More than one out of three people with gout have not had their uric acid levels checked within the past five years.
About Uric Acid
It’s normal for everyone to have at least some uric acid in their bodies. Too much of it can put people at risk for gout.
As cells die, they release substances called purines, which are also found in some foods. Purines break down and are eliminated as uric acid. Uric acid typically dissolves in the blood and then passes through the kidneys, where it is eventually eliminated through urine. If there is more uric acid than the kidneys can get rid of, a condition called hyperuricemia – or high uric acid in the blood – develops. This can lead to the development of crystals in the joints and other tissues. When these crystals accumulate, they can cause a painful attack of gout.
Not everyone with hyperuricemia will get gout – but once it develops, it is likely to return, unless treated by medicine to lower uric acid levels.
Monitoring Uric Acid Levels
To avoid gout and other problems, uric acid levels should be 6.0 mg/dL or below. A person with a level above 6.8 mg/dL is considered to have hyperuricemia.
Most experts agree that lowering a person’s uric acid level can prevent the painful consequences of hyperuricemia – particularly gout. Medical professionals measure your serum uric acid level through a simple blood test. Just as it’s important to monitor your cholesterol, it is important to know your uric acid levels. People with gout should have their uric acid levels tested every six months to be sure it is below 6.0 mg/dL.
Symptoms & Stages
Gout is an extremely painful disease. Each gout attack can last for several days, and the pain is so severe that the majority of gout patients rank their pain level as a nine or 10 on a standard pain scale.
Symptoms of gout in a joint include:
- Sudden and severe episodes of pain
- Stiffness and swelling
- Redness
- Tenderness
For more than half of all people, gout begins in the big toe – and 90 percent of gout patients will suffer gout of the big toe at some point during the course of the disease. Untreated high uric acids and gout will, in time, affect more joints, including:
- Instep
- Ankle
- Heel
- Knee
- Achilles Tendon
- Wrist
- Finger
- Elbow
Stages of Gout
There are four stages that medical professionals use to classify the severity of gout. With proper management of lifestyle and the right medication, it’s possible to manage gout symptoms, avoid future attacks and prevent joint damage.
Stage 1 – Asymptomatic Hyperuricemia
During this stage, a person has no symptoms of gout, but uric acid levels are above 6.0 mg/dL. Treatment is not usually necessary. Many people will have elevated uric acid levels for years before their first attack, so regular monitoring of uric acid levels and making healthy diet and lifestyle adjustments can help to reduce future attacks. Not everyone with high uric acid gets gout, but the higher the uric acid, the more likely it is.
Stage 2 – Acute Gout Attack
During this stage, crystals that have been depositing in the joints activate and cause episodes of intense pain and swelling in the joint. The pain will subside, even without treatment, within three to 10 days. Because the first attack is followed by others in many instances, this is the time to seek medical care for appropriate diagnosis and therapy. Another gout attack may not occur for months or years, but chances are good that more will come, so regular monitoring of uric acid levels and ongoing treatment is important.
Stage 3 – Intercritical Gout
During this stage, a person is in between gout flares. It is a symptom-free time, when their joints are functioning normally. However, even when symptoms are absent, ongoing deposits of uric acid crystals continue to accumulate, silently. Additional and more painful attacks of gout are likely to continue unless the uric acid is lowered to below 6.0 mg/dL.
Stage 4 – Chronic Tophaceous Gout
This is a late stage of gout. It now becomes a chronic arthritis which often results in deformity and destruction to the bone and cartilage. An ongoing, destructive inflammatory process is active, and kidney damage is also possible. With proper medical attention and treatment, most gout patients will not progress to this advanced, disabling stage.
Risk Factors & Triggers
Risk Factors
There are a number of risk factors for gout. The more risk factors a person has, the greater the risk for developing gout.
- Hyperuricemia – High levels of uric acid, above 6.8 mg/dL, can lead to gout attacks. The best range for uric acid is below 6.0 mg/dL regardless of age or gender.
- Family History – One in four people with gout has a family history of the disease.
- Age – Gout can occur in anyone at any age, but it typically develops in people age 45 and older.
- Gender – Gout affects men more than women, although once women are post-menopausal, their rates of gout increase almost (but not quite) to the same level as men.
- Ethnicity – The incidence of gout varies by ethnicity. Some ethnic groups suffer more gout than others. This is genetic. For example, Hispanics and African Americans are more likely to suffer from obesity.
- Obesity – Someone with a Body Mass Index (BMI) of 30 or higher is considered obese.
- Other Health Issues – Gout is associated with other health issues, including high blood pressure, heart disease, diabetes and kidney disease. It is important to receive a prompt diagnosis and ongoing treatment to manage these conditions.
- Joint Injury – People with previously damaged joints are more likely to get gout.
- A High-Fructose Diet – High-fructose corn syrup is added to many foods and drinks. It causes uric acid to go up. Sweetened soft drinks and juices; certain cereals and pastries; ice cream and candy; and processed foods at fast food restaurants often contain high-fructose corn syrup.
- Use of Certain Medications – This especially includes diuretics or water pills and certain anti-rejection medications used in transplant patients.
Gout Triggers
Gout triggers can differ from one person to another. Once a person identifies his or her specific triggers, gout can be easier to manage. Common triggers include:
- Alcohol – This includes excessive intake of alcohol, especially beer, or binge drinking.
- Purine-Rich Foods – Eating large amounts of foods high in purines, including red meat, organ meat and shellfish, can trigger attacks.
- Crash Diets – This especially includes high-protein fad diets.
- Starting Uric-Acid Lowering Medicines – Although treating gout with uric acid-lowering medications is important for many gout sufferers – and is often the best long-term solution for controlling gout – starting a new medication can actually trigger attacks. If gout symptoms seem to be developing after starting medication, call the medial professional who prescribed the medication before stopping or dismissing treatment.
- Surgery or Sudden Illness – Those who are in bed or stationary for a long period of time are at higher risk.
- Radiation Therapy
The Cost of Gout
As the incidence of gout rises, so do the costs associated with managing the disease – affecting gout sufferers individually and the economy as a whole.While the economic burden of gout has not been widely researched, there have been studies to estimate workplace productivity loss and individual health care burdens. A 2013 literature review estimated the economic burden of gout at more than $6 billion per year. According to a 2013 study from the Arthritis Research Centre of Canada, the University of British Columbia and Boston University, there is a $2,021 annual work productivity loss per gout patient suffering from more than three attacks per year. For those patients that suffer six or more gout attacks per year, direct gout-related health care costs top $12,020.
An additional study in February 2015 reported that elderly and treatment-resistant gout patients could pay $16,925 to $18,362 per person in order to manage their gout.Many of these costs can be reduced simply by understanding the cause of gout and seeking immediate treatments for the disease – right at the first attack.Strategies for Reducing Costs for Gout Sufferers
- If you think you have gout, or are suffering from symptoms of gout, get treatment early.
- Get your uric acid level checked twice a year, with a goal of keeping it below 6 mg/dL.
- Live a healthy gout lifestyle by exercising regularly and avoiding alcohol and foods that are high in purines and fructose.
- Take your medications as prescribed and talk to your health care professional about any problems with them. Often, patients will stop a uric-acid lowering medication because it can initially trigger a gout flare – but this may be the correct long-term therapy to avoid future attacks. Other times, patients will stop medications when they are symptom free. This can also lead to future attacks.
Famous People with Gout
The history of gout goes back over 4,000 years. Initially, it was often misperceived as a king’s disease – affecting only those wealthy enough to indulge in alcohol and other high purine foods like red meat, shell fish and organ meats.Although history has associated gout with that of a stout, rich man, today we know this stereotype is far from the truth. Gout can affect anyone at any time – with certain risk factors increasing a person’s risk. Even athletes – typically thought of as active and healthy – have fallen victim to gout.Here is a list of famous people – both today and throughout history – who have dealt with and endured the pain of gout.- Ansel Adams, landscape photographer
- Ludwig Van Beethoven, musician
- Jim Belushi, comedian and actor
- Maurice Cheeks, basketball player and coach
- Dick Cheney, former Vice President
- Charles Dickens, English author and social critic
- Benjamin Franklin, founding father
- King Henry VIII of England
- Samuel Johnson, British author and poet
- Harry Kewell, professional soccer player
- Jared Leto, actor
- Don Nelson, basketball player and coach
- Sir Isaac Newton, English mathematician and physicist
- Nostradamus, French apothecary
- Sir Laurence Olivier, actor
- Luciano Pavarotti, Italian operatic tenor
- Leonardo da Vinci, Italian painter, sculptor, architect and engineer
- David Wells, professional baseball player
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