Your Gout Triggers

From the WebMD Archives

When you have gout, you have higher than normal levels of uric acid in your body. When too much uric acid builds up around a joint, uric crystal forms, causing a painful gout flare.

All sorts of things -- from certain foods and drinks to stress and medicines -- can cause your uric acid levels to go up. Knowing what can trigger the uric acid to build up in your body may help you avoid future gout attacks.

Common Gout Triggers

There are some things that are likely to trigger flares in most people with gout, also known as gouty arthritis. If you know you have gout, you should try to stay away from these gout triggers.

  • Foods -- Foods that are high in a substance called purines can raise the uric acid level in your blood. This includes organ meats like liver; seafood like sardines, anchovies, mussels, and salmon; and even some vegetables such as spinach. Eating just one of these foods or several of them together, can cause a gout flare. Purines are found in all foods that have protein.
  • Alcohol -- Beer and liquor can raise the uric acid level in the blood and many bring on a gout flare. They can be extra bad for you because they also can make you dehydrated -- another common gout trigger. Wine is not linked to gout attacks and can be enjoyed in moderation.
  • Medication -- Some drugs that people take for other medical conditions -- such as high blood pressure or heart failure -- may also bring on a gout flare. Some possible flare-triggering drugs include diuretics, beta-blockers, and cyclosporine. Even low-dose aspirin can cause an attack. If your doctor is going to start you on a new medicine, be sure to tell her that you have gout.
  • Dehydration -- When your body is dehydrated, the amount of uric acid in your body rises, and your kidneys' ability to get rid of extra uric acid decreases. So when your body doesn't have enough water, you can be more likely to get a gout attack.
  • Fructose beverages -- Don't drink lots of sugary drinks containing fructose. Fructose-sweetened beverages can bring on gout flare-ups.
  • Medical stress -- Hospital visits, surgery, pneumonia, and other medical conditions and procedures can cause your uric acid levels to go up and your gout to flare. If you're going into the hospital or if you become sick, be sure to tell your doctor that you have gout.

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Know Your Gout Triggers

These gout triggers are common in most people who have gout, but not every one of them will set off an attack in every person with gout. Some people may have an attack after limited exposure, while others only react in extreme cases.

"Everybody has their own little nuances," says Robert T. Keenan, MD, MPH, assistant professor of medicine at Duke University School of Medicine. "For some people, certain foods will trigger it -- like a seafood and beer binge. Others will have their first gout attack when they go into the hospital or for stress or hydration reasons."

There's no test that lets gout patients figure out what triggers will cause their uric acid to rise. But nearly everyone with gout is able to determine the source the very first time they have an attack, says Keenan.

"Most patients will figure it out on their own relatively quick," he says. "Maybe it's, 'I was watching the game last night and drank six beers and at 3in the morning I woke up and my toe's killing me.'"

Avoid Gout Flare-Ups

Once you’ve had a painful gout flare-up, you’ll never want to experience another one.

"We really think of it as an explosive arthritis, where you go from zero to 60 in 24 hours," says rheumatologist Rebecca Manno, MD, MHS, assistant professor of medicine at Johns Hopkins University School of Medicine. "People say gout can be some of the most severe and worst pain they’ve ever experienced."

But there are other reasons for gout prevention than just pain, says Manno.

"Gout can be more than just a nuisance. It can cause destruction in the joint itself," she says. "Once there’s been damage done to the joint from gout -- that we cannot reverse."

You don't have to sit around and wait for a gout attack in order to treat it. You can help avoid gout flare-ups by lifestyle changes and medication. Here are some tips for gout prevention.

  • Avoid gout triggers. Although it’s impossible to completely avoid all purines in your diet, if you know which foods tend to set off your gout attacks, try to avoid them. You may still be able to enjoy foods with fewer purines such as beans, lentils, and asparagus.
  • Preventive medication. If you have two or three gout flares in one year, many doctors will suggest daily medicine -- such as feboxostat (Uloric), allopurinol (Lopurin, Zyloprim), and probenecid (Benemid) to lower uric acid level in the blood, and colchicine (Colcrys), to help prevent future attacks. In the first few months that you take the medicine, be aware that the gout prevention drugs may actually cause an attack. Your doctor will prepare you for this possibility by giving you medicine to take in the event you have a flare.
  • Healthy lifestyle. Eating a healthy diet, reducing or eliminating alcohol, and exercising regularly can help prevent gouty arthritis attacks and keep your uric acid level stable. Remember to drink water when exercising to avoid flare-ups due to dehydration.
  • Lose weight. If you are overweight, work with your doctor to develop a weight loss plan. Being overweight can contribute to elevated levels of uric acid and lead to gout attacks. "When we talk to patients about foods they should avoid, we also talk about weight," says Manno. "There's definitely a risk factor with being overweight."
WebMD Feature Reviewed by David Zelman, MD on October 31, 2011

Sources

SOURCES:

Rebecca Manno, MD, MHS, assistant professor of medicine, Division of Rheumatology, Johns Hopkins University School of Medicine.

Robert T. Keenan, MD, MPH, assistant professor of medicine, Division of Rheumatology and Immunology, Duke University School of Medicine.

Scott Zashin FACP, FACR, clinical professor of medicine, University of Texas Southwestern Medical School; attending physician, Presbyterian Hospital.

Lan Chen, MD, PhD, attending rheumatologist, Penn Presbyterian Medical Center.

Gout and Pseudogout Treatment & Management: "Diet and Activity."

The Johns Hopkins Arthritis Center: "Gout -- Treatments for Gout."

American College of Rheumatology: "Sip Water to Prevent Gout Attacks."

The Merck Manual: "Gout."

The George Mateljan Foundation: "What are purines and in which foods are they found?"

ArthritisToday: "Drink More Water for Fewer Gout Attacks."

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