Gout And Premature Death Risk
Gout is not just a disease of the joints. It is a disease that causes inflammation in the joints and in the body. Gout is not just a pain in the toe it affects other organs too, including the heart. Gout has been known to increase the risks of cardiovascular disease and premature death.
It has been determined that people whose uric acid levels are elevated are more susceptible to developing gout and facing death because of it. Men are at the next risk of developing arthritis than ladies. Some of the factors that can lead to gout are diet, genetic predisposition, and common medical conditions like hypertension, obesity, renal insufficiency, and heart failure.
One should consult their physician about the following if they happen to have gout:
Kidney stones and kidney disease
Kidney disease may either lead to gout and vice-versa. Damage to the kidneys inhibits their ability to filter acid or as a result from gout, uric acid crystals may damage the kidneys. Just as joint pain occurs when uric acid crystals deposit in the joints, similarly kidney stones develop when uric acid crystals are deposited in the kidneys and hence, block the urinary tract. If left untreated, kidney stones can cause kidney infections and even cause further damage.
People with gout, especially women, are at a higher risk of diabetes. It is a result of low-level inflammation from gout as well as other risk factors like high cholesterol and high blood pressure.
What Foods Should You Avoid
If youre susceptible to sudden gout attacks, avoid the main culprits high-purine foods.
These are foods that contain more than 200 mg of purines per 3.5 ounces .
You should also avoid high-fructose foods, as well as moderately-high-purine foods, which contain 150200 mg of purines per 3.5 ounces. These may trigger a gout attack.
Here are a few major high-purine foods, moderately-high-purine foods and high-fructose foods to avoid (6,
- meats: These include liver, kidneys, sweetbreads and brain
- meats: Examples include pheasant, veal and venison
- Fish: Herring, trout, mackerel, tuna, sardines, anchovies, haddock and more
- seafood: Scallops, crab, shrimp and roe
- Sugary beverages: Especially fruit juices and sugary sodas
- Added sugars: Honey, agave nectar and high-fructose corn syrup
- Yeasts: Nutritional yeast, brewers yeast and other yeast supplements
Additionally, refined carbs like white bread, cakes and cookies should be avoided. Although they are not high in purines or fructose, they are low in nutrients and may raise your uric acid levels (
Summary: If you have gout, you should avoid foods like organ meats, game meats, fish and seafood, sugary beverages, refined carbs, added sugars and yeast.
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
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Lay Off The Sheep Heart And Smelt Or Else
If you suffer from gout you should be careful to avoid foods that contain purines. Purines are organic compounds that increase the body’s production of uric acid and when you read the list below you’ll be surprised to see how many foods contain purines which, in the non-gout sufferer, are not necessarily so bad when taken in moderation. The good thing for the gout sufferer is that most of the foods that contain the highest concentration of purines are also the most disgusting. If only you had known about this stuff as a kid then you could have said “Sorry, mom, I can’t eat your sheep heart stew. It’s loaded with purines.”
In addition to the foods listed below, remember that all alcoholic beverages can lead to gout.
Foods that contain very large amounts of purine bodies in 100 grams:
|Heart, sheep 174|
Foods that contain a large amount of purine bodies in 100 grams: anchovies, bacon, codfish, goose, grouse, haddock, liver, kidneys, mackerel, mutton leg, partridge, pheasant, pigeon, salmon, scallops, trout, turkey, veal, venison.
Foods that contain a moderate amount of purine bodies in 100 grams: asparagus, bass, beef, bouillon, brains, chicken, crab, duck, eel, halibut, ham, kidney beans, lentils, lima beans, liverwurst, lobster, mushrooms, mutton chop, navy beans, oysters, peas, plaice, pork, rabbit, roe, shrimp, spinach, tongue, tripe.
Foods that contain an insignificant amount of purine or no purine:
Am I At Risk Of Having Gout
Youre more likely to have a gout attack if you:
- are male
- have a family history of gout
- have elevated levels of uric acid in the blood
- drink too much alcohol
- eat a diet high in purines such as meat, sweetbreads, offal, shellfish, and fructose
- are overweight or obese
- use diuretics
- have type 2 diabetes, high blood pressure or high cholesterol these conditions can mean that your kidneys are less able to flush out the urates
- have kidney disease
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Who Should Diagnose And Treat Gout
The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.
How Can I Manage My Gout And Improve My Quality Of Life
Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.
For gout in particular:
- Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines , and limit alcohol intake .
CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.
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Hyperuricemia Or High Uric Acid
Uric acid is a compound made up of carbon, nitrogen, oxygen, and hydrogen thatsPurines form naturally in the body, and theyre also found in some foods.
Uric acid doesnt cause health problems when you have normal levels, since its excreted by the kidney. However, sometimes, for various reasons, your uric acid levels can increase beyond acceptable levels.
When you have high uric acid, one of the most feared symptoms is gout. However, the negative consequences of hyperuricemia can be even more serious. Its related to a higher risk of kidney and cardiovascular problems, and chronic arthritic damage.
What Are Future Possible Treatments Of Gout
Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.
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How Gout Can Lead To Sleep Deprivation
Because gout attacks typically happen at night, recurrent attacks can wake you while you are sleeping. This constant awakening also disrupts rapid eye movement sleep, which is important for physical and emotional health.Once you are awake, the intense pain that follows can keep you from falling back to sleep, leading to sleep deprivation.
What Are The Signs And Symptoms Of Gout
Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remissionweeks, months, or yearswithout symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
Symptoms in the affected joint may include:
- Pain, usually intense
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Some Meat Fish Eggs Beans And Pulses
Eat these foods in moderation. Having vitamin C with meals can help to improve the absorption of iron, so drink a small glass of orange juice, have a piece of fruit for dessert, or serve up meals with plenty of vegetables. Keep your portions of meat controlled by using your hands as a serving size guide. A serving is about the size and thickness of the palm of your hand.
What Can You Drink If You Have Gout
Foods arenât the only thing that can affect uric acid. What you drink matters, too.
Itâs a good idea to drink lots of fluids — 8 to 16 cups a day. At least half of what you drink should be water. Vitamin C also can help lower uric acid, but studies also show that the high fructose in OJ may boost uric acid levels, so drink it in moderation. Caffeinated coffee can cut uric acid, too, as long as you donât overdo it.
Stay away from sugary drinks like soda and fruit juice. You also may need to limit or avoid alcohol as well. Talk with your doctor to find out whatâs right for you.
While a healthy diet can help control how much uric acid is in your system, you may still need medicine to prevent future attacks. Talk with your doctor about all your treatment options.
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Myth: If You Stay Away From Liver And Alcohol You’ll Avoid Gout Attacks
Truth: Alcoholic drinks especially beer and organ meats such as liver and some fish, including anchovies and sardines, are very high in a class of natural substances known as purines. When the body breaks down purines it creates uric acid, so eating a lot of purine-rich foods does increase the risk of an attack. But while avoiding these foods may reduce attacks, it won’t halt them, says Reveille.
Gout can be life threatening if left untreated.
Can I Manage Gout
Although it cant be cured, gout can be managed effectively with medicine and lifestyle changes.
If your uric acid levels remain high after a gout attack, doctors may prescribe medication that can lower your levels. This can lessen your risk of long-term problems.
Self-care also is important if you have gout. A diet that avoids foods high in purine, high-fructose drinks, and alcohol can lessen your long-term risks. Losing weight also can lower your chances of gout. If you use medicines like diuretics, stopping that use can help prevent gout as well.
If you have a family history of gout or suspect you may have it, schedule an appointment with your doctor.
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Failure To Lower Serum Urate Linked With Overall And Cardiovascular Mortality
Failure to achieve a target serum urate level among patients with gout was associated with a doubling of total and cardiovascular mortality, European researchers reported.
Among patients whose serum urate levels remained above the internationally recommended target of 6 mg/dL, the adjusted hazard ratio for overall mortality was 2.33 , according to Fernando Pérez Ruiz, MD, PhD, of Hospital Universitario Cruces in Barakaldo, Spain, and colleagues.
And the hazard ratio for cardiovascular mortality was 2.05 , the researchers reported online in RMD Open: Rheumatic & Musculoskeletal Diseases.
“A large body of evidence incriminates gout as a major determinant of mortality, both total and cardiovascular. This risk increases with the severity of the gout,” the team wrote.
However, the effects on mortality of the currently recommended treat-to-target approach, with all patients advised to achieve a serum urate level below 6 mg/dL, have not been established.
Therefore, to explore this in a large cohort with long follow-up, Pérez Ruiz and colleagues conducted a prospective longitudinal study of patients seen at Cruces Hospital from 1992 to 2017.
Baseline data included demographics, clinical characteristics, comorbidities, and medications used.
All patients were given low-dose colchicine prophylaxis for 6 to 12 months or prednisone, 2.5 mg twice/day, and urate-lowering therapy with dosages titrated to achieve the target.
How Does Food Affect Gout
If you have gout, certain foods may trigger an attack by raising your uric acid levels.
Trigger foods are commonly high in purines, a substance found naturally in foods. When you digest purines, your body makes uric acid as a waste product .
This is not a concern for healthy people, as they efficiently remove excess uric acid from the body.
However, people with gout cant efficiently remove excess uric acid. Thus, a high-purine diet may let uric acid accumulate and cause a gout attack (
However, there is one exception to this rule. Research shows that high-purine vegetables do not trigger gout attacks .
And interestingly, fructose and sugar-sweetened beverages can increase the risk of gout and gout attacks, even though theyre not purine-rich (
For instance, a study including over 125,000 participants found that people who consumed the most fructose had a 62% higher risk of developing gout .
Summary: Foods can either raise or lower your uric acid levels, depending on their purine content. However, fructose can raise your uric acid levels even though it is not purine-rich.
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How Gout Can Affect Your Joints Inside And Out
When untreated gout turns into advanced, chronic gout, uric acid crystals can cause hard nodules called tophi that form under the skin, on the surface of joints, or on cartilage. Typically, tophi develop on the hands, feet, elbows, and along the back of the ankles. Fortunately, they are painless, but when left untreated they can cause joints to deteriorate.
How Does Drinking Alcohol Affect Gout
Alcoholic drinks tend to be high in purines and consuming more than the recommended amount can increase the risk of a gout attack. It is therefore recommended to limit alcohol intake, avoid binge drinking and avoid all alcohol if you have painful gout or are having a gout attack. Try limiting alcohol to a maximum of 14 units per week for both men and women and 1-2 units per day with a minimum of two alcohol-free days a week. Beer, stout, port and fortified wines tend to be higher in purines and should be restricted. Moderate consumption of wine is not associated with a significant increased risk.
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Do I Need To Stop Eating Meat If I Have Gout
No, but practice moderation, Dr. Burg reiterates. Avoid organ meats such as liver because they have higher levels of purines, which can cause flare-ups. Moderate intake of lean meats such as chicken and turkey should not affect your condition. Seafood such as shrimp and lobster tends to be higher in purines, though, so dont make it a regular part of your diet.
How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
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