Gout is on the Rise. How Can You Lower Your Risk?

Gout, an inflammatory condition traditionally associated with dietary indiscretion and alcohol consumption, has become increasingly more common. A Global Burden of Diseases study revealed that gout is now 20% more prevalent in the United States than it was in 1990. Are you at risk for developing gout or triggering another painful flareup?

What is gout?

“There are two phenotypes of gout,” says Jose Pablo Garcia, M.D., a rheumatologist with the University of Miami Health System. “The first is the classic red, hot, swollen joints of the big toe or the feet, ankles, and knees. This is called podagra. The second, lesser-known phenotype, is gouty arthritis, a chronic arthritis that causes bony erosions.”

This painful condition develops when uric acid in the blood, a bodily waste product of breaking down purines, builds up to form sharp crystals in the joints, triggering inflammation. Purines are natural substances found in all human cells and many foods. Diets high in purines (lots of beef, pork, and/or shellfish) can lead to excess uric acid in the blood, as can drinking alcohol. In addition, being of heavier weight can stimulate the production of uric acid and prevent it from passing. Genetics and other medical conditions can also play a part (including certain metabolic diseases and genetic predispositions).

The significant rise in cases of gout is not due to a single cause. Instead, it reflects generational changes in the average age, weight, and diet of the American population.

The connection between obesity and gout

“The increase in obesity in the U.S. actually correlates pretty well with the increase in cases of gout. The majority of patients with gout are over a healthy weight or obese,” Dr. Garcia says. “That’s because fatty (adipose) tissue makes enzymes that produce more uric acid. Too much uric acid leads to gout.”

Adipose tissue also releases hormones that interfere with the body’s ability to eliminate uric acid. “Those hormones act on the kidney and the gut to increase serum uric acid levels,” he says. “Not only is more uric acid being produced in obese people, their bodies are also less efficient at getting rid of it.”

Could your diet trigger gout?

We all know that the amount we eat greatly affects our ability to maintain a healthy weight. Beyond your caloric consumption, your dietary choices also matter when it comes to preventing gout.

“Gout has a few overt triggers: red meat (pork and beef), shellfish, and alcohol,” Dr. Garcia says. “An honorable mention that rheumatologists recommend avoiding is sugary drinks — sodas, juices, and energy drinks.”

These foods and beverages contain high levels of purines or promote metabolic pathways that increase uric acid. While some emerging research suggests that drinking cherry juice or consuming low-fat dairy products may help lower uric acid levels, the evidence is not strong enough for recommendations.

Genetics: why gout runs in some families

Some patients develop gout, despite maintaining a healthy weight and avoiding high-purine foods and drinks. “It’s quite possible for vegetarians who don’t drink alcohol and maintain a healthy weight to still get gout,” Dr. Garcia says.

This often comes down to genetics — specifically, how efficiently the body removes uric acid using proteins called transporters in the gut (the ABCG2 transporter protein) and kidneys (the GLUT9 transporter protein). “Some people are born with very efficient transporters,” he says. “Others are born with very inefficient ones.” Gene variants of these transporters can run in families, making it more likely that people with a family history of gout also develop the condition. “But, the overwhelming majority of patients with gout have other risk factors for it.”

The role of aging

Gout develops over time and with age — though men tend to develop gout earlier (in their 50s) than women (after menopause). “High uric acid levels over long periods of time accumulate in joints, sub-clinically — that is, without any symptoms whatsoever,” Dr. Garcia says. Eventually, this silent buildup can trigger painful gout flares.

In addition, as you get older, you are more likely to develop chronic diseases that increase the risk for gout, such as diabetes, heart disease, kidney disease, high blood pressure, and metabolic disorders. Kidney function declines naturally with age, reducing the body’s ability to filter uric acid. At the same time, older adults are more likely to receive treatments that can raise uric acid levels, such as certain medications (like diuretics) and immune system-suppression therapies (like chemotherapy).

Aging also puts you at risk for traumatic injuries, surgery, or infections that can make you more vulnerable to developing gout.

Treatment and care for gout

The same lifestyle and dietary choices that can trigger gout can be corrected to help you recover from a gout flareup.

• Maintain a healthy weight through diet and exercise.
• Avoid high-purine foods (beef, pork, and shellfish).
• Limit alcohol and added sugars.

“Exercise and dietary changes help because these efforts can decrease fatty tissue,” Dr. Garcia explains. “Exercise encourages weight loss, which lowers risk for gout and gout attacks. If you correct those risk factors, gout can be short-lived. It may never come back.”

However, patients who experience gout flares several times a year can require long-term medication to keep the disease under control. In these cases, “the mainstay of treatment for gout is medications that reduce uric acid production, including xanthine oxidase inhibitors like allopurinol,” Dr. Garcia says. The prescription drug probenecid can also help the kidneys remove uric acid from the body more effectively.

Additional treatments include icing the affected joints and using over-the-counter nonsteroidal anti-inflammatory oral medications and creams, prescription corticosteroids (such as prednisone), and the anti-inflammatory drug colchicine — all of which can relieve the inflammation, swelling, and pain associated with gout.

When the condition goes untreated, patients with gout can develop complications including joint damage, visible deposits of uric acid crystals under the skin (called tophi), and uric acid crystals in the urinary tract that can lead to kidney stones.

Written by Dana Kantrowitz. Reviewed by Jose Pablo Garcia, M.D.

Tags: Dr. Jose Garcia, gout risk factors, high uric acid, Why is gout becoming more common?