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Bone, Muscle & Joint Health | Family Health | Living With Chronic Conditions
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Got Gout? 4 Ways to Avoid an Attack

How to monitor and treat this chronic condition

If you’ve experienced the pain and other symptoms of an acute gout attack — from swelling and redness in the joints to sensitivity that makes even sleeping a chore — you probably don’t want to go through it again.

You might not have to. We’ve gotten much more aggressive in how we monitor and treat this chronic, inflammatory form of arthritis in the past decade or so. If you’re one of the 8 million people in the country with gout, you can take an active role in managing your condition.

1. Make regular appointments — and keep them

If you have gout, don’t ignore this advice. Even if you go for a long period without symptoms, uric acid crystals continue to build up in your joints. This buildup can cause “silent damage” to your joints and boost your risk of an acute attack.

In your first year on therapy for gout, see your doctor every 3 months. As you get your uric acid levels in check over time, you can taper off to twice a year.

“People no longer eat much organ meat. However, high fructose corn syrup has been tied to gout, and obesity is a major risk factor.”

Scott Burg, DO

Department of Rheumatologic and Immunologic Disease

2. Know your uric acid number

Testing your serum uric acid level, or how much uric acid is in your blood, is one of the main reasons for regular checkups. If you can keep your level below 6 mg/dl, uric acid crystals start to dissolve, and your risk of a flare-up goes down. 

Medications for reducing uric acid have come a long way. For example, febuxostat (Uloric®) works well while being metabolized in the liver — important for the many gout patients who also have a kidney condition. Allopurinol (Aloprim®, Lopurin®, Zyloprim®) and probenecid (Benemid®) work for many people, too. They are metabolized in the kidneys, which means they are not ideal for people with certain kidney conditions.

3. If your treatment isn’t working, ask for adjustments

Drugs such as febuxostat, allopurinol and probenecid actually can increase your risk of a breakthrough flare in the first few months. But that doesn’t mean you should avoid these medications, which are helpful in the long run. Your doctor might recommend that you take another medication — such as colchicine (Colcrys®), corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs) — temporarily while you adjust to the uric-acid drugs. And if these medications don’t work, the IV drug pegloticase (Krystexxa®) can help reduce uric acid.

Treatments for other conditions affect gout, too. Certain diuretics for high blood pressure can lead to attacks, so ask if there are other ways to treat your blood pressure without causing gout symptoms.

4. Learn the risk factors

Even while we’ve gotten better at treating gout, the number of cases has risen. For example, we see more women developing gout at earlier ages, in part because of the reduced use of estrogen therapy after menopause.

Our diets are partly to blame, too — but not in the same way they used to be. People no longer eat much organ meat. However, high fructose corn syrup has been tied to gout, and obesity is a major risk factor. If your food label says “high fructose corn syrup” (it’s in more products than you think), toss it.

Losing weight can only help. We can’t say, “If you lose X pounds, your uric acid will go down by X points.” But along with proper treatment, close monitoring and a healthier diet, losing weight can help lower your risk of future acute attacks.

Tags: gout, medications, rheumatology, symptoms, uric acid
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Scott Burg, DO, is a staff rheumatologist who specializes in osteoarthritis, rheumatoid arthritis, gout, osteoporosis and golf injuries.

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  • Leslie Rush Vahldieck

    my husband uses tart cherry capsules daily I think 250 mg. its a big help, no attack since
    1 1/2 yrs.

  • Thomas Joseph Chorba

    I use tart cherry juice. A small amount in a shot glass. After a few
    Bottles. My gout went away but I also
    Became more active and lost some weight

  • smokeyman

    I agree with the cherry juice drinkers and I do feel a little better, one question I have is : Are you not supposed to eat Pistachios? I thought they were supposed to be good for you.

  • wilma

    wilma Jackson thanks for the tart cherry capsule info where can I find them in cleveland ?have gout 3yrs never controled,constant flare up.

    • Debbie Sickul

      Go to the health food store and buy pure concentrated cherry and celery juice. The cherry juice is great in yogurt and over ice cream. Use the celery juice over all veggies and in soup once done. There are a couple of terrific books, go to the library, some people can eat things others can’t, beer is outlawed.

      • Joy Ballard

        I would like information about pseudogout, Its different than gout. So, if anyone out there has it please send info. I am heading to Cleveland Clinic this month!! Thank you Lord.

        • Angelia Sherertz

          I would like to offer you encouragement for both you & your providers to investigate both ionized and total calcium as well as intact PTH levels, as something to possibly keep in mind.

  • Richard Kovacs

    Tart cherry juice works for me. I no longer eat mushrooms, pistachios or oatmeal, and I limit meats and other proteins. I no longer drink beer (sigh). The last three times I drank a single bottle of beer I got a painful gout reaction. A glass of wine or a shot of whisky are okay.

  • ABQ fan

    My sister had an attack, and initially we put her on 8oz of water, 1 Tablespoon apple cider, and 1 teaspoon honey. It seems to have helped clear up her conditions. She also gave up Soda, and eats frozen cherries twice a week with oatmeal. She also loves milk. I think that the Soda sacrifice has resulted in a small amount of weight loss. Every little bit helps.

  • Angela

    I have gout 4 25yrs I am in the top 5% now I have it in my elbows, hands, feet. I don’t know what to do. Doctors don’t know what to do. Can you please help?

    • Joe

      I understand, Angela. I am in the same boat. I have had really good luck with the 100% cherry juice to help with acute attacks. I have stopped drinking beer; in fact, I drink nothing but water, coffee, and milk. I seem to be having good luck with Uloric too.

  • carol

    I have been drinking tart cherry juice for about a month. At first I would have some every couple of hours. Now a couple of tablespoons morning and night. Only have had a shot or 2 of pain in the last 2 weeks. Thanks to all who commented . peace

  • Rhonda

    You can find cherry tablets are cherry juice at GNC stores. My father has been taking them for 7 years hasn’t had a attack since . He’s swears by them he takes one every morning . He used to get attacks bad but not anymore. Spread the word they work!

  • Robyn Eskridge Fuller

    I had my one and only gout attack 2 years ago but I have all the same
    symptoms now except the red toe or foot . Is it possible to have the gout
    without that symptom?

    • Rosie

      What is the difference between osteoarthritis and gout?

      • Bethany

        Osteoarthritis (OA) is simple wear and tear on joints while aging or from injury. Joints will be painful, but won’t swell. Also OA is a progressive condition, meaning it will get worse with time.
        Gout on the other hand is caused from a deposit of uric acid crystals in joints and connective tissue and it typically occurs suddenly without warning. The crystals can lead to excessive irritation and damage of the joints that are affected.
        Hope this information helps =]

    • Joe

      Yes it is. I have had gout for over 25 years and have almost every kind of gout attack that is possible, even in the soft tissues. I recently had an attack in an elbow. My entire forearm was swollen almost to the wrist. And yes, I have had attacks without redness or heat.

  • corbin downing

    well actually, diet can cause a lot of flare ups…

  • Bethany

    Uric acid is the final product in protein break down. Most protein in our diet comes from eating meat. By eating large amounts of meat, like most Americans do, a patient suffering from gouty arthritis is only exacerbating their condition further. Try a more plant based diet, which is naturally lower in proteins than meat. There will not be an IMMEDIATE change, but after a few weeks you will likely see the inflammation and irritation decrease and eventually your uric acid will be excreted appropriately, rather than stored in your joints, as long as you have normal kidney and liver function.
    In addition, taking an NSAID (for example, Advil) will not work in a gouty arthritis patient’s favor either. When breaking down uric acid, an NSAID will compete in the kidneys to be excreted before uric acid. Therefore, the uric acid is left in the body longer to accumulate, causing more crystals to form.

    • anonymous

      wrong – uric acid is the final product of PURINE metabolism.

      • Bethany

        You’re correct, my apologies. Regardless, PURINES do come from meat and the rest of the information provided for nsaids is also correct.

    • Joe

      Beer is plant-based (barley), yet it is terrible for gout. Whats up with that?

      • Bethany

        Honestly when I first read your comment I didn’t have an answer for you. I did a little bit of research on the topic and learned that even though barley is a plant, making beer a plant-based product, it is naturally high in purines. The metabolism of purines in the body leads to uric acid. One of my textbooks states that barley is typically 95-96 mg of uric
        acid/100 g. Even though it seems like a small amount, it could certainly
        do some damage to an individual suffering with gout. Consuming beer would therefore cause flare ups. I’m certainly not an expert by any means in the field, but at the time of the post several months ago I was learning these exact concepts in several classes for a graduate program so I wanted to share my knowledge so others could benefit! Hope this helps =]

  • Richard

    Why do Americans say ‘gotten’ instead of the correct’got’.

    I had a gout attack yesterday, the most excruciating pain I have ever had. This is the second attack and, apart from the medication the doctor gave me, I need to watch my diet more closely and avoid the foods that exacerbate the condition. I had never heard of high fructose corn syrup but will now check packaged foodstuffs for this ingredient and avoid it.

    • Rebecca M. Owens

      Interesting – I always wonder why people don’t use “gotten” anymore. It’s ye olde english, I guess.

    • Joe

      “gotten” is a fine word, but its the past participle version of “get” so it is preceded by “have” or “had”, aka the “en” for of the verb.

    • Jerry

      The use of the word ‘Got’ or ‘Gotten’ used predominately in the mid-west, I believe. ‘I have’, means the same.

  • out with the gout.

    I’ll tell you what. I’ve had gout for about seven years, with about 4-5 flare ups per year. I’ve felt like taking a hatchet to my toe just to be done with the pain.
    At first, flooding my body and drinking huge amounts of water did the trick. This seemed to make my blood thinner and dissolve the crystals. This doesn’t seem to work as well anymore, and there are signs my body gives me when there is about to be a flare up. My elbows start popping, my wrists feel tight, and even my knee feels like there’s a catch in it. Within 2-3 days, it settles in my toe, and I want to chop it off.
    There’s also something I learned from my back doctor: Post surgery, while in the hospital, I had a severe attack in both toes. He told me I should have said something. The morphine they were pumping into me, he said, can bring about flare ups. So, avoid morphine, and it’s other derivitives, like codeine.
    I have heard about cherry juice and cranberry juice. But I think lowering the overall amount of protein you take in is probably the best answer. I LOVE STEAK! But beans, peas, nuts, legumes, etc. All make the problem worse.
    High Fructose Corn Syrup. I’m not buying this. Sugar is sugar, whether it comes from beets, cane, or corn, is still sugar. Same calories, same chemical structure, same everything. Industries switched to HFCS because it’s easier to store and transport liquids than it is crystals. Yes, it’s in thousands of products. But I think doctors are reaching a little bit to find an answer to the obesity problems we face.
    I will try the cherry juice. I’ve got nothing to lose. ..except this toe!

  • Martin Morrison

    I got the grout about 8 years ago.After my doctor try a few medicines that did not work,i finally went to a arthritis doctor. i was getting attacks twice a months for 5 days at a time.he cure my grout after 6 months,Now i only take uloric 80 daily.no more grout for 20 months,thank god.my level was 10.9 when i first saw him,now it down to 4.0.Igo twice a year for check ups.

  • Wayne

    nobody mentioned celery seed extract capsules all natural.

  • Debbie Sickul

    Concentrated cherry juice, concentrated celery juice, no pastatio nuts, no salami pepperoni, no red meat, no red wine, nothing high in purines, no spin ache and definitely no alcohol. My Dad had the worst case ever seen, I read so much at the library and applied it. Even turkey gave him gout. The medicine is hard on your kidneys, one is a preventative, the other is to knock a bad case out of your body, the medicine knocks you out, so plan a big sleep. Uris acid crystals are like permanent glass shards in your body, melting them out with cherrys, celery and lots of water.

  • Angelia Sherertz

    Since reportedly uric acid levels at baseline, are significantly higher in patients with Primary Hyperparathyroidism (PHPT), and there is noted improvement after Parathyroidectomy ( surgical removal of adenoma(s) ) owing to a normalization of previously elevated calcium levels, perhaps something to keep on the radar in those with gout.

  • Diane Jividen

    My doctor ran a bunch of test on me years ago and informed me then I had gout and asked if my big toe hurt. Told him there were times I wish I could cut it off it hurt so bad. Then watching one of the talk shows and had a doctor on it made a statement that one of the triggers are nuts especially cashews. I had a small bag and sure enough oh the pain. I have not had a cashew in 6 years and haven’t had a major attack since My arthritis doctor said on my first visit he never heard of that second visit he told me he did some research on it and said he start recommending it to all his patients. And he was a specialist. Don’t plan on going back to him.

  • Toni Corley Bolding

    Wow. Thanks everyone for advice and comments about the tart cherry capsules etc. I’m going to pick some up tomorrow. My gout started about 9 months ago and I’ve had 3 major attacks in those months. The first only in my big toe, the others were my entire foot and ankle. Never ever want to do that again. My foot is never completely normal though. Wearing shoes too long or too tight start to irritate it easily. I have to take a blood pressure with diuretic med otherwise they don’t work on me so I’m kinda screwed there. Again thanks for tons of first hand knowledge input. Unless you have gout, you simply cannot understand the agony it causes.

  • Stan Rogers

    Uloric it worked for me I don’t have gout anymore talk to your doc. It takes time but it will go away. Try it.