Ask the doctors 9/24 - Thu, 24 Sep 2020 PST

Dear Doctor: Can you please explain what gout is and how it’s treated? Our father is 81 years old and was just told that he has gout. His doctor says it could be because he takes water pills for swelling due to congestive heart failure. Does that make sense?

Dear Reader: Gout is a type of arthritis that can occur due to the presence of high levels of uric acid, a metabolic waste product, within the body. The kidneys eliminate uric acid via the urine, and some is excreted via the gut. But sometimes the accumulation of uric acid in the blood can exceed the amount that is excreted. This can lead to the buildup of tiny needle-shaped deposits, known as urate crystals, in and around the joints.

The condition causes periodic episodes of swelling and pain, which can be intense. Symptoms of someone’s first gout attack typically begin at the base of the big toe. In subsequent flare-ups, however, gout can also affect the other joints of the lower leg, including in the foot, ankle and knee. Although gout can affect either sex, it’s three times more common in men than in women. For men, the onset typically begins in middle age, often around age 40 and onward. Women become more susceptible to developing gout during and after menopause.

Diagnosis begins with a physical exam, and includes tests to measure blood levels of uric acid. The patient is asked about the location and severity of their pain, when the attacks first began and how quickly they arise. This last bit of information is important because one of the hallmarks of gout flares is their sudden onset, usually at night or in the early morning. Many patients report pain so severe that it wakes them from sleep. The affected joints are often swollen, sensitive to pressure and warm to the touch. Gout flares tend to subside over the course of a week or two. Some people have frequent flares, while others can go months, or even several years, between attacks.

A diet high in meat, fish, seafood, alcohol and sugary drinks can contribute to elevated blood levels of uric acid. Having diabetes or taking certain medications, including the diuretics that your dad is taking to manage his edema, or swelling, can impede the removal of uric acid. So can being overweight. A family history of gout is also considered to be a risk factor for developing the condition.

Treatment focuses on managing pain and swelling during an attack, as well as adopting preventive behaviors. These include staying hydrated, avoiding or limiting the use of alcohol, cutting back on meat, poultry and fish and maintaining a healthy body weight. If someone needs to lose weight, it’s important to do so gradually. Crash diets can have the effect of temporarily increasing levels of uric acid. In your father’s case, he should let his cardiologist know he has developed gout. It’s possible that a different type of diuretic may be helpful.

Send your questions to askthedoctors@mednet.ucla.edu.