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Managing Gout Between Flares

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WebMD Feature
Reviewed by David Zelman, MD

An attack of gout can be so painful that most people would do anything to avoid another. Unfortunately, flare-ups often occur. Studies show that people who have suffered a first attack of gout have a 62% chance of suffering another within a year. The odds climb to almost 80% within two years. "Over time, repeated attacks can eat into bone and cartilage, causing permanent damage to affected joints," says rheumatologist Herbert Baraf, MD, clinical professor of medicine at George Washington University.

Gout occurs when uric acid levels rise too high in the bloodstream. Excess uric acid is deposited as crystals around cartilage and bone. Acute attacks, sometimes called gouty arthritis, occur when these deposits become inflamed and intensely painful.

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For most people, gout attacks can be largely prevented with proper treatment, experts say. "The biggest problem we see is undertreatment," Lianne Gensler, MD, assistant clinical professor of medicine at the University of California, San Francisco, told WebMD. "Patients aren't given appropriate medications to prevent flare-ups and complications, or they get don't get adequate doses to control their gout."

After a first gout attack

The first step in avoiding repeated attacks of gout is eliminating factors that can trigger gout. Certain medications can raise uric acid levels too high. These include some commonly used blood pressure pills, chemotherapy for cancer, niacin (vitamin B supplements), and aspirin. In many cases, doctors can prescribe alternative medications that don't increase the risk of gout.

Lifestyle factors can also contribute to gout. To avoid problems, experts recommend:

  • Drinking plenty of fluids to remain well-hydrated.
  • Avoiding excessive alcohol consumption, especially beer. However, moderate wine drinking does not appear to increase your risk of gout.
  • Limiting the amount of organ meats, sardines, anchovies, and red meats you eat. These foods are high in purines.
  • Avoiding sweetened beverages, especially those containing fructose, which have been linked to higher risk of gout.
  • Losing weight if you are overweight or obese.

For some people, eliminating triggers and making lifestyle changes are enough to avoid flare-ups of gouty arthritis. But many people will also need to take a medication to lower uric acid levels.

Controlling chronic gout

After a first attack, doctors usually wait to see if gout flares up again before recommending medications that lower uric acid levels. "Because of potential side effects, we don't want to start patients on long-term drug therapy until we know they have chronic gout," said rheumatologist Tuhina Neogi, MD, an associate professor of medicine at Boston University School of Medicine.

However, doctors may recommend medication immediately in patients who have lumps of uric acid crystal deposits forming under their skin, called tophi. Tophi, which are a sign of chronic gout, can occur anywhere. But they are most likely to form on the ear cartilage or helix, elbows, the Achilles tendon, or around affected joints. Other complications related to chronic gout include the formation of kidney stones and kidney disease.

To diagnose gout, doctors typically measure uric acid levels in the bloodstream. Uric acid levels of 6.8 mg/dL or higher can lead to the formation of uric acid crystals. However, uric acid levels are not a good measure of the severity of gout, Baraf told WebMD. Some people have significantly elevated uric acid levels and no symptoms of gout. Others may have severe gout and only slightly elevated uric acid levels. If levels reach as high as 11 mg/dL, doctors usually recommend lowering uric acid with medication even if there are no gout symptoms.

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