If you are one of the 12.1 million people in the U.S. living with gout, you know the sudden, intense pain of this inflammatory form of arthritis way too well. Gout occurs when uric acid builds up and forms crystals in your joints. Your joints swell, look red, and feel warm.
Being forewarned is being forearmed as you can take steps to stave off future attacks. Fewer future attacks means less risk of the complications that result from uncontrolled gout.
There’s plenty you can do to stave off future gout attacks and the complications that can occur if your gout isn’t controlled. Learn more about uncontrolled gout, the complications, and how to prevent future problems.
Uncontrolled Gout: What That Means
When gout is left untreated or uncontrolled, pain, swelling, and other symptoms will worsen, and your attacks will become more frequent. The buildup of uric acid can form crystals in your joints, and these crystals form hard lumps called tophi in your tissues.
“Gout gets worse over time,” says Theodore R. Fields, MD, a rheumatologist at the Hospital for Special Surgery in New York City. “You may start with one or two flares a year, but the next year you will have three, then four attacks of acute gout, and often a degree of pain even between attacks.”
The goal is to stop gout in its earliest stages and prevent any downstream complications with medication and lifestyle changes.
Complications of Gout
Gout is a chronic condition that never goes away. If left untreated, gout can set you up for a host of health problems, including heart and kidney disease, which could potentially shave years off of your life. Untreated gout can set you up for a host of complications.
Tophi
These are hard lumps of uric acid crystals under your skin, often in your fingers, hands, feet, elbows, or the backs of your ankles (Achilles tendons).
Joint deformity
When tophi form in the small joints of your fingers, they can restrict movement and lead to joint damage, pain, and deformity over time. What’s more, tophi under the skin can be unattractive and set you up for infection if the skin over them breaks open.
Bone loss
Gout can block bone formation and promote the destruction of bones. This sets the stage for the brittle bone disease osteoporosis and related bone fractures.
Kidney stones
Fully 90% of people with gout have kidneys that don’t remove enough uric acid, while 10% produce too much uric acid. The over-producers are at risk for uric acid kidney stones, Dr. Fields said.
Kidney disease
Kidney stones can block your kidneys, interfering with their ability to remove waste. That can lead to infection and scarring, and ultimately chronic kidney disease and potential kidney failure.
Heart attacks
“Research shows that heart attack risk is elevated in the 90 days after a flare among people with gout who experience frequent flares,” says Fields. The inflammation seems to promote the deposit of cholesterol in heart arteries.
Sleep apnea
Marked by lapses in breathing and loud snoring during sleep, sleep apnea may also occur if you have gout. When your oxygen levels fall during sleep, it can raise uric acid levels.
How You Can Prevent Complications of Gout
Preventing complications of gout starts with getting a proper diagnosis and treatment plan. Then, taking your medication as directed and watching your diet and weight.
You can largely avoid gout complications with medication and lifestyle changes. You can also manage your symptoms and prevent flare-ups with your medicines and lifestyle choices.
The overarching goal is to keep your uric acid levels at 6 mg/dL or below. It typically requires medication along with lifestyle changes, Fields says. “If we can get you below 5 mg/dL, the tophi will shrink faster, but very few people can get to these goals without medication.”
Lose weight if you are overweight or have obesity
Weight loss reduces uric acid and gout risk. “Some people who lose weight on injectable weight loss medications have fewer gout flares than we would expect to see based only on their weight loss alone, suggesting that these drugs may have other effects on inflammation,” Fields says.
Eat a gout-safe diet
Eating right for gout starts with limiting the high-purine foods and beverages in your diet, as these foods raise uric acid levels. The American College of Rheumatology suggests avoiding:
- Alcohol
- Red meat
- Shellfish
- High-fructose corn syrup, a sweetener found in soda, juice, and candy
- Organ meats
Instead, focus on eating lean meat and poultry, low-fat dairy, and legumes such as beans, chickpeas, and lentils for protein.
Addantioxidants
Increase consumption of antioxidants in your diet too, including tart cherries, citrus fruit, and fish oil, as these can help cool inflammation, says Abhijeet Danve, MD, a rheumatologist at Yale Medicine in New Haven, Connecticut.
Drink water
Drink plenty of water and stay hydrated throughout the day. If you don’t, your uric acid levels might spike because your kidneys don’t flush out uric acid efficiently.
Treat your gout
Take medication to keep uric acid levels in the normal range. This is an essential part of any advanced gout management strategy. In fact, you may wonder if you'll need to take gout medicine for the rest of your life.
Medications that lower uric acid levels are meant to be taken for the long-term. Other medications that control pain during a flare are taken only as needed.
There are several types of medication that lower uric acid and even more are being tested. These drugs must be taken for the long term. You and your doctor will discuss the best gout plan for your health.
Treat your other conditions, too
The overwhelming majority of people with gout have additional health conditions, including heart disease, obesity, high cholesterol and/or triglycerides, high blood pressure, or diabetes. You may need to tweak any medications that you are on for other diseases if you also have gout.
“If you have high blood pressure, for example, diuretic medications, which remove extra fluid from your body, may worsen gout symptoms,” Danve says.
Your doctor may suggest switching to a different class of blood pressure-lowering drugs.
Signs Your Gout Is Getting Worse
If you are having more frequent and severe flares and your joints always appear swollen, red, and warm, your gout may be getting worse. Other signs that your gout is worsening may include:
- Restricted joint mobility
- Tophi under your skin
- Kidney stones
Talk to your doctor about stepping up your treatment regimen if you notice any of these symptoms. Your doctor can let you know what else you can and should be doing to protect your health.
Treating advanced gout will involve long-term use of a medication to lower your uric acid levels and a lifelong focus on weight control and avoiding foods known to trigger flares.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
International Journal of Molecular Science: “Advances in Gouty Arthritis Management: Integration of Established Therapies, Emerging Treatments, and Lifestyle Interventions.”
Sleep and Breathing: “A meta-analysis of the association between gout, serum uric acid level, and obstructive sleep apnea.”
Hospital for Special Surgery: “Gout statistics and facts,” “What are the four stages of gout?” “How can a gout attack be prevented?”
Theodore R. Fields, MD, rheumatologist, Hospital for Special Surgery, New York City.
Mayo Clinic: “Gout, “Gout diet: What's allowed, what's not.”
National Kidney Foundation: “Gout and kidney disease.”
Journal of the American Heart Association: “Association of gout with long‐term cardiovascular outcomes among patients with obstructive coronary artery disease.”
Harvard Medical School: “Gout: Sleep apnea may raise your risk.”
Arthritis Care and Research: “2020 American College of Rheumatology Guideline for the Management of Gout.”
Abhijeet Danve, MD, rheumatologist, Yale Medicine, New Haven, Connecticut.
