (50 to 55 percent of calories and 30 percent of calories, respectively) will also help your body get rid of uric acid. If your doctor recommends dietary restrictions, avoid foods containing 150 milligrams or more of purines per 100-gram (roughly 3 ounce) serving. Eat no more than 3 ounces of lean meat per meal. You may need to drink 2 to 3 quarts of liquids every day, but keep alcohol consumption to a minimum. Or, your doctor may advise you to avoid alcohol completely. It's often helpful to wait a few hours after a big meal before going to sleep. Finally, maintain a healthy weight proportional to your size. If you're overweight, keep in mind that it's best to lose weight gradually. Avoid fasting or extremely low-calorie diets.

Food concentrations of purines

Group A: foods with high purine concentrations (more than 150 milligrams of purines per 100-gram serving -- approximately 3 ounces). These foods should be avoided. For example:

  • scallops
  • sardines
  • anchovies
  • herring
  • mackerel
  • liver
  • beef kidney
  • brain
  • meat extracts
  • sweetbreads (organs of young animals, such as thymus or pancreas)
  • game meat

Group B: foods and beverages with moderate purine concentrations (50 to 150 milligrams of purines per 100-gram serving -- approximately 3 ounces) are allowed in moderate amounts on a purine-restricted diet. For example:

  • poultry
  • meat and fish other than those mentioned in group A
  • meat gravies or soups made with meat stock
  • whole-grain breads and cereals, oatmeal and wheat germ
  • baker's and brewer's yeast
  • asparagus
  • cauliflower
  • mushrooms
  • spinach
  • green peas
  • dried beans
  • dried peas
  • lentils
  • peanut butter
  • nuts

Group C: foods and beverages with low purine concentrations (less than 50 milligrams of purines per 100-gram serving -- approximately 3 ounces) are recommended in a purine-restricted diet. For example:

  • skim or 1 percent milk
  • low-fat cheese
  • low-fat yogurt
  • ice milk
  • eggs
  • refined cereals and breads (avoid high-fat breads such as biscuits or muffins, however)
  • spaghetti, macaroni and other types of pasta
  • potatoes
  • rice
  • barley
  • vegetables other than those mentioned above (limit avocados due to fat content, however)
  • vegetable soups
  • fruits, fruit juices and fruit drinks
  • plain cookies
  • angel food cake
  • flavored gelatin
  • tapioca, custard and pudding
  • herbs and spices
  • coffee
  • tea
  • chocolate and cocoa
  • carbonated beverages

Sugar, sweets, butter, margarine, oil and other fats are also low in purines and may be included in moderation in a healthful, low-purine diet.

Certain medications may increase the level of uric acid in your blood, including low doses of aspirin, pyrazinamide (for tuberculosis) and thiazide diuretics (for high blood pressure). Because certain medications may be needed for various reasons, consult your doctor before making any medication changes if you're on a purine-restricted diet.

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