GOUT FAST FACT
50% of first-time attacks occur in the big toe.
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Gout Risk Factors and Triggers
Gout Risk Factors
Gout is associated with several other disorders, making prompt diagnosis and management of comorbidities important. Following are risk factors for gout; these risk factors are cumulative.
One out of four people with gout has a family history of the condition.
Urate crystals are more likely to form in a joint that was previously damaged and/or a recent injury can bring on an attack.
Diuretics (taken for high blood pressure, leg swelling or heart failure)
Diuretics can decrease the kidneys’ ability to remove uric acid, resulting in hyperuricemia.
The breakdown and rapid turnover of cells leads to increased production of uric acid levels.
Because an elevated uric acid level is strongly associated with cardiovascular disease, hypertension, kidney disease and obesity, studies are underway and there is accumulating data that uric acid is a contributor and may have a direct role in causing these disorders.
Management of potentially serious associated disorders should not be withheld or delayed because of concern over the degree of hyperuricemia or the frequency of gouty attacks.
Gout is often associated with cardiac problems, including high blood pressure, coronary artery disease and congestive heart failure. Hyperuricemia has been associated with a higher risk of death from these conditions.
Gout may contribute to unhealthy cholesterol and lipid levels. Although necessary for normal functioning of cells, when certain lipids are increased or deposited in blood vessel walls blockages may result in a heart attack or stroke.
Diabetes is a disease in which blood glucose levels are above normal due to a lack of insulin in the blood or resistance to the action of insulin. Preliminary research suggests that insulin resistance may play a role in the development of gout, and hyperuricemia may worsen insulin resistance. Learn about gout and diabetes.
Kidney Stones and Kidney Disease
Kidney stones often are composed of uric acid. They may block the urinary tract and, if left untreated, can result in infection and damage to the kidneys. Approximately one out of five gout sufferers will develop kidney stones.
Hyperuricemia and gout can be associated with decreased kidney function. Moderate impairment is when the kidneys function at less than one half the normal function of an adult’s kidneys. Severe impairment is when the kidneys’ function drops below 25 percent; below 10 to 15 percent is referred to as end-stage renal disease.
Someone who carries excess body fat severely out of proportion to their height is obese. An obese person is four times as likely to develop gout as someone with a normal body weight. The Body Mass Index (BMI) is a calculation to help determine if a patient is at a healthy weight or at risk for obesity. Click here for a BMI calculator to determine if a patient’s BMI is in the healthy range. Discuss concerns about BMI and appropriate diet and lifestyle modification with your patient.
Taking the anti-rejection transplant medication cyclosporine or tacrolimus increases the risk of gout.
Common Gout Triggers
- Regular, excessive alcohol intake, especially beer, or binge drinking
- Surgery or a sudden, severe illness
- Consuming large quantities of purine-rich foods, especially red meat, organ meat and shellfish
- A diet high in fructose
- Radiation therapy
- Crash diets, especially high-protein fad diets
- Starting a uric acid-lowering treatment medicine (even though it may be the correct long-term therapy)
- Taking the anti-rejection transplant medication cyclosporine
Gout Treatment Options
There are currently two major categories of medications for gout sufferers:
- Treatments to relieve pain and reduce swelling
- Treatments to lower uric acid levels and prevent future attacks.
The type of treatment recommended is often based on the patient’s health, age, lifestyle and the severity of the condition. A number of different gout treatments may need to be explored to determine which is the most effective for a particular patient.
Contemporary management modalities are highly effective in interrupting the progression of acute gouty arthritis and in reducing the frequency of attacks. Through proper monitoring and treatment, patients can avoid painful episodes and long-term joint damage and disability due to gout and maintain their normal lifestyle.
The goals of gout treatment are to:
- Ease the pain associated with acute attacks
- Prevent future attacks
- Avoid the formation of tophi and kidney stones
- Reduce the risk of long-term damage to affected joints.
For most patients, medications are the most effective way to fight gout. Work with your patient to find the right medication to gain control of gout symptoms.