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How to prevent gout attacks

To reduce painful recurrences of gouty arthritis, know your uric acid level and take appropriate doses of medication.

Gout is a painful joint condition that affects 3.4 million American men. Historically, it was called the “disease of kings” because of its association with excess aristocratic consumption of mutton and mead, but the underlying cause is more down to earth: Gout attacks flare when uric acid, a chemical produced in the body, builds up to an excessive level and starts to form crystals in the affected joint. This triggers inflammation and severe pain, sometimes with fever, muscle aches, and other flu-like symptoms.

In 2012, the American College of Rheumatology (ACR) issued its first-ever guideline for prevention and treatment of gout. If you are at risk, the key to escaping gout’s excruciating grip is keeping uric acid below 6.0 milligrams per deciliter (mg/dL), according to rheumatologist Dr. Robert -Shmerling, associate professor of medicine at -Harvard-affiliated Beth Israel Deaconess Medical Center. “If you have frequent attacks of gout,” Dr. Shmerling says, “it’s good to know your number.”

Gout Prevention Tips

Foods to avoid

  • High-fructose corn syrup

  • Organ meats

  • Excessive alcohol

Foods to limit

  • Large portions or concentrations of meat and seafood

  • Naturally sweet fruit juices

  • Sugar, desserts, and salt

Foods that are encouraged

  • Low-fat or nonfat dairy foods

  • Vegetables

Lifestyle modifications

  • Weight loss if you are overweight

  • Smoking cessation

  • Regular exercise

What is gout?

Gout attacks come on suddenly, with sharp pain, often in a single joint. The big toe is a common target. Buildup of uric acid can trigger gout attacks. Some people just tend to produce a lot of uric acid. In others, the problem is low kidney function, which can’t keep pace with the uric acid being produced. Taking diuretics (“water pills”) for high blood pressure may also contribute.

Certain foods can increase the risk of gout attacks. These gouty foods contain chemicals called purines, which break down in the body to form uric acid. The chief offenders are red meat, meat gravies, seafood, and alcohol (especially beer). Some vegetables also raise uric acid, such as beans, peas, lentils, spinach, asparagus, cauliflower, and mushrooms. High-fructose corn syrup has been linked to gout.

However, only about 10% of the uric acid produced in the body comes from foods. If uric acid is high, changes in diet alone are not likely to lower it to a healthy level. “It’s not terribly effective,” Dr. Shmerling says.

But don’t ignore diet. Keeping your beer consumption to a minimum may reduce gout attacks. In overweight men, dropping some pounds helps. There’s evidence that eating cherries regularly might reduce your risk a bit, although how much it really helps is unclear.

The role of medication

Certain signs point toward the need for daily medication: frequent attacks (two or three times per year), severe attacks that are difficult to control, gout with a history of kidney stones, or gout that affects several joints. The new ACR guideline adds that having kidney disease indicates a need for uric acid-lowering drugs.

The ACR also endorses higher doses of uric acid-lowering drugs to bring levels below 6.0 mg/dL. In the past, doctors prescribed doses of these medications that may have been too low out of concern for the effect on kidney function.

Not everyone with gout needs to take a uric-acid lowering drug. For one thing, just having high uric acid levels in your blood does not always trigger gout. And some people have attacks infrequently, and can control them well by just taking a nonsteroidal anti-inflammatory drug (NSAID) during flare-ups.

“If you have an attack every two years, and the NSAIDs work every time, I don’t think you need lifelong daily drug therapy,” Dr. Shmerling says.

Colchicine (pronounced COL-chi-seen) has been a mainstay of gout treatment for many years. The ACR recommends lower doses of colchicine when taken to help calm gout attacks, although the drug works in only about a third of people within 24 hours. Once a person goes on long-term uric-acid lowering drugs, taking colchicine can lessen the chance of a gout attack over the months it may require for the uric-acid lowering drug to take full effect.

Overdoing it: No free pass

Although a low-purine diet won’t necessarily immunize a gout-prone man from painful attacks of “the disease of kings,” there are plenty of other good reasons to moderate your meat and savor your seafood and beer in smaller amounts.

Diets high in red meat are associated with cancer and heart disease. Having more than two beers or other alcoholic beverages might not bring on a roaring gout attack every time, but it’s not heart healthy and contributes to weight gain. Nor are there any health benefits to imbibing more than the occasional drinks sweetened with high-fructose corn syrup.

Posted by: Dr.Health

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