Medical FAQ: Gout

After interviewing Dr. Chris Parker about gout, we learned about how it affects millions of people in the United States each year and, unknowingly, millions more who are on the track towards developing this illness. Defined as a form of inflammation in the joints, gout can cause severe pain, redness, tenderness, and swelling, Gout has many different stages and can sometimes attack completely out of the blue. Between acute gout, interval gout, and chronic gout, gout occurs in roughly four percent of American adults. You’re also more likely to develop symptoms if someone in your family has experienced it before. Conditions such as diabetes, heart disease, and high cholesterol increase your chances of development as well. 

What are the signs of gout?

Gout usually starts, not in the hands, but in the feet (its favorite is the big toe joint.) Most doctors, if they see a sick, swollen, red toe—and it looks like a hammer dropped on it—will say, ‘you’ve got gout.’ That pattern is very different than other types like osteoarthritis and rheumatoid arthritis where it starts with certain rows of joints in the hand. Gout starts as one joint at a time, especially in the big toe joint, and it comes and goes. If you don't do anything about it, it will move north over time.

What causes gout?

It comes from a normal waste product in the blood called uric acid, which your kidneys will excrete in urine. If kidneys can't keep up with the load, it will build up and it settles in the joints and the soft tissues. It’s a normal waste product, but you can get gout if you have too much. More than 8 million people in the United States have gout and more than 20 million people in the United States have high uric acid levels, so they’re at risk for gout. 

Where does extra uric acid come from?

There are two ways to get it. One way it can happen is from the inability to excrete all of the uric acid because your kidneys just aren't working well enough. That’s why a lot of people with kidney disease get it. The other way is from consuming too much food or drink containing high levels of purines that get broken down into uric acid; the kidneys can't keep up. Some of the things that are very high in purines are organ meats, shellfish and alcohol—especially beer. I don't tell people that they have to stop drinking beer or alcohol, I just tell them, ‘If your uric acid levels are really high we're going to have to be careful with that.’ 

How can you manage your uric acid levels?

I tell patients what foods and drinks are high in purines but I'm also careful to share that some people, even if they have a healthy diet, just have a genetic predisposition to make lots of uric acid. I make it really clear that diet is important, but you may not get it under control with diet alone.