INSIDE• 4 stages of gout• Medications that can help• How diet affects gout• Why gout attacks are

more common at night• A former NFL player

describes living with gout

YOUR GUIDE TO GOUT

Gout 101GOUT IS THE MOST common form of inflammatory arthritis, affecting as many as 8.3 million Americans. If you’re overweight, eat a diet high in purines (specific chemical com-pounds found in certain foods), or drink too much alcohol, you’re at risk of developing the condition. And for some of us, the holiday season’s rich foods and frequent get-togethers can put us at a higher risk of a painful gout attack.

In this special downloadable guide, you can learn about what causes gout and how to treat it. Plus, read the lat-est news about gout research, take a quiz about the condition, and meet

a former NFL player who was diag-nosed with gout at age 29. Many of the articles here were published in recent issues of Pain-Free Living and its pre-decessor, Arthritis Self-Management.

Please let me know what you think about our guide. Was it helpful or not? What else would you like to learn about gout? What topics should we cover in future guides? Drop me a note at editor@painfreelivinglife.com.

Drug for Gout Flares in DevelopmentA GOUT FLARE is just what it sounds like. People can have gout without discomfort for a long time, but then it flares up, causing significant irritation and pain.

Several drugs are available for treating gout flares. (Diet and lifestyle medications can also help.) A recent study published in Nature Reviews Rheumatology has demonstrated the effec-tiveness of a new medication in the treatment of the flares. It’s called arhalofenate, and it’s the first compound in a new class of investigational therapies that its manufacturer, CymaBay Therapeutics, Inc., calls urate lowering anti-flare therapy. The description indicates that the drug lowers the amount of urate crystals, which cause gout (and related pain) when they accumulate in a joint. Urate crystals might form when a person has high levels of uric acid in the blood.

The study enrolled 239 subjects who had experienced more than three gout flare-ups in the previous year. The subjects were assigned to one of four groups: The first received arh-alofenate, the second received the drug allopurinol, the third received allopurinol plus colchicine, and the fourth received a placebo.

After 12 weeks, the results showed that the incidence of gout

flares was significantly lower in the arhalofenate group than in the allopurinol group or the placebo group. The results for the allopurinol plus colchicine group were roughly the same as for the arhalofenate group. No serious side effects were reported, and arhalofenate appeared safe. The key finding, the researchers said, was that unlike other gout medications, arhalofenate has a “dual method of action.” That is, it not only lowers the levels of uric acid in the blood, but also it has an anti-inflammatory action that, the researchers reported, is “well suited to treating gout.”

Researchers are now conducting a phase III trial that com-bines arhalofenate with Uloric (febuxostat) to test how the drugs work for people with chronic gout.

➫NEWS

EDITOR'S NOTE

THE DOSE

Matt MendenhallEditor

CONNECT WITH US

ONLINE Find news, info

about pain conditions and treatments,

recipes, and more. painfreelivinglife.com

FACEBOOK facebook.com/painfreeliving

E-NEWSLETTER Receive our biweekly

newsletter in your in-box. Subscribe at

painfreelivinglife.com/Newsletter/Subscribe/

TWITTER twitter.com/MadavorArth

Sleep Apnea Tied to GoutA STUDY published in the journal Arthritis and Rheu-matology has shown a strong connection between sleep apnea and gout.

Sleep apnea is a condition in which people expe-rience multiple pauses in breathing while they sleep — sometime 30 or more times an hour. As a result, they get poor sleep and feel tired during the day. The study, conducted by researchers at the Boston University School of Medicine, found that among sleep apnea patients, the likelihood of a gout attack is about 50 percent higher than in people who don’t have the condition.

The scientists relied on data from the Health Improvement Network in Great Britain. They studied nearly 10,000 people with sleep apnea, none of whom had gout at the beginning of the survey. After a year, about half had developed gout, and

the increased risk was found without regard to sex, age, or weight.

Why would sleep apnea be connected to gout? The researchers say sleep apnea causes a rise in uric

acid, which is the main physiological driver of gout. They also looked at the related

phenomenon of hypoxia. A common side effect of sleep apnea, hypoxia

is an episode of low oxygen in the blood. Earlier studies had shown that hypoxia changes the ratio of uric acid and creatine in the

blood, which is also a contribut-ing factor for gout. Finally, hypoxia

enhances a process called nucleotide turnover, and it stimulates the production

of purines that turn into uric acid.The study’s authors say physicians might be able

to reduce gout attacks by first treating sleep apnea and hypoxia. That will be the subject of the next stage of their research.

Hold the Tomatoes?People who are told they have gout usu-ally are advised to avoid certain foods because they can trigger gout flare-ups. Among the most common are organ meats such as liver and kidneys, certain seafoods (anchovies, scallops, herring, mussels and others), red meat, and beer. But researchers are continuing to learn about the relationship between certain foods and gout.

Recently, researchers at the University of Otago in New Zealand surveyed 2,051 people who had been diagnosed with gout. They asked these patients if any of them had experienced any food triggers and learned that 71 percent of them had. The first three were no surprise: seafood, alcohol, and red meat. But the fourth most mentioned food trigger was somewhat unexpected: tomatoes. The researchers decided to pursue this lead further and collected and analyzed data from more than 12,000 people who had participated in three long-running U.S. studies. That data indicated that tomato consumption was related to higher levels of uric acid in the blood. Because high uric acid levels cause gout, it made sense that tomatoes could be a trigger food.

The researchers cautioned that the aim of their research was not to prove that tomatoes trigger gout flare-ups. But their study indicated that tomatoes can raise uric acid to a level that compares with other proven trigger foods. They also advised their research does not show that people with gout should never eat tomatoes. For one thing, not every gout patient who eats a tomato will suffer a gout attack; it’s best to think of tomatoes as a possible trigger. Second, there are medications that reduce uric acid levels. If people with gout are diligent in taking one of these medications, they most likely can eat tomatoes without harmful effects.

The Gout, Atrial Fibrillation connectionSometimes it’s a bit of a surprise how two health conditions that seem unrelated actually can be connected. As has been shown in a new study, that’s the case with gout and atrial fibrillation (a rapid and irregular heart beat).

The researchers, from Brigham and Women’s Hospital in Boston, knew that both gout and atrial fibrillation are asso-ciated with inflammation, so they won-dered if there might be some connection. Also, they were intrigued by recent studies suggesting there might be an increased risk of arrhythmia (irregular heartbeat) in people with high levels of uric acid in the blood, which is characteristic of gout patients.

To look further into these issues, they collected data taken from a large com-mercial health plan for the years 2004 through 2013. They divided the patients into two comparison groups. The first group had more than 70,000 people with gout and more than 200,000 peo-ple with osteoarthritis. The researchers included patients with arthritis because they shared similar characteristics with

those with gout, such as their health-care usage, a tendency toward obesity and what are known as “comorbidities” (that is, associated health issues such as high blood pressure). The second comparison group included more than 90,000 peo-ple with gout and about 275,000 people without it. These two groups, however, were matched by age, gender, and the date of diagnosis. The follow-up time for both comparison groups was two years.

The researchers determined that people with gout have a 13-21 percent increased risk of atrial fibrillation. This risk was assessed as “modest,” but it was not insignificant.

Seoyoung C. Kim, the lead researcher of the project, said gout might raise the risk of atrial fibrillation because of “complex inter-related mechanisms” of inflammation and high levels of uric acid in the blood. She also said the findings “have important implications for future studies aimed at reducing the risk of atrial fibrillation,” noting the potential for drug therapy to be an effective way of lowering that risk.

➫NEWS THE DOSE

Gout-associated Hyperuricemia: FDA Approves New DrugAFFECTING MORE THAN 8 million people in the U.S., gout is a painful form of arthritis. It is caused by an excess of uric acid in the blood known as hyperuri-cemia. People with gout often experience severe pain and swelling of the joints.

The U.S. Food and Drug Administration (FDA) in January 2016 approved Zurampic, a new medication to help treat gout-associated hyperuricemia. The recommended dosage is 200 mg, once daily. This approved dose has been associated with a lower incidence of serious adverse events and has been considered safe. It is recommended Zurampic be used in combination with a xanthine oxidase inhib-itor (XOI), a type of drug that reduces the body’s production of uric acid.

Zurampic’s ability to help treat gout-associated hyperuricemia is two-fold: First, it helps reduce the body’s production of uric acid; second, it helps increase the kidney’s excretion of uric acid. It inhibits the kidney’s transporter proteins, which are involved in uric acid reabsorption. While most gout medica-tions currently available decrease the body’s pro-duction of uric acid, Zurampic increases its excretion, which is a major difference.

According to the Arthritis Foundation, Zuram-pic is the first in a new class of drugs referred to as “selective uric acid reabsorption inhibitors” (SURIs) to be approved in the U.S. It represents an important advance in treatment for people whose gout is not controlled by current medications, said Jasvinder Singh, M.D., a rheumatologist at the University of Alabama at Birmingham (UAB) and an investigator in the Zurampic clinical trials.

“Controlling hyperuricemia is critical to the long-term treatment of gout,” said Badrul Chowdhury, M.D., director of the Division of Pulmonary, Allergy and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research. “Zurampic provides a new treatment option for the millions of people who may develop gout over their lifetimes.”

Diet Over-prioritized in Gout TreatmentA survey from the Gout & Uric Acid Education Society (GUAES) finds many Americans with gout may be placing too much emphasis on diet when it comes to managing the disease and controlling painful flares. Of all the steps taken to manage gout, respondents cited changing their diet by eliminating or reducing consumption of certain foods as their top step taken (50 percent) — even ahead of taking medications to lower their uric acid levels (40 percent) and maintaining an overall healthy fit-ness level (33 percent). Furthermore, nearly one in three with gout incorrectly believes that the disease can be com-pletely avoided by eliminating certain foods; and more than one in four said they would not take medications if they were making dietary changes.

“Physicians all too often see patients who believe they can successfully man-age their gout with diet alone,” said N. Lawrence Edwards, M.D., a rheumatol-ogist and GUAES chairman. “But even with extremely rigid diet restrictions, most gout patients will only be able to lower their uric acid levels slightly — not nearly enough to achieve a healthy level to control flares and reduce risk for long-term damage.”

Gout is an extremely painful and chronic form of inflammatory arthritis caused by elevated uric acid levels. Over time, uric acid can accumulate and form crystals in the joints and other tissues — leading to painful flares. Untreated, gout can lead to permanent bone, joint, and tissue damage, and other serious health issues, including kidney disease, heart disease, and diabetes.

GUAES urges gout suffers to learn more about the disease, seek immediate treatment, and take ongoing steps to manage gout — with the most import-ant step being to check uric acid levels regularly (every six months) and aim for a healthy target of 6 mg/dL or below. While uric acid-lowering medications are typically needed to control gout

and reduce future risks, those with gout should also make lifestyle changes — which includes following a healthy and balanced diet.

There isn’t a regimented gout diet, but those with gout should make healthy food choices and may need to reduce consumption of certain foods. Because uric acid is formed from the breakdown of purines, foods high in purines — such as beer, red meat, and shellfish — have been known to trigger gout flares. Foods containing high-fructose corn syrup — including soft drinks, sweetened juices, pastries, and processed foods — should also be avoided or eaten in moderation. Those with gout are instead encour-aged to eat fresh fruit and vegetables, low- or no-fat dairy products, and nuts and grains.

While cherry juice is often in the news as a potential treatment of gout, Dr. Edwards urges gout patients to take steps beyond adding this to their diet.

“The role of cherry juice in gout man-agement is overstated,” said Dr. Edwards. “While Vitamin C — which is found in cherry juice or cherries — can play a role in lowering uric acid levels, consuming cherry juice alone is not going to be enough. Additionally, if patients are drinking cherry juice that is sweetened with high-fructose corn syrup, that can even contribute to or worsen a flare.”

The GUAES survey found that nearly one in six gout patients (16 percent) believes that drinking cherry juice is just as effective as taking uric acid-lowering medications.

“In symptomatic gout, it’s not,” added Dr. Edwards. “Those with gout need to monitor their uric acid levels closely, and work with their physician to deter-mine an appropriate treatment plan to keep levels to 6 mg/dL or even below, depending on the stage of the disease and severity of symptoms.”

For additional information and resources about gout and diet and other topics, visit GoutEducation.org.

➫NEWS THE DOSE

When Gout StrikesAS FAR BACK as the 17th century, people who suffered from gout swore they suffered more gout attacks at night. But even though this complaint has been around for centuries, no one actually had conducted research to see if it was true. Until now.

In a new study, researchers at Massachusetts Gen-eral Hospital and Harvard Medical School recruited 724 patients who had been diagnosed with gout. They were mostly male and white, their median age was 54 and they had been suffering from gout for an average of five years. To find out if gout attacks were more frequent at certain times, the researchers divided the day into three blocks of time: Block One from midnight to 7:59 a.m., Block Two from 8 a.m. until 3:59 p.m. and Block Three from 4 p.m. until 11:59 p.m. Over the course of the study, the participants suffered 1,433 gout attacks.

After assigning the attacks to the different time blocks, the researchers discovered that Block One (the night shift) contained 733 attacks, while Block Two had 310 attacks and Block Three had 390. In other words, the risk of a gout attack was more than twice as high during the night and early morning hours than during the day or evening. The researchers also adjusted for other factors and reported there did not appear to be any connection between the attacks and the patients’ intake of alcohol or purine-rich foods (a high-purine diet can raise uric acid levels in the body, which can lead to gout). Age, sex, obesity, and medication use also did not seem to affect the timing of the attacks.

The researchers were unable to give a definitive explanation for why gout attacks occur more fre-quently at night, but they offered several possible reasons. First, it’s well known that body temperatures drop during the night, so it’s possible that lower body temperatures promote the formation of the sharp, needle-like uric acid crystals that cause gout pain. Also, blood cortisol levels drop after a person falls asleep — a possible cause of morning stiffness. Another possibility has to do with sleep apnea (a disorder in which a person has pauses in breathing or shallow breaths during sleep). Half of all sleep apnea patients have what’s known as hyperuricemia, a condition characterized by abnormally high levels of uric acid in the blood. For this reason, sleep apnea might be related to gout attacks.

All these possibilities will be explored in fur-ther research. The first step was to find out if gout attacks really occur more frequently at night. Now that researchers know they do, they can move on to possibly developing new measures for preventing gout attacks, especially after bedtime.

Drinking Wine May Cause a Gout FlareDiet, including the consumption of alco-hol, has long been cited as a potential trigger for gout flares. However, it had been thought that wine, drunk in moderation, did not greatly increase a person’s gout flare risk. But a study suggests wine may not only increase the risk, it may do so more than beer or hard liquor.

Gout is thought to affect more than 8 million Americans, making it the most common form of inflammatory arthritis in the United States. In people with gout, increased blood levels of uric acid lead to the formation of crystals in joints, which can cause redness, inflammation, and pain so intense that an acute flare of gout is often touted as one of the most painful events in any form of arthritis.

Gout is more common in men, post-menopausal women, and people with dia-betes, obesity, and certain cardiovascular problems. Eating certain foods — such as organ meats, red meats, and lobster — is thought to increase a person’s risk of a gout flare, as is drinking alcoholic beverages, especially beer. But the results of a 2004 study of nearly 50,000 people suggested moderate wine consumption may not greatly increase a person’s risk.

However, the findings of a study pub-lished in 2014 in The American Journal of Medicine may prompt people with gout to steer clear of wine as well. The study authors said much of the research looking at the link between gout and alcohol — including the study from 2004 — focused on a person’s first gout attack, rather than looking at the risk of subsequent, recurrent attacks in people with established gout. To see what effect the moderate consumption of different kinds of alcohol might have on people who already have gout, the researchers looked at a year’s worth of gout attacks in more than 700 people who had at least one gout attack the year before.

Over the course of a year, the researchers asked the study participants to fill out a questionnaire when they had an attack of gout. The questionnaire asked about possible risk factors for gout, such as what the participants ate and drank, in the 24 hours before the attack. For comparison,

the researchers also asked participants to fill out questionnaires about 24-hour periods when they had not had attacks.

The researchers found that regardless of the type of alcohol drunk, drinking one alcoholic drink in a 24-hour period didn’t seem to increase a person’s risk of a flare that much. But drinking any more than that resulted in a one-third increase in the risk of a gout attack compared to not drinking at all. And the more a per-son drank, the more his risk of a flare increased. Compared to not drinking at all, having more than 2-4 drinks over 24 hours raised a person’s risk of a flare 50 percent, having more than 4-6 drinks doubled the risk of a flare, and having more than 8 drinks more than tripled it.

When the researchers looked at the risks associated with specific kinds of alcoholic drinks, they found more than 1-2 glasses of wine more than doubled a person’s risk of a flare. Drinking the equivalent of about twice as many cans of beer or shots of hard liquor only increased a person’s risk about half as much.

The researchers said previous studies may have found less of a risk with wine because people who drink wine tend to eat healthier diets than people who drink beer. Since this study compared each par-ticipant’s gout risk at different times, it may have better isolated the effects of each beverage from those of a person’s diet and overall lifestyle.

They also said the risk factors for a first gout attack and a recurrent gout attack may be different.

The researchers also found allopurinol (brand name Aloprim) and colchicine (Colcrys), drugs commonly used to treat gout, helped to lessen the negative effects of alcohol on gout. Nonsteroidal anti-in-flammatory drugs (NSAIDs) did not seem to have much of an effect.

Although diet is an important tool in preventing acute attacks of gout, it is just one part of successful gout management. If you have gout or are at risk for gout, talk to your doctor about finding the right combi-nation of lifestyle changes and medicines to help you avoid flares.

➫NEWS THE DOSE

GOUT IS A TYPE of inflammatory arthritis caused by crystals of uric acid (UA) that accumulate in the joints. Gout has been around as long as humans have been writing about health—it was first described in Egypt nearly 4,000 years ago.

“We have chemicals within our bodies called purines that are very important for many cellular functions, from energy generation to making DNA,” says Bruce N. Cronstein, M.D., professor of medicine at the New York University School of Medicine in New York City. “In humans, these purines are metabolized to UA, which is then excreted mainly through the kidneys.”

According to the Centers for Disease Control and Preven-tion (CDC), gout affects approximately 8.3 million people in the United States each year, and overall, more than five million American adults have had gout at least once. Some indicators suggest that the number may be rising.

“Many researchers, including myself, think gout is on the rise,” says Angelo L. Gaffo, M.D., assistant professor of medicine in the Division of Rheumatology at the University of Alabama at Birmingham and a rheumatologist at the Birmingham Veteran’s Administration. “The best research suggests that five million or so people in the United States have gout, and when you look at large databases from America and Europe, the numbers seem to be rising.”

UA CRYSTALS Since UA can only minimally dissolve in water, it tends to crystalize into a salt (monosodium urate) when not eliminated through urination. When either too much UA is manufactured as purines are metabolized (the case in 10% of people with gout), or too little is excreted by the kidneys (90%), the crystals can deposit in the joints and other tissues. This causes the inflammation, swelling, and pain that are the hallmarks of gout.

“The joint becomes swollen, warm, and red,” says Emilio B. Gonzalez, M.D., professor and director of the Division of Rheumatology at the University of Texas Medical Branch in Galveston. “But what usually brings a patient to my office is the intense pain.”

For most people, the first joints affected are those in the big toe. (This phenomenon even has its own name, podagra.) Other joints and areas around them also can be affected, including ankles, heels, the insteps of the feet, wrists, fingers, and elbows.

Gout is very painful, but it’s easily treatedBY KURT ULLMAN, RN

Bad News,Good News

©is

tock

/Sup

erM

egan

eAng

le

In addition to the joints, deposits of UA known as tophi can be seen as lumps under the skin around the joints and rim of the ear. Finally, UA crystals can collect in the kidneys and produce stones that can damage them.

STAGES OF GOUTThere are four stages of gout.

• Asymptomatic gout. In this stage, you have too much UA in the blood (also called hyperuricemia) but no other symptoms. Because of this, you seldom need the attention of a doctor, and no is treatment needed.

• Acute gout or “flares.” At this point, deposits of UA crystals have accumulated in the joint spaces, which results in a very sudden onset of intense pain and swelling. The joints may be warm to the touch and very tender—many people complain that even just having sheets touch their big toe hurts. Untreated, these attacks usually fade within 10 days, and it may be months or even years until the next one. However, attacks usually come closer together over time if left untreated.

• Interval or intercritical gout. This is the “quiet time” between acute attacks. You have no symptoms.

• Chronic or tophaceous gout. This is the most disabling stage and takes a long time to develop. If you reach this stage, you prob-ably will have permanent damage to the joints, and possibly to your kidneys from stone formation. With proper treatment, few people get to this stage.

You are more likely to develop gout when you have high levels of uric acid in your body. That raises the question of what factors increase the UA level.

RISK FACTORSTwo important factors are age and sex. Your likelihood of having gout is much higher throughout your life if you are male. Estrogen appears to be protective against hyperuricemia, so gout in women is very rare until menopause. Postmenopausal women see an increase in gout, although they don’t catch up with men.

Age itself is thought to increase the likelihood of gout. Even in very healthy people, the kidneys become less efficient in excreting uric acid as a person ages.

Diet can be important. One high in meat, seafood, and bev-erages containing high levels of fructose will increase the uric acid in your body. Beer and liquor consumption can also up your chances of developing gout. Wine does not seem have an impact.

Closely related to diet is obesity. When you’re overweight,

your body produces more UA and may overwhelm the kidneys’ ability to filter it out. For reasons not completely understood, very rapid weight loss may also trigger gout flares.

Some medical conditions make it more likely you’ll develop gout. Obviously, anything that limits the kidney’s ability to get rid of uric acid will cause problems; others include high blood pressure, diabetes, and heart diseases. Surgery and trauma are common triggers of gout attacks in people with hyperuricemia.

Medications have been linked to additional risk of gout. Thiazide diuretics, or “water pills” that are used to treat high blood pressure, and low-dose aspirin to prevent heart attacks or strokes can add to your risk for gout. Some transplant anti-re-jection medications are implicated in increased UA levels.

Family history can be a factor. If members of your family have had gout, you’re more likely to develop it. However, while some cases may be hereditary (especially if your family comes from certain areas of southeast Asia), much of the genetic link is not well understood.

“If you have gout and a strong family history of it, my first reaction is to tell you that genetics could be playing an important role,” says Dr. Gaffo. “However, we really still don’t understand which genes contribute the most to having UA and gout. It is also hard to tease out how much is related to genetics versus a shared environment. For instance, children and parents might share similar dietary factors.”

DIAGNOSIS IS KEY Sometimes discerning gout as a condition separate from other kinds of arthritis is difficult. Proper diagnosis is a key issue.

Your doctor will start looking for gout when you have joint swelling and intense pain in one or two joints, fol-lowed by pain-free times between attacks. Unlike some other forms of arthritis, gout usually has a sudden onset of pain

and symptoms. “The gold standard is doing a joint tap also known as arthrocentesis, which takes some fluid from the joint,” says Dr. Gonzalez. “When we see urate crystals under a microscope, we know you have gout.” Uric acid lev-els in the blood serum are often drawn, with normal considered to be at or under 5.0 mg/dL.

Of course, this is not useful during an acute attack. “While an attack is ongoing, the body releases inflam-

matory mediators in an effort to defend itself,” notes Dr. Gonzalez. “The mediators increase the excretion of UA, which can result in very low blood serum readings. Blood tests for UA are much more important and useful when the acute phase is over.”

X-rays may show joint damage, but this tends to be in gout of long-standing. Ultrasound and CT scans show earlier features of gouty joints and are more useful during diagnosis.

Gout medications can treat acute attacks, prevent future attacks, and reduce your risk of complications

such as the development of tophi from crystal deposits.

GOUT IS MUCH MORE COMMON

IN MEN, AND THE RISK OF

GOUT INCREASES WITH AGE.

MEDICATIONS FOR TREATMENTGout medications can be used to treat acute attacks, prevent future attacks, and reduce your risk of complications such as the development of tophi from crystal deposits. What medications you and your doctor choose will be based on your current health and your own preferences.

There are two targets for treating gout. One is to stop the current acute attack; the second step focuses on long-term care by getting your blood serum UA levels to around 5.0 and keeping them there.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used in both acute and chronic care. This class of drugs lowers the inflammation caused by crystals in the joint, but have no effect on the levels of uric acid. Over-the-counter options include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others), as well as more powerful prescription medicines including indomethacin (Indocin) or celecoxib (Celebrex).

Another medication frequently used is colchicine (Colcrys, Mitigare), a special type of anti-inflammatory that effectively reduces gout pain when used during an attack. The best use for this medication is to prevent attacks. One pill a day will stop future attacks and still be well tolerated in most users.

Heat is another useful treatment, especially for the pain associated with acute attacks. Keeping the joint immobilized and elevated is suggested as well.

Corticosteroid medications such as prednisone may control gout inflammation and pain. They can be given by mouth or injected directly into the joint. Because of their adverse effects, corticosteroids are generally reserved for people who can’t take either NSAIDs or colchicine. In very severe cases, they may be used short term to help calm the storm.

MEDICINES TO PREVENT FURTHER ATTACKSYou may be one of the lucky ones and have only one acute attack, with no further need for treatment—these cases are rare, but they do happen. For most people, however, the attacks increase in both frequency and severity if left untreated. In those instances, medications will be prescribed to help prevent complications of gout, and you likely will have to take them for the rest of your life.

One class is medications that lower UA levels by blocking uric acid production in the body. Drugs called xanthine oxidase inhib-itors—including allopurinol (Aloprim, Lopurin, and Zyloprim) and febuxostat (Uloric)—limit the amount of uric acid your body makes. This may lower your blood’s uric acid level and reduce your risk of gout attacks.

The other group works to improve your kidney’s ability to rid the body of uric acid. Probenecid (Probalan) lowers your uric acid levels and reduces risk of gout, but increases uric acid in your urine, which can lead to kidney stones.

“Your doctor will track serum UA levels over time to see how well you’re doing, and medications will usually be titrated to where the level is less than 6 mg/dL,” says Dr. Cronstein. “If it stays at that level, the crystals in the joints will be reabsorbed and eliminated entirely from your body. We try to give you the lowest dose of medication that meets that goal.”

OTHER OPTIONS Other approaches are available to lower your uric acid levels. With the exception of those with borderline high results, though, medications will still be needed to stay gout free.

Lifestyle changes can be very important. If you are obese, losing weight can bring down UA levels. So can limiting the

amount of beer, red meat, seafood, and high fructose soft drinks you consume.

“‘Moderation’ is the key in diet changes,” says Dr. Gaffo. “For most patients, it isn’t that you can’t have beer—just that you should limit yourself to no more than a serving or two each week. Same with red

meats, where you can enjoy a weekly small steak.”Some research suggests that a half a cup of cherries

and dark berries daily helps reduce uric acid levels. Greater vitamin C intake is another possibility, as is up to

5 cups of dairy products daily. Drinking 8 to 10 glasses of water will increase the filtering of the kidneys and flush out uric acid.

THE FUTUREDevelopments currently on the horizon could impact gout diag-nosis and treatment over the next three to five years. Multiple medications are being studied that increase the efficiency of kidney excretion, and one or more of these could be released to the market soon.

“Some of the most exciting areas are looking at how we can treat gout better,” says Dr. Gaffo. “We have medications that work well, but the fact that some patients don’t take their medicines correctly, or at all, leaves a big gap in our understanding.”

Another area of interest centers on finding out why some people can have very high uric acid levels for many years, along with deposits in their joints, and yet never exhibit the inflam-mation and damage seen in others. Discovering what protects these patients may lead to newer treatments and interventions in the long run.

“Gout is a disease that we can cure and make sure attacks either come less often or go away altogether,” says Dr. Cronstein. “I think this is a very hopeful time for our patients.” ■

Kurt Ullman has been a medical writer for 30 years. He is based in Indiana.

©is

tock

/Sup

erM

egan

eAng

le

RECEIVING THE PROPER

DIAGNOSIS IS KEY FOR TREATING GOUT

AND PREVENTING FUTURE FLARES.

1. Gout is a form of _____?A. Skin conditionB. Inflammatory arthritisC. SprainD. Diabetes

2. What are the classic symptoms of a gout attack?A. Moderate to severe chest painB. Mild pain or tingling in a jointC. Sudden onset of excruciating pain and swelling in a joint D. Fever and rapid weight gain

3. How is a gout diagnosis confirmed?A. Extracting synovial fluid from the affected jointB. Blood testC. Ultrasounds, MRIs, and CT ScansD. Physical examinationE. Both A and C

4. True or False: Gout can be cured.A. TrueB. False

5. Which of the fol-lowing can contribute to an increased risk for gout?A. Hyperuricemia (elevated uric acid level above 6.8 mg/dL)B. A family history of goutC. Other health conditions, including obesity, high blood pressure, diabetes, and kidney diseaseD. Eating foods that are high in fructoseE. All of the above

6. What percentage of gout sufferers are receiving needed, ongoing treatment?A. 10%B. 30%C. 50%D. 90%

7. Untreated, gout can eventually lead to ________.A. Permanent joint and tissue damageB. Kidney stonesC. DiabetesD. Heart problemsE. All of the above

8. Which of the follow-ing is not a good prac-tice for someone who has been diagnosed with gout?A. Monitor uric acid levels regularly, with a goal of keeping it below 6 mg/DLB. Exercise regularly and maintain a healthy body weightC. Eat a diet that is low in purines and fructoseD. Eat a diet that is high in proteinE. Limit alcohol intake

9. Which of the following can help to decrease the pain of a gout attack?A. Drinking alcoholB. ExercisingC. Taking colchicine or a non-steroidal anti-inflammatory drugD. All of the above

10. Last question! What are the most important steps in treating and managing gout?A. Getting a correct diagnosisB. Adhering to a medication planC. Living an overall, healthy lifestyleD. Monitoring/ controlling other health conditionsE. Communicating with your doctor on an ongoing basisF. All of the above

➫QUIZ HOW MUCH DO YOU KNOW ABOUT GOUT?TAKE THIS QUIZ

This quiz is courtesy of the Gout and Uric Acid Education Society.

Q:

TEST YOUR KNOWLEDGE

1. The correct answer is B. Gout is the most common form of inflammatory arthritis – affecting more than 8.3 million Americans today. It is also usually regarded as the most painful, with most gout sufferers ranking their level of pain as a 9 or 10 on a standard pain scale.

Gout is 3-4 times more common than rheumatoid arthritis. (Prevalence of RA in U.S. adults is 0.8%-1.2%, and prevalence of gout is approximately 3.5%-4.5%).

2. The correct answer is C. A gout attack is characterized by sudden and severe epi-sodes of pain, warmth, and swelling in a joint. The inflam-mation can be so severe that the affected joint cannot bear weight and is tender to even the lightest touch. The pain will typically stay in the area(s) for 3-10 days before subsiding. Without treat-ment, attacks are likely to occur again in the future.

To learn more about gout symptoms, click here.

3. The correct answer is E. The gold standard of a correct diagnosis of gout is through the extraction of synovial fluid from the inflamed joint. Once the fluid is extracted, the medical professional will check it for the presence of uric acid crystals using a polarized microscope.

As technology has advanced, clinicians now believe that ultra-sounds and related technology can help to detect the presence of tophi (crystals under the skin) in all stages of gout, helping to identify the disease early on.

While a blood test can be used to determine a patient’s uric acid level, it is not a conclu-sive diagnosis of gout. Similarly, the physical examination of a painful, swollen joint cannot distinguish gout from other conditions, such as infection, pseudogout, and injury. Only an estimated 1 in 5 people with an elevated uric acid level about 7 mg/dL will ever experience the symptoms of gout.

4. The correct answer is B – false. Unfortunately for most people, there is no cure for gout – how-ever, the underlying cause of gout, elevated uric acid, can be controlled by taking the right medications, along with making lifestyle and dietary changes.

By taking these steps, the symptoms and destruction of gout can be reduced or even eliminated. However, even when symptoms are completely gone, most people with gout will need to stay on uric acid-lowering medication for the rest of their lives to pre-vent the disease from returning.

If you have gout, talk to your doctor to learn more about the steps you can take to better manage the disease for the long term.

5. The correct answer is E – all of the above. The more risk factors that a person has, the greater the risk for developing gout. Having one or more of the

above risk factors does not necessarily mean that a per-son will develop gout.

To learn more about the risk factors for developing gout, click here.

6. The correct answer is A.More than 8.3 million

Americans are suffering from gout, but only 10 percent are receiving adequate, ongoing treatment.

Gout is very serious and, once it is diagnosed, it needs to be managed for life through a combination of medications, diet, and life-style changes. If not treated, gout can lead to permanent joint and tissue damage, including disfiguration of the joints – particularly in the hands and feet – and lead to loss of normal use.

If you or a loved one think you may be suffering from gout, talk to your medical professional immediately.

7. The correct answer is E – all of the above. Untreated, gout can lead to permanent joint and tissue damage from the buildup of uric acid crystals – and can even lead to loss of normal use of the affected area.

Other untreated health issues, like diabetes and problems with the kidneys and heart, can be a precursor for gout – or can result from untreated gout. Because of this, a prompt diagnosis and early, ongoing treatment of gout is critical.

To learn more about health issues associated with gout, click here.

8. The correct answer is D. All of the above can help to manage gout symptoms and reduce future attacks, with the exception of a high-protein diet.

Click here to learn more about living with gout.

9. The correct answer is C. Colchicine, taken orally, is typically used to treat the pain and inflammation of an acute gout attack. Non-ste-roidal anti-inflammatory drugs, such as Advil or Aleve, can also be used to help reduce inflammation. If you have gout symptoms, check with a physician or pharma-cist first before taking these medications, especially if you have other health issues.

Those experiencing a gout attack should avoid alcohol consumption. While exer-cising is a great way to stay healthy and reduce future attacks, it will not help to decrease pain caused by an acute attack. Many people find that the application of ice to the affected joint also helps to reduce pain in the acute setting. However, ice should not be left on the affected joint for more than 20-25 minutes at a time.

For additional tips on treating and managing gout, click here.

10. The correct answer is F – all of the above. By taking these steps, those suffering from gout can help “Take a Stand on Gout” and keep future, painful attacks at bay.

To learn more, visit GoutEducation.org.

A:➫QUIZ TEST YOUR KNOWLEDGE

ONE 2 ONE

PFL: How did you endure four years of flare ups before receiving a diagnosis? What was your reaction to finally learning you had gout? AA: I did suffer from painful flares but just kept brushing them aside, thinking my pain was a result of normal wear and tear from the football season. I didn’t have any tests conducted and the pain eventually went away. Since I didn’t know it was gout, I wasn’t receiving the proper treatment to

prevent flares, and I did not have my uric acid levels under control. If I had known, I could have potentially avoided years of flares. That’s why it’s so important for any-one who has gout symptoms to visit their doctor and get their uric acid levels checked.

In 2009, I experienced another flare after a break during the Chicago Bears’ 2009 season. The pain was excruciat-ing—it felt like I sprained my foot and I couldn’t walk. Before I even came back for

the season, I had to be put on the injury report. It kind of felt like getting fired on my day off! The Chicago Bears team trainer initially diagnosed me with gout. He scheduled an appointment for me to see a rheumatologist, who ran a series of blood tests to confirm my diagnosis.

I was only 29 at the time of my diagno-sis. Even though I had been experiencing flares for years, I couldn’t believe I had gout. I thought I was way too young, because I had always heard that gout affects older men. But the truth is, because gout is con-nected with so many other risk factors, it can affect anyone at any time.

PFL: What steps have you taken to keep your sUA level below 6?AA: First, I get my uric acid checked reg-ularly—the recommendation is every six months—and I work with my physician to keep my levels below 6 mg/dL. I take daily uric acid-lowering medications and I also exercise regularly, stay hydrated and eat a healthy diet. I have learned to avoid foods that may trigger a gout flare, like red meat. This isn’t something that has always been easy for me to do!

PFL: How did you get involved with the “Go For Six” campaign and what will you be doing to promote awareness and sUA monitoring?AA: The Gout & Uric Acid Education Society approached me leading up to the 2015 Gout Awareness Day to help raise awareness about the severity of gout, the importance of getting a confirmed gout diagnosis and the need to follow an ongoing treatment plan to help avoid future gout flares and long-term damage. The “Go for 6” campaign really focuses on the magic number six—which I like to refer to as a touchdown. It’s so important for people with gout to have their uric acid levels checked every six months, with a goal of keeping levels to 6 mg/dL or below, depending on the doctor’s recommendation.

Through the campaign, I participated in a satellite media tour on Gout Awareness

Day (May 22) and have shared my story through the Society’s website and patient education materials. Raising awareness about the severity of gout and elevated uric acid levels is important to me, and I hope to continue working with the Society in the future to further make an impact.

PFL: What advice would you give someone newly diagnosed with gout?AA: Get your uric acid levels checked every six months—and keep up with your treat-ment regimen. Many people with gout will stop taking medications when they aren’t experiencing a flare. Beyond medications, it’s important to maintain a healthy body weight, stay hydrated and reduce consumption of food triggers.

– Cheryl A. Rosenfeld

ANTHONY “SPICE” ADAMSAt age 25, Anthony “Spice” Adams, then a noseguard for the San Francisco 49ers, woke up unable to bend his knee. But he ignored the pain, assuming it was normal football wear and tear. It was not until four years later that he was diagnosed with gout. Adams was selected #57 overall in the second round of the 2003 NFL Draft by the San Francisco 49ers, after graduating from Penn State. He played for the 49ers from 2003 to 2006 and then signed as an unrestricted free agent to the Chicago Bears from 2007 to 2011.

Now, Adams has teamed up with the Gout & Uric Acid Educa-tion Society (GUAES), a nonprofit organization of health-care professionals, as the spokesperson for the “Go for 6” campaign to raise awareness about the severity of gout and the importance of managing uric acid levels.

Gout is an extremely painful form of inflammatory arthritis caused by an accumulation of uric acid crystals in the joints. Too much uric acid also can increase risk for kidney disease, heart disease and diabetes. And left untreated, gout can lead to permanent joint damage. New research from GUAES finds 53% of Americans do not know what uric acid is. More than 8.3 million Americans are living with gout—but just 10% of them are getting needed, ongoing treatment. Of those with gout, half don’t believe it’s important to monitor their uric acid levels regularly.

Last May, GUAES launched the “Go for 6” public awareness campaign, urging those with gout to get their uric acid levels checked every six months ands to determine long-term treatment to keep levels to 6 mg/dL or below.

Subscribe to Pain-Free Living and GET 6 ISSUES delivered to your door FOR ONLY $14.97 $6. With the

latest news and advice on managing and preventing pain, we’re here to help!

SUBSCRIBE

THE ULTIMATE RESOURCE FOR PEOPLE LIVING WITH CHRONIC PAIN.