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 three 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.”
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.